Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: Is It Still Imperative in the Era of Targeted Therapy?
Open Access
- 15 January 2007
- journal article
- review article
- Published by American Association for Cancer Research (AACR) in Clinical Cancer Research
- Vol. 13 (2), 693s-696s
- https://doi.org/10.1158/1078-0432.ccr-06-1916
Abstract
In the era before cytokine therapy, controversy existed about the need for cytoreductive nephrectomy in treating patients with metastatic renal cell carcinoma. In 1978, Dekernion showed that nephrectomy alone had no effect on survival. During this period, removal of the malignant kidney was confined to palliative therapy in some settings of metastatic RCC, such as pain related to the kidney mass, intractable hematuria, erythrocytosis, uncontrolled hypertension, or poorly controlled hypercalcemia. When interleukin-2 was approved by the Food and Drug Administration in 1992, the role of nephrectomy was reexamined. After a decade of controversy, two randomized controlled studies established that cytoreductive surgery has a role in properly selected patients and offers a survival advantage when done before cytokine therapy. Unfortunately, the mechanisms underlying this benefit remain poorly understood. Immunotherapy may work best when there is a small volume of cancer present, and removing a large primary tumor may prevent the seeding of additional metastases. Data have also suggested that primary tumors were capable of producing immunosuppressive compounds that might decrease the efficacy of immunotherapy. Another hypothesis suggested that removing the kidney altered the acid/base status of the patient to such an extent that the growth of the tumor was hindered. With the emergence in 2006 of two targeted agents for advanced renal cell carcinoma, the role of cytoreductive nephrectomy has reemerged as a source of controversy. Although evidence-based medical practice suggests a role for nephrectomy before the use of targeted agents, the arguments for and against this practice will be weighed.Keywords
This publication has 25 references indexed in Scilit:
- Activity of SU11248, a Multitargeted Inhibitor of Vascular Endothelial Growth Factor Receptor and Platelet-Derived Growth Factor Receptor, in Patients With Metastatic Renal Cell CarcinomaJournal of Clinical Oncology, 2006
- RENAL CELL CARCINOMA 2005: NEW FRONTIERS IN STAGING, PROGNOSTICATION AND TARGETED MOLECULAR THERAPYJournal of Urology, 2005
- Cancer Statistics, 2005CA: A Cancer Journal for Clinicians, 2005
- Cytoreductive Nephrectomy in Patients With Metastatic Renal Cancer: A Combined AnalysisJournal of Urology, 2004
- THE CHANGING NATURAL HISTORY OF RENAL CELL CARCINOMAJournal of Urology, 2001
- Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trialThe Lancet, 2001
- Rising Incidence of Renal Cell Cancer in the United StatesJAMA, 1999
- Increased Transforming Growth Factor β1 Plasma Level in Patients with Renal Cell Carcinoma:A Tumor-Specific Marker?Urologia Internationalis, 1998
- Reduction of Brain Metastasis Following Immunotherapy with Interleukin-2 for Stage IV Renal Cell CancerActa Oncologica, 1997
- Cytoreductive Surgery for Stage IV Renal Cell CarcinomaJournal of Urology, 1995