TY - JOUR
T1 - Cytoreductive nephrectomy in metastatic renal cell carcinoma
AU - Margulis, Vitaly
AU - Matin, Surena F.
AU - Wood, Christopher G.
PY - 2008/9
Y1 - 2008/9
N2 - PURPOSE OF REVIEW: Cytoreductive nephrectomy has an established role in management of metastatic renal cell carcinoma when performed in properly selected patients prior to administration of systemic cytokine therapy. Within the past several years, novel molecular targeted agents have not only revolutionized management of metastatic renal cell carcinoma but also created controversy regarding the necessity, patient selection for and timing of cytoreductive nephrectomy. RECENT FINDINGS: Benefits of targeted molecular therapeutics have largely been observed in the context of prior cytoreductive nephrectomy, and limited available evidence supports cytoreductive nephrectomy in appropriately selected patients with metastatic renal cell carcinoma who are candidates for targeted systemic therapy. Presurgical systemic therapy with targeted molecular agents is an attractive paradigm, which not only offers a rational approach to select patients who are most likely to benefit from cytoreductive nephrectomy but also allows access to treated tumor tissue to study molecular mechanisms of response and resistance. Surgical approaches increasingly utilized in patients with localized kidney cancer, such as nephron-sparing and minimally invasive techniques are similarly relevant and should be utilized, when appropriate, in patients with metastatic renal cell carcinoma. SUMMARY: Cytoreductive nephrectomy should be considered to provide a survival benefit for patients with metastatic renal cell carcinoma and should be used in patients who are candidates for systemic therapy before or after surgery.
AB - PURPOSE OF REVIEW: Cytoreductive nephrectomy has an established role in management of metastatic renal cell carcinoma when performed in properly selected patients prior to administration of systemic cytokine therapy. Within the past several years, novel molecular targeted agents have not only revolutionized management of metastatic renal cell carcinoma but also created controversy regarding the necessity, patient selection for and timing of cytoreductive nephrectomy. RECENT FINDINGS: Benefits of targeted molecular therapeutics have largely been observed in the context of prior cytoreductive nephrectomy, and limited available evidence supports cytoreductive nephrectomy in appropriately selected patients with metastatic renal cell carcinoma who are candidates for targeted systemic therapy. Presurgical systemic therapy with targeted molecular agents is an attractive paradigm, which not only offers a rational approach to select patients who are most likely to benefit from cytoreductive nephrectomy but also allows access to treated tumor tissue to study molecular mechanisms of response and resistance. Surgical approaches increasingly utilized in patients with localized kidney cancer, such as nephron-sparing and minimally invasive techniques are similarly relevant and should be utilized, when appropriate, in patients with metastatic renal cell carcinoma. SUMMARY: Cytoreductive nephrectomy should be considered to provide a survival benefit for patients with metastatic renal cell carcinoma and should be used in patients who are candidates for systemic therapy before or after surgery.
KW - Cytoreductive nephrectomy
KW - Immunotherapy
KW - Renal cell carcinoma
KW - Targeted molecular therapy
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U2 - 10.1097/MOU.0b013e32830a4f21
DO - 10.1097/MOU.0b013e32830a4f21
M3 - Review article
C2 - 18670270
AN - SCOPUS:54549120308
SN - 0963-0643
VL - 18
SP - 474
EP - 480
JO - Current opinion in urology
JF - Current opinion in urology
IS - 5
ER -