Paul Eber, MD, urologist, The Conrad Pearson Clinic, discusses patient selection for cytoreductive nephrectomy for the management of metastatic renal cell carcinoma (mRCC).

The ideal candidates for surgery, Eber says, are the patients with what appears to be an easily resectable tumor and very low-volume metastatic disease. Medical oncologists and urologists would both agree that these patients would derive the most benefit from nephrectomy followed by targeted therapy. Eber adds that ongoing studies in this space will hopefully clarify this question even more; however, in the meantime, urologists should always seek a second opinion from a medical oncologist on which route to take.

Community oncologists hoped that the CARMENA trial would help distinguish between this traditional procedure and the role of VEGF TKIs. Instead, the results led to more questions for physicians. The phase III trial showed that the addition of cytoreductive nephrectomy to sunitinib (Sutent) did not provide a survival benefit in patients with intermediate- and high-risk mRCC. Results showed that the median overall survival was 18.4 months and 13.9 months for patients who received sunitinib alone compared with surgery followed by targeted therapy, respectively.

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Paul Eber, MD, urologist, The Conrad Pearson Clinic, discusses patient selection for cytoreductive nephrectomy in the treatment of metastatic renal cell carcinoma.

Dr. Eber Discusses Patient Selection for Cytoreductive Nephrectomy in mRCC

Paul Eber, MD, urologist, The Conrad Pearson Clinic, discusses the utility of cytoreductive nephrectomy in metastatic renal cell carcinoma (mRCC).

The biggest takeaway from the CARMENA trial was that urologists should refer patients with mRCC to medical oncologists prior to undergoing surgery, says Eber. The phase III trial showed that the addition of cytoreductive nephrectomy to sunitinib (Sutent) did not provide a survival benefit in patients with intermediate- and high-risk mRCC. Results showed that the median overall survival rates were 18.4 months and 13.9 months for patients who received sunitinib alone compared with surgery followed by sunitinib, respectively.

Therefore, if and when urologists see patients with high-risk, high-volume mRCC, Eber says that surgeons should be wary of recommending surgery because it may decrease the patient’s chance of survival. Eber adds that the CARMENA trial only examined sunitinib, whereas now there are more tyrosine kinase inhibitors that confer better survival advantages than what was shown in the trial.

Paul Eber, MD

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Dr. Eber Discusses Patient Selection for Cytoreductive Nephrectomy in mRCC

Dr. Eber on the Utility of Cytoreductive Nephrectomy in mRCC