Dr. Eber on the Utility of 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.