Dr. Vaishampayan on the Role of Cytoreductive Nephrectomy in mRCC

Ulka Vaishampayan, MD, professor of oncology at Wayne State University, and the chief of the Solid Tumor Program at Barbara Ann Karmanos Cancer Institute, discusses the current role of cytoreductive nephrectomy in metastatic renal cell carcinoma.

The phase III CARMENA trial showed that 20% of patients never made it to systemic therapy and had worse outcomes as a result. Therefore, if a patient presents with a primary lesion and metastatic disease, they should receive systemic therapy first, because it is known to benefit the primary and metastatic sites. Cytoreductive nephrectomy can be considered after, says Vaishampayan.

Although this is thought to be the optimal approach, it has never been formally evaluated in a clinical trial. To that end, a SWOG trial will evaluate whether up-front immunotherapy followed by cytoreductive nephrectomy versus continued systemic therapy is the optimal approach, concludes Vaishampayan.