Current status of cytoreductive nephrectomy in metastatic renal cell carcinoma.
The incidence of metastatic renal cell carcinoma (mRCC) continues to rise. While treatment options have increased dramatically in the last few years, few patients achieve a cure. The standard of care for mRCC in cytokine-eligible candidates is nephrectomy followed by high-dose IL-2. High-dose IL-2 can induce durable complete remissions, but only select patients can enjoy its benefits owing to toxicities. While not curative, the newer targeted therapies offer a broader patient population the chance for treatment response and prolonged survival. This review highlights the historical background of cytoreductive nephrectomy in mRCC, discusses the available treatment options and considers alternative treatment paradigms, such as the integration of the targeted agents with nephrectomy and the use of systemic therapy as medical selection for determining appropriate nephrectomy candidates.
Harshman
Lauren C
LC
Fellow, Medical Oncology, Stanford University School of Medicine, Division of Medical Oncology, 875 Blake Wilbur Drive, Stanford, CA 94305, USA. laurenhs@stanford.edu
Srinivas
Sandy
S
D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016503:Drug Delivery Systems; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009362:Neoplasm Metastasis; D009392:Nephrectomy; D011379:Prognosis