Reports of spontaneous resolution of pulmonary metastasis after nephrectomy in patients with metastatic renal cell carcinoma (mRCC) provided the rationale for surgical debulking because systemic treatment options were limited. This ultimately led to 2 randomized clinical trials evaluating cytoreductive nephrectomy (CN) in the immunotherapy era. In the first trial led by the Southwest Oncology Group (SWOG),1 246 patients with mRCC were randomized to undergo radical nephrectomy followed by treatment with interferon alfa-2b or up-front treatment with interferon alfa-2b alone. Overall survival (OS), the primary end point, was significantly improved in the nephrectomy group (11.1 vs 8.1 months; P = .05). In the second randomized study by the European Organization for Research and Treatment of Cancer (EORTC),2 83 patients were randomized to similar treatment arms. There was a significant improvement in both progression-free survival (PFS) (5 vs 3 months; P = .04) and OS (17 vs 7 months; P = .03). A subsequent combined analysis of survival outcomes in patients in both studies revealed an improved OS favoring CN prior to immunotherapy (13.6 vs 7.8 months), representing a 31% decrease in the risk of death (P = .002).3 These results established CN as standard of care in patients with synchronous mRCC, who are candidates for surgery.
Agarwal N, Shuch B, Pal SK. Up-front Targeted Therapy Prior to Cytoreductive Nephrectomy in Treatment-Naive Patients With Metastatic Renal Cell Carcinoma. JAMA Oncol. 2016;2(10):1273-1274. doi:10.1001/jamaoncol.2016.1198