Role of cytoreductive nephrectomy in metastatic renal cell carcinoma patients with tumor thrombus: does it change with development of systemic therapy?

The role of cytoreductive nephrectomy (CN) is changing with improvement of systemic therapy for metastatic renal cell carcinoma (mRCC) patients. In the era of cytokine therapy, immediate CN prior to systemic therapy had been the standard of care for mRCC patients. Two randomized, phase 3 trials demonstrated survival advantages of CN plus interferon therapy over interferon alone with respective median overall survival (OS) of 11.1 versus 8.1 months (1) and 17 versus 7 months (2). However, the first-line treatments for mRCC patients have been replaced by molecular targeted agents in the first decade of the 21st century and are being taken over by immuno-oncology drugs and their combination with targeted agents in the second decade.