Role of cytoreductive nephrectomy in Latin America: from CARMENA to COVID 19
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i3.891Keywords:
Metastatic kidney cancer, immunotherapy, cytoreductive nephrectomyAbstract
Introduction: Metastatic kidney cancer continues to be a therapeutic challenge for urologies and oncologies. With the new systemic therapies, the indication for initial cytoreductive nephrectomy is becoming increasingly controversial. The treatment of the primary tumor at a stage with systemic involvement continues to be a controversial issue.
Materials and Methods: By conducting a survey of Latin American hospitals, this publication aims to evaluate the indication for cytoreductive nephrectomy, the preferred surgical technique and the results obtained, estimating regional therapeutic lines. Online survey was made, based on the most important topics of discussion on cytoreductive nephrectomy and metastatic kidney cancer.
Results: A total of 20 centers participated on the survey, al of them affirmatively about the realization of cytoreductive nephrectomy. Most of them also offer systemic treatment. Regarding the surgical technique used, most used minimally invasive techniques.
Discussion: The international evidence about the role of cytoreductive nephrectomy in this context is varied and subject to permanent change. Individualized treatment, multidisciplinary team are fundamental for the approach of these patients.
Conclusions: The subgroup of patients with metastatic kidney cancer is conceptually heterogeneous. Cytoreductive nephrectomy continues to play an important role, sometimes leading role, in the management of selected patients.
References
Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019 Jan;75(1):74–84. doi: https://doi.org/10.1016/j.eururo.2018.08.036
Comisión Honoraria de Lucha contra el Cáncer. Situación Epidemiológica del Uruguay en relación al Cáncer - Mayo 2022. Comisión Honoraria de Lucha contra el Cáncer. 2022. [accessed 24 Jun 2022] Available from: https://www.comisioncancer.org.uy/Ocultas/Situacion-Epidemiologica-del-Uruguay-en-relacion-al-Cancer--Mayo-2022-uc108
Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R, European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet Lond Engl. 2001 Sep 22;358(9286):966–70. doi: https://doi.org/10.1016/s0140-6736(01)06103-7
Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001 Dec 6;345(23):1655–9. doi: 10.1056/NEJMoa003013
Mejean A, Escudier B, Thezenas S, Beauval J-B, Geoffroy L, Bensalah K, et al. CARMENA: Cytoreductive nephrectomy followed by sunitinib versus sunitinib alone in metastatic renal cell carcinoma—Results of a phase III noninferiority trial. J Clin Oncol. 2018 Jun 20;36(18_suppl):LBA3–LBA3. doi: http://dx.doi.org/10.1200/JCO.2018.36.18_suppl.LBA3
Bex A, Mulders P, Jewett M, Wagstaff J, van Thienen JV, Blank CU, et al. Comparison of Immediate vs Deferred Cytoreductive Nephrectomy in Patients With Synchronous Metastatic Renal Cell Carcinoma Receiving Sunitinib: The SURTIME Randomized Clinical Trial. JAMA Oncol. 2019 Feb 1;5(2):164–70. doi: https://doi.org/10.1001/jamaoncol.2018.5543
Bernstein A, Kutikov A. El Papel Contemporáneo de la Nefrectomía Citorreductora: Este Carpe Diem cumple con El Primum Non Nocere. AUA NEWS Span Ed. 2021;14(3):1–3.
Bakouny Z, Xie W, Dudani S, Wells C, Gan CL, Donskov F, et al. Cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICI) or targeted therapy (TT): A propensity score-based analysis. J Clin Oncol. 2020 Feb 20;38(6_suppl):608–608. doi: https://doi.org/10.1200/JCO.2020.38.6_suppl.608
NCCN. COVID-19 Resources. National Comprehensive Cancer Network. [accessed 24 Jun 2022] Available from: https://www.nccn.org/covid-19
EAU. COVID-19 Recommendations by EAU Guidelines panels - Uroweb. Uroweb - European Association of Urology. [accessed 24 Jun 2022] Available from: https://uroweb.org/news/covid-19-recommendations-by-eau-guidelines-panels
Motzer RJ, Rini BI, McDermott DF, Arén Frontera O, Hammers HJ, Carducci MA, et al. Nivolumab plus ipilimumab versus sunitinib in first-line treatment for advanced renal cell carcinoma: extended follow-up of efficacy and safety results from a randomised, controlled, phase 3 trial. Lancet Oncol. 2019 Oct;20(10):1370–85. doi: https://doi.org/10.1016/s1470-2045(19)30413-9
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