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      Is Cytoreductive Nephrectomy Still Beneficial for Patients With Metastatic Renal Cell Carcinoma in the Contemporary Immunotherapy Era?

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      https://www.riss.kr/link?id=A108244560

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      다국어 초록 (Multilingual Abstract)

      Cytoreductive nephrectomy (CN) has long been the standard of care for patients with metastatic renal cell carcinoma (mRCC) since 2 clinical trials revealed its role during the cytokines era. With discovery of novel and effective drugs, such as vascular endothelial growth factor-targeted therapies, the role of CN started to be challenged. The 2 recent prospective randomized trials Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques (CARMENA) and Immediate Surgery or Surgery After Sunitinib in Treating Patients with Metastatic Kidney Cancer trial (SURTIME) have changed the therapy paradigm for patients with mRCC. The CARMENA trial was performed to reveal whether CN is required in the targeted therapy, whereas SURTIME evaluated whether initial sunitinib can aid in the selection of patients who are most likely to benefit from subsequent CN or identify patients with innate resistance to targeted therapy. These trials suggest that CN does not provide a survival benefit for patients with poor‑risk disease. Especially, current evolutions in systemic therapies have demonstrated improved oncological outcomes from immunotherapy (IO) such as immune checkpoint inhibitor, particularly in its combination or combination with tyrosine kinase inhibitor. Accordingly, the role of CN continues to be questioned. Taken together, these findings reinforce the concept that the ultimate impact of CN on oncologic outcomes of mRCC patients in the era of IO still needs further investigation to represent a key for unmet clinical need.
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      Cytoreductive nephrectomy (CN) has long been the standard of care for patients with metastatic renal cell carcinoma (mRCC) since 2 clinical trials revealed its role during the cytokines era. With discovery of novel and effective drugs, such as vascula...

      Cytoreductive nephrectomy (CN) has long been the standard of care for patients with metastatic renal cell carcinoma (mRCC) since 2 clinical trials revealed its role during the cytokines era. With discovery of novel and effective drugs, such as vascular endothelial growth factor-targeted therapies, the role of CN started to be challenged. The 2 recent prospective randomized trials Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques (CARMENA) and Immediate Surgery or Surgery After Sunitinib in Treating Patients with Metastatic Kidney Cancer trial (SURTIME) have changed the therapy paradigm for patients with mRCC. The CARMENA trial was performed to reveal whether CN is required in the targeted therapy, whereas SURTIME evaluated whether initial sunitinib can aid in the selection of patients who are most likely to benefit from subsequent CN or identify patients with innate resistance to targeted therapy. These trials suggest that CN does not provide a survival benefit for patients with poor‑risk disease. Especially, current evolutions in systemic therapies have demonstrated improved oncological outcomes from immunotherapy (IO) such as immune checkpoint inhibitor, particularly in its combination or combination with tyrosine kinase inhibitor. Accordingly, the role of CN continues to be questioned. Taken together, these findings reinforce the concept that the ultimate impact of CN on oncologic outcomes of mRCC patients in the era of IO still needs further investigation to represent a key for unmet clinical need.

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      참고문헌 (Reference)

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      2 Bex A, "Updated European Association of Urology Guidelines for cytoreductive nephrectomy in patients with synchronous metastatic clear-cell renal cell carcinoma" 74 : 805-, 2018

      3 Jiang T, "Tumor neoantigens : from basic research to clinical applications" 12 : 93-, 2019

      4 Saad AM, "Trends in renal‑cell carcinoma incidence and mortality in the United States in the last 2 decades : a SEER‑based study" 17 : 46-, 2019

      5 Stoecklein VM, "Trauma equals danger : damage control by the immune system" 92 : 539-551, 2012

      6 Choueiri TK, "The impact of cytoreductive nephrectomy on survival of patients with metastatic renal cell carcinoma receiving vascular endothelial growth factor targeted therapy" 185 : 60-66, 2011

      7 Graham J, "The evolving role of cytoreductive nephrectomy in metastatic renal cell carcinoma" 29 : 507-512, 2019

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      9 Choueiri TK, "Systemic therapy for metastatic renal‑cell carcinoma" 376 : 354-, 2017

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      51 Konishi S, "Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma : a real-world multicenter analysis" 36 : 6-, 2018

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      54 Culp SH, "Can we better select patients with metastatic renal cell carcinoma for cytoreductive nephrectomy?" 116 : 3378-3388, 2010

      55 Choueiri TK, "Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk(Alliance A031203 CABOSUN randomised trial) : Progressionfree survival by independent review and overall survival update" 94 : 115-125, 2018

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      57 Warren M, "A population-based study examining the effect of tyrosine kinase inhibitors on survival in metastatic renal cell carcinoma in Alberta and the role of nephrectomy prior to treatment" 3 : 281-289, 2009

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