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Cytoreductive nephrectomy in metastatic renal cancer

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Abstract

Recent randomized prospective trials have suggested that cytoreductive nephrectomy confers a survival advantage in patients with metastatic renal cancer who receive immunotherapy with interferon-alfa-2b. It appears that the patients most benefiting from this approach are those with good performance status, lung-only metastases, and adequate cardiac and pulmonary reserve. Nonrandomized trials have further suggested that this survival advantage may be extended in patients who receive more aggressive interleukin-2-based immunotherapy.

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References and Recommended Reading

  1. Flanigan RC: Role of surgery in patients with metastatic renal cell carcinoma. Semin Urol Oncol 1996, 14:227–229.

    PubMed  CAS  Google Scholar 

  2. Motzer R, Russo P: Systemic therapy for renal cell carcinoma. J Urol 2000, 163:408–417.

    Article  PubMed  CAS  Google Scholar 

  3. Figlin RA, Pierce WC, Kaboo R, et al.: Treatment of metastatic renal cell carcinoma with nephrectomy, interleukin-2 and cytokine-primed or CD8(+) selected tumor infiltrating lymphocytes from primary tumor. J Urol 1997, 158:740–745.

    Article  PubMed  CAS  Google Scholar 

  4. Greenlee RA, Murray T, Bolden S, Wingo PA: Cancer statistics 2000. CA Cancer J Clin 2000, 50:7–33.

    PubMed  CAS  Google Scholar 

  5. Flanigan RC, Salmon SE, Blumenstein BA, et al.: Nephrectomy followed by interferon-alpha-2b compared with interferon alfa-2b alone for metastatic renal cell cancer. N Engl J Med 2001, 345:1655–1659. This paper represents the largest experience to date investigating the role of cytoreductive nephrectomy in metastatic renal cancer. A 50% increase in survival was demonstrated across all prestudy variables including PS, lung-only metastases, and evaluable disease.

    Article  PubMed  CAS  Google Scholar 

  6. Mickisch GHJ, Garin A, van Poppel H, et al.: Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon-alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001, 358:966–970. This study, which follows the exact protocol used by SWOG 8949, revealed very similar results in a smaller number of patients. The study also supported the SWOG finding of low perioperative morbidity and a small percentage of patients who were unable to proceed to IFN therapy after surgery.

    Article  PubMed  CAS  Google Scholar 

  7. Freed S: Nephrectomy for renal cell carcinoma with metastases. Urology 1997, 9:613–616.

    Article  Google Scholar 

  8. Spencer WF, Linehan WM, McClellan MW, et al.: Immunotherapy with interleukin-2 and interferon in patients with metastatic renal cell cancer in situ primary cancers: a pilot study. J Urol 1992, 147:24–30.

    PubMed  CAS  Google Scholar 

  9. Figlin RA: Renal cell carcinoma: management of advanced disease. J Urol 1999, 161:381–386.

    Article  PubMed  CAS  Google Scholar 

  10. Robertson CN, Linehan WM, Pass HI, et al.: Preparative cytoreductive surgery in patients with metastatic renal cell carcinoma treated with adoptive immunotherapy with interleukin-2 or interleukin-2 plus lymphokine activated killer cells. J Urol 1990, 144:614–617.

    PubMed  CAS  Google Scholar 

  11. Rackley R, Novick A, Klein E, et al.: The impact of adjuvant nephrectomy on multimodality treatment of metastatic renal cell carcinoma. J Urol 1994, 152:1399–1403.

    PubMed  CAS  Google Scholar 

  12. Walther MM, Alexander RB, Weiss GH: Cytoreductive surgery prior to interleukin-2-based therapy in patients with metastatic renal cell carcinoma. Urology 1993, 42:250–257.

    Article  PubMed  CAS  Google Scholar 

  13. Fallick ML, McDermott DF, LaRock D, et al.: Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol 1997, 158:1691–1695. This review highlights the importance of patient selection in this setting and describes patients most likely to achieve a meaningful improvement in survival with IL therapy.

    Article  PubMed  CAS  Google Scholar 

  14. Mani S, Todd MB, Katz K, et al.: Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers. J Urol 1995, 154:35–40.

    Article  PubMed  CAS  Google Scholar 

  15. Motzer RJ, Mazumdar M, Bacik J, et al.: Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999, 17:2530–2540.

    PubMed  CAS  Google Scholar 

  16. Elson PJ: Prognostic factors in metastatic renal cell carcinoma. In Current Clinical Oncology: Renal Cell Carcinoma: Molecular Biology, Immunology and Clinical Management. Edited by Bukowski RM, Novick AC. Totowa, NJ: Humanan Press; 2000.

    Google Scholar 

  17. Muss H, Constanzi JJ, Leavitt R, et al.: Recombinant alfa interferon in renal cell carcinoma: a randomized trial of two routes of administration. J Clin Oncol 1987, 5:286–291.

    PubMed  CAS  Google Scholar 

  18. Umeda T, Niijima T: Phase II study of alpha interferon on renal cell carcinoma. Summary of three collaborative trials. Cancer 1986, 58:1231–1235.

    Article  PubMed  CAS  Google Scholar 

  19. Fisher RI, Coltman CA Jr, Doroshaw JH, et al.: Metastatic renal cancer treated with interleukin-2 and lymphokine-activated killer cells. A phase II clinical trial. Ann Intern Med 1988, 108:518–523.

    PubMed  CAS  Google Scholar 

  20. Walther MM, Yang JC, Pass HI, et al.: Cytoreductive surgery before high dose interleukin-2 based therapy in patients with metastatic renal cell carcinoma. J Urol 1997, 158:1675–1678.

    Article  PubMed  CAS  Google Scholar 

  21. Walther MM, Lyne JC, Libutti SK, Linehan WM: Laparoscopic cytoreductive nephrectomy as preparation for administration of systemic interleukin-2 in the treatment of metastatic renal cell carcinoma: a pilot study. Urology 1999, 53:496–501.

    Article  PubMed  CAS  Google Scholar 

  22. Pantuck AJ, Zisman A, Chao D, et al.: Survival advantage of interleukin-2 over interferon immunotherapy when combined with cytoreductive nephrectomy based on SWOG 8949-matched populations. J Urol 2002, 167:166.

    Google Scholar 

  23. Slaton JW, Perrotte P, Balbay MD, et al.: Reassessment of the selection criteria for cytoreductive nephrectomy in patients with metastatic renal cell carcinoma. J Urol 2000, 163(Suppl 4):179.

    Google Scholar 

  24. Wood CG, Huber N, Madsen L, et al.: Clinical variables that predict survival following cytoreductive nephrectomy for metastatic renal cell carcinoma. J Urol 2001, 165(Suppl 5):184.

    Google Scholar 

  25. Wolf JS, Aronson FR, Small EJ, Carroll PR: Nephrectomy for metastatic renal cell carcinoma: a component of systemic treatment regimens. J Surg Oncol 1994, 55:7–13.

    Article  PubMed  Google Scholar 

  26. Bennett RT, Lerner SE, Taub HC, et al.: Cytoreductive surgery for stage IV renal cell carcinoma. J Urol 1995, 154:32–34.

    Article  PubMed  CAS  Google Scholar 

  27. Levy DA, Swanson DA, Slaton JW, et al.: Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma. J Urol 1998, 159:1168–1173.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Loyola University Stritch School of Medicine, Building 54, Room 237A, 2160 S. First Avenue, 60153, Maywood, IL, USA

    Robert C. Flanigan MD

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  1. Robert C. Flanigan MD
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Flanigan, R.C. Cytoreductive nephrectomy in metastatic renal cancer. Curr Urol Rep 4, 36–40 (2003). https://doi.org/10.1007/s11934-003-0055-6

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  • DOI: https://doi.org/10.1007/s11934-003-0055-6

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