The Evolving Role of Cytodeductive Nephrectomy | Urology Grand Rounds

Recorded live on February 16th, 2024

In this recorded Urology Grand Rounds presentation, Associate Surgeon at Brigham and Women’s Hospital and Dana-Farber Brigham Cancer Center, and Assistant Professor of Surgery at Harvard Medical School, Dr. Steven L. Chang discusses the management of metastatic renal cell carcinoma, focusing on the role of cytoreductive nephrectomy. Dr. Chang begins with the historical development of treatment approaches, from the cytokine era with interleukin-2 and interferon alpha, to the targeted therapy era with agents like sunitinib, and the current era of immunotherapy and combination therapies. In his lecture, Dr. Chang reviews the CARMENA trial, a randomized controlled study which showed that sunitinib alone was non-inferior to cytoreductive nephrectomy plus sunitinib, challenging the previous standard of care. Dr. Chang then discusses four clinical scenarios where cytoreductive nephrectomy may still be beneficial. Dr. Chang concludes by highlighting the importance of personalized, multidisciplinary care and the potential for future advancements such as vaccines and HIF2-alpha inhibitors.

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Learning Objectives:
1. Consider cytoreductive nephrectomy for palliative purposes to relieve symptoms such as pain, hematuria, and paraneoplastic syndromes in patients with significant tumor burden.
2. Evaluate patients for consolidative cytoreductive nephrectomy after successful systemic therapy to eliminate residual disease.
3. Discuss the biopsy of larger tumors suspected of being metastatic to identify non-clear cell histologies.
4. Evaluate cytoreductive nephrectomy and metastasis-directed therapy for patients with oligometastatic disease.
5. Implement a multidisciplinary approach involving medical oncology for personalized treatment planning and decision-making.

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