• Luigi Napolitano, Celeste Manfredi, Luigi Cirillo, Giovanni Maria Fusco, Francesco Passaro, Marco Abate, Roberto La Rocca, Francesco Mastrangelo, Lorenzo Spirito, Savio Domenico Pandolfo, Felice Crocetto, Davide Arcaniolo, and Biagio Barone.
• Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy.
• Medicina (Kaunas). 2023 Apr 15; 59 (4).

AbstractIn the past decades, several treatments have been proposed for the management of metastatic renal cell carcinoma (mRCC). Among these, cytoreductive nephrectomy (CN) represents a controversial and open issue in the era of targeted therapy and novel immunotherapy with immune checkpoint inhibitors. Two important studies, CARMENA and SURTIME, analyzed therapy with sunitinib with or without CN, and immediate CN followed by sunitinib versus a deferred CN after three cycles of sunitinib, respectively. CARMENA showed the non-inferiority of sunitinib alone versus sunitinib plus CN, whereas SURTIME showed no difference in progression-free survival (PFS), but a better median OS among patients with deferred CN. Therefore, more prospective clinical trials and appropriate patient identification are necessary to support CN in this new scenario. This review provides a snapshot of the current evidence for CN in mRCC, discusses the management strategies, and offers perspectives on the direction of future research.

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