Cytoreductive nephrectomy for oligometastatic clear cell renal cell carcinoma in the era of immuno-oncology.

Abstract

Purpose of review: Advancements in immune-oncology treatments and metastasis-directed therapy (MDT) techniques have significantly transformed treatment paradigms for patients with oligometastatic clear cell renal cell carcinoma (ccRCC). Within this evolving therapeutic landscape, the role of cytoreductive nephrectomy remains a topic of debate. This review aims to synthesize recent literature regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the contemporary immune-oncology era.

Recent findings: While no prospective data are available regarding the role of cytoreductive nephrectomy for patients with oligometastatic ccRCC in the new immune-oncology (IO) era, results from recent retrospective studies suggest that careful patient selection remains critical. Apart from patients with symptomatic primary tumors, cytoreductive nephrectomy may still play a role in the treatment of oligometastatic patients with favorable clinical features, such as no immediate need for systemic therapy, absence of adverse metastatic sites, or oligometastatic lesions amenable to MDT. Deferred cytoreductive nephrectomy may have a rationale in patients with a deep response to IO at oligometastatic sites. Prognostic biomarkers to assess the biological behavior of oligometastatic disease and identify patients most suitable for cytoreductive nephrectomy are currently lacking. Novel imaging remains under investigation, with its treatment implications in oligometastatic RCC yet to be established.

Summary: Notwithstanding the lack of prospective evidence, cytoreductive nephrectomy may still play a role for selected patients with oligometastatic ccRCC. Future research efforts should aim to identify prognostic tools aiding tailored decision-making in this setting.