Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma

Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. Patient summary: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered. CARMENA demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in intermediate- and poor-risk patients with metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden that poor-risk patients experience on hearing that removal of their primary tumour will not be beneficial should be carefully considered. The renal cell carcinoma guidelines panel has revisited their treatment recommendations for Memorial Sloan Kettering Cancer Center intermediate- and poor-risk patients.