- traditional chemotherapeutic agents and radiation treatments have no role (efficacy) in RCC.
- RCC is an immunogenic tumor, and removing the primary tumor may have systemic effects
- laboratory data demonstrates inhibition of the immune system by RCC
- the only systemic therapies shown to improve survival in advanced RCC are immunotherapies or immunomodulators
- The first was the SWOG (Southwest Oncology Group) 8949 Trial led by Dr. Robert Flanigan and published in the New England Journal of Medicine.
Flanigan RC, Salmon SE, Blumenstein BA,et al: Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001; 345: 1655-1659
|N Engl J Med 2001; 345: 1655-1659|
- The second was a smaller study led by Dr. Mickisch for the European Organization for Research and Treatment of Cancer (EORTC) published in The Lancet.
|Lancet 2001; 358: 966-97|
These manuscripts collectively were the first to demonstrate a meaningful benefit to cytoreductive nephrectomy - a combined analysis in 2004 solidified the benefit of cytoreductive nephrectomy in the urologic literature. In addition, they define the characteristics of patients who will possibly benefit from surgery (i.e. good performance status, resectable primary and favorable sites (lung) of metastases). The figures above are some of the most prevalent figures in talks on kidney cancer and the articles are cited nearly 2,000 times. Finally, they serve as the impetus for subsequent trials in the tyrosine kinase inhibitor era that have improved the overall survival for patients with metastatic RCC to 2-3 years.[2,3]
 Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis.J Urol. 2004 Mar;171(3):1071-6.
 Robert J. Motzer, M.D., etal. Pazopanib versus Sunitinib in Metastatic Renal-Cell Carcinoma. N Engl J Med 2013; 369:722-731August 22, 2013DOI: 10.1056/NEJMoa1303989
 Bernard Escudier, M.D., etal. for the TARGET Study GroupSorafenib in Advanced Clear-Cell Renal-Cell Carcinoma. N Engl J Med 2007; 356:125-134January 11, 2007DOI: 10.1056/NEJMoa060655
Classic Manuscripts in Urology will be posted on this blog on regular basis. These articles are meant to highlight the achievements of our predecessors, recognize the work from which we build our careers and stimulate new conversations and discussion on a variety of urological topics. Please feel free to comment on this manuscript, help point out its strengths and weaknesses, or suggest a new manuscript and topic.