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On the basis of the results of CARMENA and SURTIME trials, the role of cytoreductive nephrectomy (CN) has been redefined and CN has been reserved to selected cases.These trials were designed in the Tyrosine Kinase Inhibitors (TKIs) era, when sunitinib was the standard of care for the treatment of advanced renal cancer.However, new drug combinations (lenvatinib plus pembrolizumab, nivolumab plus cabozantinib, nivolumab plus ipilimumab, pembrolizumab plus axitinib) have shown to be superior to TKIs in terms of progression free survival (PFS) and/or overall survival (OS).All of these combinations are currently recommended as a first line therapy for metastatic renal cell carcinoma (mRCC).While ipilimumab plus nivolumab is recommended only for intermediate and poor risk groups, the other regimens can be used regardless of the International Metastatic RCC Database Consortium (IMDC) prognostic score.The role of CN in this new modern era, where randomized clinical trials (RCTs) have led to the approval of several new drug combinations for the treatment of advanced renal cancer, has not been investigated yet.We described two cases where a deferred CN was offered to poor risk IMDC pts after a major response to the combination of pembrolizumab and axitinib.
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Federico et al. (2023) studied this question.
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