The role of metastasectomy in advanced renal cell carcinoma

ABSTRACT

Introduction: So far, clinical experiences have proved metastasectomy as the only approach in the setting of metastatic renal cell carcinoma that may achieve the ‘no evidence of disease’ status, with an associated improvement in survival.

Areas covered: This review aims to summarize the body of knowledge on therapeutic approaches to mRCC, with a specific insight on the role of metastasectomy and on which underlying factors could be good predictors to select patients who may benefit from surgery. In detail, we managed to identify as potential selection criteria: the number of lesions and their site, the DFI, patients’ performance status and, most of all, the completeness of resection.

Expert opinion: The definition of the optimal treatment strategy of mRCC patients is still an unmet clinical need. The decision-making process about treatment strategy should consider specific tumor’s and patient’s characteristics, as well as the integration of the available therapeutic approaches with the aim to reach the best clinical outcome. We consider multidisciplinary management mandatory in order to tailor the treatment approach according to the patient and disease features. The experience of clinicians may be considered crucial in order to select the best candidates for a multimodal approach.

KEYWORDS:

• Metastasectomy
• renal cell carcinoma
• surgical approach
• targeted therapies
• immunotherapy

Article highlights

• In metastatic disease, metastasectomy has been so far reported as the only approach that may allow to achieve the ‘not evidence of disease’ status with an associated improvement in survival.

• In order to achieve the best clinical outcome, the selection of patients eligible for surgery of metastases is the key point: no precise criteria have been validated so far, however, both disease and patients’ characteristics should be taken into account.

• Several studies reported different prognostic factors. In our knowledge, the number of lesions and their site, DFI, as well as patients’ performance status and, most of all, the completeness of resection could be considered as prognostic factors and potential selection criteria.

• The decision-making process about treatment strategy should consider the integration of other available therapeutic approaches.

• A multidisciplinary team (MDT) (including clinicians, surgeons, radiotherapists, and radiologists) may be facilitated in the formulation of a treatment strategy.

• Some ongoing trials are exploring the possible role of adjuvant systemic therapy after radical surgery of metastases from RCC.

• Further research is necessary to validate prospectively the meaning of metastasectomy in advanced disease.

Declaration of interest

G Procopio declares receiving honoraria for advisory board from Bayer, Bristol Myers Squibb, Ipsen, Merck, Novartis, and Pfizer. E Verzoni declares receiving honoraria for advisory board from Pfizer, Bristol Myers Squibb, Ipsen, and EUSA pharm. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.