Cytoreductive nephrectomy in the era of targeted- And immuno- therapy for metastatic renal cell carcinoma: An elusive issue? A systematic review of the literature

Background: The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) in the era of targeted- (TT) and immuno- (IT) therapy remains controversial. Design: The primary objective of the present systematic, performed according to PRISMA guidelines review, was to assess the prevalence of nephrectomy in mRCC patients enrolled in TT/IT randomized phase II/III clinical trials (RCTs) or expanded access programs (EAPs). Medline database was searched from 2003 to 2019 for studies with available nephrectomy data. Results: We identified 609 studies, subsequently restricted to 57 randomized phase II/III clinical trials and 6 EAPs. Overall, 33,196 patients with mRCC were included, among whom 28,700 (86.4 %) underwent nephrectomy. The trends over time of nephrectomy occurrence remained substantially stable from 2003 to 2019. Conclusions: Our analysis highlighted that data from RCTs and EAPs driving the clinical practice originate from nephrectomized patient populations. This evidence supports the clinical relevance of CN also in mRCC patients candidate to receive TT/IT.