Cytoreductive nephrectomy (CN) is the surgical procedure to remove the primary tumor in patients with metastatic kidney cancer. “The role and timing for CN—whether or not to offer it, in whom to offer it, and when to offer it—have been a moving target over the past couple decades as therapies have evolved,” explains urologist Nirmish Singla, M.D.

“Multiple retrospective studies, including those done in collaboration with Brady investigators, have demonstrated benefits to CN in select patients,” Singla continues. “The key here is patient selection,” but this is not always clear. “A combination of patient factors and tumor factors are important to consider in determining whether it would be beneficial to offer CN upfront,” before systemic treatment; after a durable response to systemic therapy (this is “deferred” CN), or not at all. “This decision often involves a nuanced and complex multidisciplinary discussion tailored to each individual patient.”

Singla and medical oncologist Yasser Ged, M.D., who co-lead the Kidney Cancer Program and established the Kidney Cancer Multidisciplinary Clinic at Johns Hopkins, recently proposed a treatment algorithm to help physicians and patients make this decision. It is based on several factors including the type of kidney cancer, degree and location of metastases, and whether the patient has other medical conditions. Their comprehensive review was published in Current Opinion in Urology, with postdoctoral fellow Stephan Brönimann, M.D. as first author.