• When is monotherapy with a TKI appropriate?
A report and literature review exploring the limitations
of combination therapy and the role of single agents in
the targeted therapy era.
• What is the rationale for combination immunotherapy
plus targeted therapy in RCCa?
• Reexamining the landscape of adjuvant therapy,
analyzing information from ongoing pivotal trials.
Kidney Cancer Journal,
Now in Its 16th Year
Kidney Cancer Journal 63
landmark trial? Not so fast, and here’s why.
Let’s not rush to judgement on this issue. In his
enthusiasm to usher in the results of this trial, the lead
author of CARMENA, Arnaud Mejean, MD, a urologist
at the Department of Urology, Hôpital Européen
Georges-Pompidou - Paris Descartes University in Paris,
said: .“Our study is the first to question the need for
surgery in the era of targeted therapies and clearly
shows that surgery for certain people with kidney
cancer should no longer be the standard of care.” The
pitfall lies in the propensity to extrapolate the results
to a segment of the patient population for which CN
may still be the standard of care, and this needs to be
emphasized. These pitfalls are expertly described in an
Editorial in a June issue of the New England Journal of
Medicine (Motzer RJ, Russo P. Cytoreductive nephrectomy—
patient selection is key. N Engl J Med. DOI:
10.1056/NEJMe1806331).
As Motzer and Russo point out, interpretation of
the results is complicated for a number of reasons.
Although CARMENA is pivotal and will soon be
followed by other reports addressing the same questions,
Motzer and Russo drill down into its data and
methodology and enable us to question assumptions
some observers have made and clarify its implications.
One caveat: a slow and incomplete enrollment over 8
years at 79 centers in Europe raises the possibility that
many centers saw few patients with stage IV disease.
Or, when surgeons saw patients with intermediate-risk
disease who were likely to benefit from combination
therapy, they were unwilling for them to undergo
randomization and instead treated them outside the
trial.
The Editorial delves into other considerations possibly
confounding the results, all of which serve to call
us back to fundamental standards of care, namely, not
to abandon nephrectomy but instead carefully select
patients undergoing nephrectomy on the basis of
published and well recognized risk models.
Robert A. Figlin, MD
Editor-in-Chief
EDITOR’S MEMO
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