Nefrectomia citorredutora pós‐sunitinib no carcinoma das células renais metastizado. A propósito de um caso clínico

Introduction

Over the past three decades, nephrectomy for the treatment of patients with metastatic renal cell carcinoma (mRCC) has undergone several modifications, resulting from the implementation of systemic therapies, such as those using cytokines (IL‐2 and IFN‐α), and more recently molecular targeted therapies, such as inhibitors of angiogenesis and mTor. Using a case report as a starting point, we conducted a literature review to determine whether there is still a place for cytorreductive nephrectomy in an “era” that sees the increasing use of systemic therapies.

Clinical case

We present a 53‐year‐old patient who was diagnosed with metastatic RCC and underwent laparoscopic cytorreductive nephrectomy after completion of neo‐adjuvant therapy with Sunitinib.

Discussion

Although cytorreductive nephrectomy is associated with an increase in the overall survival of patients with metastatic RCC when it is accompanied by immunotherapy (INF‐α and IL‐2), the morbidity and mortality inherent to surgery and the positive results obtained by monotherapy regimens, including inhibitors of angiogenesis, such as Sunitinib, has launched a debate on the true benefit of nephrectomy. With this in mind, we analised studies to evaluate whether there is a benefit in administering Sunitinib before and/or after surgery, or just as part of a monotherapy regimen. We found that neo‐adjuvant Sunitinib therapy not only reduced the size of the primary renal tumor, with an increase in the overall survival of the patients, but also allowed the early detection of patients who were refractory to systemic therapy and not likely to benefit from surgery.

Conclusion

Preliminary studies indicate that treatment of patients with metastatic RCC will probably depend on an approach that includes both cytorreductive nephrectomy and systemic therapies