CARMENA.

Headline: With the advent of targeted therapies. patients with metastatic renal cell carcinoma (mRCC) don’t benefit from cytoreductive nephrectomy anymore. So, yeah, we hedged a little too hard on this one. This non-inferiority trial randomized 450 patients with clear cell mRCC to standard nephrectomy followed by sunitinib versus sunitinib alone. Median overall survival with sunitinib alone was so non-inferior as to look outright superior, at 18 months versus 14 months with the addition of nephrectomy. This advantage held true across intermediate and high risk subgroups and is most likely due to fewer surgical complications and/or delays in initiation of systemic therapy. Bottom line: In the era of targeted therapies, patients with mRCC should keep their kidneys. | Méjean, N Engl J Med 2018