Re: Kosuke Takemura, Matthew S. Ernst, Vishal Navani, et al. Characterization of Patients with Metastatic Renal Cell Carcinoma Undergoing Deferred, Upfront, or No Cytoreductive Nephrectomy in the Era of Combination Immunotherapy: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.10.002

We read with great interest the recent article by Takemura et al. [ [1] Takemura K, Ernst MS, Navani V, et al. Characterization of patients with metastatic renal cell carcinoma undergoing deferred, upfront, or no cytoreductive nephrectomy in the era of combination immunotherapy: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.10.002. Google Scholar ]. Although results from CARMENA trial raise a question regarding the net benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma, dynamic changes in the treatment landscape with the emergence of immuno-oncology (IO)-based regimens have once again added complexity to the situation [ [2] Mejean A. Ravaud A. Thezenas S. et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med. 2018; 379: 417-427 Crossref PubMed Scopus (577) Google Scholar ]. The work by Takemura and colleagues has significant clinical relevance, particularly in the context of their use of the largest international database of its kind. The study cohort is unique as it is composed solely of patients who underwent current standard-of-care regimens. For this, the authors deserve commendation. Analyses for CN in the IO era have only been performed in small trials. The results from this study will undoubtedly encourage clinicians to further investigate the true benefits that CN may offer in the current treatment landscape. We would like to raise two points for future debate in light of these findings.