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Randomized studies of cytoreductive nephrectomy in patients with metastatic renal cancer in the interferon alpha era led to the broad adoption of this surgical approach, which continued unabated through the targeted-therapy era from around 2004 to the present day.
In 2009, French Investigators initiated a multicenter, intent-to-treat, randomized, noninferiority study (CARMENA) to evaluate the role of cytoreductive nephrectomy in patients with metastatic disease treated with a standard dose and schedule of sunitinib. During a period of 8 years, 450 patients of a planned 576 were enrolled to receive sunitinib with or without nephrectomy; 42%–44% had poor-risk characteristics, and the rest had intermediate-risk characteristics.
At a median follo…