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Tyrosine Kinase Inhibitors Before Cytoreductive Nephrectomy: Where Do We Stand?

Sean P Stroup, MD, and Ithaar H Derweesh, MD

Metastatic renal cell carcinoma (mRCC)has been associated with a poor prognosis. While multimodal treatment with upfront cytoreductive nephrectomy followed by interferon-α (IFN-α) or interleukin-2 (IL-2) was established in the immunotherapy era, the role of cytoreductive nephrectomy in the setting of targeted therapy has been questioned. In this article, we review the published experience of using targeted molecular therapy in the neoadjuvant treatment of patients with metastatic renal cell carcinoma. A number of small series have supported the safety of this strategy, but further investigation is required to assess the role, timing, and sequencing of targeted therapy and cytoreductive nephrectomy in the treatment of metastatic renal cell carcinoma.

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