In light of the recently published CARMENA trial, is there still a role for cytoreductive nephrectomy in metastatic RCC patients?

Several features of CARMENA make the data not applicable to all mRCC patients with primary in place. These include a large percentage of poor risk/poor PS patients, lack of receiving intended protocol therapy, including delayed nephrectomy in almost 1 of every 5 patients, and a primary tumor burden representing only 63% of total tumor burden on average. The exceedingly low accrual rate suggests investigators were highly selective. That is, they selected patients in whom debulking nephrectomy ben...