The induction of targeted drugs for the treatment of @entity1358 has changed the treatment strategy for systemic therapy. Surgical treatment for @entity1358 should also be reconsidered in the light of the effect of targeted drugs. The clinical benefit of cytoreductive nephrectomy for cases of @entity1358 was proved in randomized trials in the cytokine era. However, at present, there has not been level 1 evidence for this in the targeted therapy era. @entity1 with better performance status and without poor risk factors tend to benefit from cytoreductive nephrectomy. Two ongoing large-scale randomized studies might shed light on this issue. One of the remarkable differences in the efficacy between cytokines and targeted drugs, particularly @entity4149 kinase inhibitors, is the reduction in the size of the @entity5 by @entity4149 kinase inhibitors, including @entity2240 and @entity16231 . Initial experiences with targeted therapy suggest that the neoadjuvant setting of @entity4149 kinase inhibitors could be a viable option when the @entity5 shows local invasion and/or is unresectable. The present study does not support the routine neoadjuvant use of @entity2240 because of the possibility of disease progression during the neoadjuvant therapy, and modest response and benefit. @entity16231 , in contrast, shows larger reduction in the size of the @entity5 and might be used in the near future. Another issue is the combination of targeted therapy with metastasectomy. There is a lack of evidence for improved prognosis resulting from the neoadjuvant setting of @entity4149 kinase inhibitors followed by metastasectomy. Further studies are warranted to investigate this.

Treatment strategies for advanced XXXX : A new paradigm for surgical treatment.

@entity1 :: ('9606', 'Species') :: ['Patients'] @entity2240 :: ('MESH:C473478', 'Chemical') :: ['sunitinib'] @entity16231 :: ('MESH:C503983', 'Chemical') :: ['Axitinib', 'axitinib'] @entity5 :: ('MESH:D009369', 'Disease') :: ['primary tumors', 'primary tumor'] @entity1358 :: ('MESH:D002292', 'Disease') :: ['metastatic renal cell carcinoma'] @entity4149 :: ('D014443', 'Chemical') :: ['tyrosine']
@entity1358 :: (MESH:D002292,Disease) :: ['renal cell carcinoma']
