We would like to respond to the editorial 'Benefit of cytoreductive nephrectomy in metastatic RCC: do we learn from retrospective studies and small prospective studies?' by Bernard Escudier [1].While we agree with many aspects of the editorial, there is one issue that we would like to clarify. The editorial correctly points out that a large proportion of patients treated with upfront sunitinib in our publication did not go on to have nephrectomy (30%) [2]. However, we feel the safety concern raised regarding this may not be justified. On reviewing our manuscript, we felt that we did not pay this point an adequate attention and would like the opportunity to address this. Our meta-analysis on safety and efficacy of presurgical sunitinib was carried out on patients with intermediate and poor MSKCC risk factors in two prospective trials [2]. The protocols of both studies dictated that symptomatic patients with progressive disease should not undergo nephrectomy. This accounted for the majority of the cases that did not have nephrectomy (63%). Recent data from American Society of Clinical Oncology Genito-Urinary (ASCO-GU) Conference show that this group has a poor outcome irrespective of further treatment [3, 4].
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