Laura Iisager, Johanne Ahrenfeldt, Frede Donskov, Börje Ljungberg, Axel Bex, Lars Lund, Iben Lyskjær, Niels Fristrup.
BMC Cancer. 2024 Feb 24;24(1):260. doi: 10.1186/s12885-024-11987-3.

“The critical question is whether the primary kidney tumor should be removed in patients with de novo, synchronous, mRCC treated with IO-based therapy” –Niels Fristrup MD PhD, Principal Investigator the NORDIC SUN trial.

Primary tumor removal by cytoreductive nephrectomy (CN) in synchronous metastatic renal cell carcinoma patients has been investigated in the context of various treatment regimens.

In the era of targeted tyrosine kinase inhibitor therapy two randomized trials, CARMENA and SURTIME, have questioned the role and timing of CN in synchronous mRCC patients with results pointing towards an improved benefit upon a deferred approach; except for IMDC poor risk patients. The deferred CN approach ensures systemic therapy for all patients, avoids systemic treatment delay, and spares surgery in patients with progressive tumors.

During the recent years standard treatment has evolved to IO-IO or IO-TKI combinations, and in NORDIC SUN (NCT03977571) we test the effect of deferred CN in mRCC patients receiving contemporary mRCC treatment. Concurrently, the PROBE trial (NCT04510597) is recruiting in the US, also trying to answer this clinical question, thereby underlining its importance in the management of primary metastatic RCC.

NORDIC SUN furthermore integrates a comprehensive translational research program with tissue, blood, and microbiome sampling for biomarker analysis, see Figure 1.