Primum Non Nocere: When Nephrectomy Becomes a Selective Approach in Metastatic Renal Cell Carcinoma (European Urology Oncology)

Primum non nocere: first do no harm is the first ethical principle of medicine. The CARMENA trial [1] raised the question of the value of nephrectomy in metastatic renal cell carcinoma (mRCC). By demonstrating that the overall survival (OS) of patients treated with sunitinib was not inferior than that of patients treated with nephrectomy and sunitinib, CARMENA answered the first part of the question. The second part would be to know how to treat the primary tumor in patients who are good responders to mRCC systemic therapies.