(UroToday.com) The European Society of Medical Oncology (ESMO) 2021 annual meeting’s non-prostate cancer session included a presentation by Dr. Marc-Oliver Grimm discussing the role of prior nephrectomy on outcomes of avelumab + axitinib versus sunitinib in the JAVELIN Renal 101 trial for metastatic renal cell carcinoma (RCC). Cytoreductive nephrectomy has been a standard of care in metastatic RCC for 20 years, although its role in patients receiving currently available therapies remains controversial. In the randomized phase 3 CARMENA trial, OS results showed that treatment with sunitinib alone was not inferior to cytoreductive nephrectomy followed by sunitinib.1 In the randomized phase 3 SURTIME trial, there was no significant difference in PFS observed with sunitinib before deferred nephrectomy compared with cytoreductive nephrectomy followed by sunitinib.2 However, the role of prior nephrectomy in patients treated with immune checkpoint inhibitor remains unknown. In this extended follow-up analysis of the phase III JAVELIN Renal 101 trial (NCT02684006),3 Dr. Grimm and colleagues assessed the role of prior nephrectomy in patients with metastatic RCC presenting with synchronous metastases at the time of diagnosis and treated with avelumab + axitinib or sunitinib.