Rationale: The SWOG trial persisted through Y2K to report a survival benefit with cytoreductive nephrectomy for metastatic renal cell carcinoma prior to interferon therapy. Yes, interferon. But since sunitinib (or immunotherapy) is used in 2018, is nephrectomy still necessary? This trial asked if sunitinib alone is non-inferior to nephrectomy + sunitinib. A tricky feature to this prediction is that it is another non-inferiority trial, which relies on an accurate prediction of event numbers and effect sizes. Betting line: Sunitinib will not be non-inferior with respect to overall survival...but it won’t be inferior either. #hedged | ASCO Plenary 2018


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