Background/ Aim: We evaluated surgical outcomes following nephrectomy and thrombectomy with and without presurgical treatment with pazopanib in patients with advanced renal cell carcinoma with inferior vena caval tumor thrombosis. Materials and Methods: We compared surgical outcomes between patients undergoing presurgical treatment with pazopanib vs. surgery-alone in 19 patients who underwent surgery for advanced renal cell carcinoma with high-level inferior vena caval tumor thrombosis at the Kobe University Hospital. Results: Comparing the presurgical group with the surgery-alone group, respectively, the average operative time was 497 min vs. 627 min (p=0.08); average blood loss was 1,928 ml vs. 7,393 ml (p<0.05); average postoperative hospitalization duration was 15.3 days vs. 21.6 days (p=0.05); and the perioperative complication rate was lower (presurgical: 33% vs. surgery-alone: 50%). Conclusion: Presurgical treatment with pazopanib decreased surgical difficulty and improved surgical outcomes for advanced renal cell carcinoma with high-level inferior vena caval tumor thrombosis. Patients and Methods This study was approved by the institutional review board of Kobe University Hospital (approval No.170073). Informed consent for the treatment and evaluation was obtained from all the patients. We performed a retrospective chart review of 16 patients who underwent surgery for advanced RCC with level III or IV IVC tumor thrombosis at Kobe University Hospital from March 2008 to 2013 This article is freely accessible online.
Combination therapies of an immune checkpoint inhibitor and a molecular targeted agent are widely accepted as an appropriate initial systemic therapy for metastatic renal cell carcinoma (RCC), but there is little published evidence regarding the efficacy of this approach in patients with end-stage renal disease (ESRD). Here, we report three patients who were undergoing hemodialysis for ESRD whose metastatic RCC was successfully treated using avelumab plus axitinib. The patients were a 67-year-old man with swollen lymph nodes, a 65-year-old man with pleural dissemination, and a 71-year-old man with lung nodules and an infra-diaphragmatic nodule. They were administered a combination of avelumab plus axitinib as their initial systemic therapy following definitive surgical therapy. The best response of three patients was graded as partial response. No severe adverse events were identified. This is the first report of the use of combination therapy consisting of avelumab plus axitinib in patients with ESRD undergoing hemodialysis. We found that this combination was useful in such patients.
Background/Aim: The survival benefit of immune checkpoint inhibitors for non-clear cell renal cell carcinoma (nccRCC) is unclear. Our purpose was to evaluate the real-world survival benefit of ipilimumab plus nivolumab retrospectively. Patients and Methods: We retrospectively reviewed medical records of 33 patients with metastatic nccRCC who received combination therapy with ipilimumab plus nivolumab or monotherapy with a molecular targeted agent as initial systemic therapy. Progression-free survival (PFS), overall survival (OS) and objective response rate were compared between the two groups. Results: Median PFS of each therapy was 3.5 and 4.7 months (p=0.61) and median OS was 19.6 and 10.6 months (p=0.23), respectively. Three patients treated with ipilimumab and nivolumab had a complete response, resulting in an objective response rate of 30.0%, while that for molecular targeted therapy was 4.5% (p=0.04). Conclusion: Ipilimumab plus nivolumab achieved statistically non-significant, but longer overall survival and significantly higher objective response rate.
Patients and MethodsThis study was conducted under Institutional Review Board approval of the Kobe University Hospital (approval No. B210089). We retrospectively reviewed the medical records of 33 patients with metastatic nccRCC at Kobe University Hospital between April 2008 and December 2020. Patients who received nivolumab monotherapy as subsequent systemic therapy during follow-up were also included in the patient group of molecular targeted therapy. Baseline clinical data including age, gender, body mass index, ethnic origin, Karnofsky performance status, prior nephrectomy status, primary histology, metastatic sites, and laboratory data were collected by reviewing patient medical records. Treatment outcomes, including best response [assessed by RECIST 1.1 (12)], time to treatment failure, progression-free survival (PFS), OS, and adverse effects retrieved from medical records were evaluated according to the nature of initial systemic therapy.All statistical analyses were performed with JMP 12.0 (SAS Institute Inc, Cary, NC, USA), using p<0.05 to indicate significant results. PFS and OS were estimated with Kaplan-Meier curves, and differences were analysed by log-rank test.
ResultsThe clinicopathological characteristics of eligible patients are listed in Table I. The median age of eligible patients was 65 years, and there were 24 men (72.7%) and 9 women (27.3%). Prior definitive surgical therapy had been performed in 26 973 This article is freely accessible online.
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