A case of clear cell renal cell carcinoma with vena cava thrombus responding to presurgical avelumab, and axitinib

Abstract

Introduction We report a case of renal cell carcinoma with vena cava thrombus showing a marked reduction with presurgical avelumab plus axitinib, facilitating nephrectomy with thrombectomy. Case presentation A 50‐year‐old man was taken to emergent care unit due to spontaneous renal rupture and was diagnosed to have left‐sided renal cell carcinoma with level IV tumor thrombus. After hemostasis was obtained via transcatheter arterial embolization, avelumab plus axitinib was introduced because upfront surgery was deemed unfeasible due to poor performance status and possible retroperitoneal tumor dissemination. After four treatment cycles, thrombus was reduced to level II, and nephrectomy with thrombectomy was performed. Histological analyses revealed massive CD8+ T cell infiltration in the thrombus, suggesting immunotherapy efficacy. He has remained recurrence‐free without any additional treatment for eight months. Conclusion For locally advanced renal cell carcinoma with vena cava thrombus, presurgical combination therapy with avelumab plus axitinib could be an option to facilitate curative surgery.

Presurgical avelumab plus axitinib in an immunosenescent octogenarian with renal cell carcinoma invading the vena cava

“…Our group also reported a patient whose venous thrombus responded markedly to presurgical avelumab and axitinib. 3 Most recently, Yoshida et al 4 reported that three of five patients treated with ICIs showed a decreased venous thrombus.…”

Editorial Comment from Dr Nagata to Nomogram for predicting survival of renal cell carcinoma with tumor thrombus based on perioperative clinicopathological factors from a Chinese high‐volume center

“…Currently, some cases have been reported in which neoadjuvant IO‐combo therapy using drugs such as avelumab plus axitinib 3,4 and ipilimumab plus nivolumab 5 had made radical surgery or minimally invasive surgery possible. It is also suggested that, even in IVC thrombus cases without metastases, these preoperative immunocombined treatments may enable minimally invasive surgery if down‐stage is obtained and that preoperative systemic treatment may reduce the risk of recurrence.…”