Neoadjuvant Sunitinib Decreases Inferior Vena Caval Thrombus Size and Is Associated With Improved Oncologic Outcomes: A Multicenter Comparative Analysis

Field, Charles; Cotta, Brittney; Jiménez, Julio Díaz; Lane, Brian R.; Yim, Kendrick; Lee, Hak J.; Ryan, Stephen; Hamilton, Zachary; Patel, Sunil; Wang, Song; Kane, Christopher J.; Dey, Sumi; McKay, Rana R.; Noyes, Sabrina L.; Millard, Frederick E.; Rini, Brian I.; Campbell, Steven C.; Derweesh, Ithaar

doi:10.1016/j.clgc.2019.01.013

Cited by 29 publications

(32 citation statements)

References 19 publications

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“…However, in RCC patients with IVC tumour thrombi, neoadjuvant treatment with targeted molecular therapy like sunitinib have proved to have minimal to limited effects 10–13. Even when sunitinib has shown small regressions in tumour thrombi, it is not clear if this has an added survival benefit 14 15. Of note, pazopanib, another TKI, has shown to have a greater impact on tumour thrombi 16.…”

Section: Discussionmentioning

confidence: 99%

Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus

Berends¹,

Gourley²,

Kaushik³

2019

BMJ Case Rep

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A 47-year-old previously healthy man presented with acute moderate flank pain. Evaluation revealed left renal cell carcinoma, with inferior vena cava tumour thrombus invasion. Patient had no significant history or risk factors to pre-dispose him to genitourinary cancers. Surgery was deemed to not be appropriate due to distant metastases, but patient received targeted molecular therapy and immunotherapy with striking regression of the thrombus.

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Section: Discussionmentioning

confidence: 99%

Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus

Berends¹,

Gourley²,

Kaushik³

2019

BMJ Case Rep

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“…Although those in the neoadjuvant group had improved median cancer‐specific survival (72 vs 38 months, P = 0.023), no difference between groups for OS (72 vs 37 months, P = 0.08) was found between the neoadjuvant group and controls, and no difference in complication rate between groups was noted (50% vs 31.6%, P = 0.194). The authors concluded that neoadjuvant sunitinib might be beneficial in select patients with IVC thrombus, and that further investigation was necessary to confirm their findings …”

Section: Downstaging Ivc Thrombus Levelmentioning

confidence: 99%

“…The authors concluded that neoadjuvant sunitinib might be beneficial in select patients with IVC thrombus, and that further investigation was necessary to confirm their findings. 56 Neoadjuvant therapy in the management of localized RCC: Future directions Further investigation in the neoadjuvant setting utilizing targeted agents, immune checkpoint inhibitors, combinations thereof or vaccine immunotherapy are currently under way. Currently, seven clinical trials investigating the neoadjuvant therapy in non-metastatic RCC are ongoing and are summarized in Table 4.…”

Section: Downstaging Ivc Thrombus Levelmentioning

confidence: 99%

Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives

et al. 2019

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Systemic therapy strategies in the setting of localized and locally advanced renal cell carcinoma have continued to evolve in two directions: (i) as adjuvant therapy (to reduce the risk of recurrence or progression in high‐risk localized groups); or (ii) as neoadjuvant therapy as a strategy to render primary renal tumors amenable to planned surgical resection in settings where radical resection or nephron‐sparing surgery was not thought to be safe or feasible. In the realm of adjuvant therapy, the results of adjuvant therapy phase III randomized clinical trials have been mixed and contradictory; nevertheless, the findings of the landmark Sunitinib Treatment of Renal Adjuvant Cancer study have led to approval of sunitinib as an adjuvant agent in the USA. In the realm of neoadjuvant therapy, presurgical tumor reduction has been shown in a number of phase II studies utilizing targeted molecular agents and in a recently published small randomized double‐blind placebo‐controlled study, and an expanding body of literature suggests benefit in select patients. Thus, large randomized clinical trial data are not present to support this approach, and guidelines for use of presurgical therapy have not been promulgated. The advent of immunomodulation through checkpoint inhibition represents an exciting horizon for adjuvant and neoadjuvant strategies. The present article reviews the current status and future prospects of adjuvant and neoadjuvant therapy in localized and locally advanced renal cell carcinoma.

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“…Neoadjuvant systemic treatment to reduce tumor thrombus and then facilitate surgery has been discussed [20][21][22][23] . A previous retrospective study of 14 patients received neoadjuvant sunitinib or sorafenib for 2 cycles demonstrated limited results.…”

Section: Discussionmentioning

confidence: 99%

Survival Benefits After Surgery of Renal Cell Carcinoma Patients with Inferior Vena Cava Thrombus

Taweemonkongsap

Chotikawanich

Jitpraphai

et al. 2021

Preprint

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OBJECTIVE: To evaluate surgical and oncological outcomes after surgery in renal cell carcinoma (RCC) patients with inferior vena cava (IVC) tumor thrombus METHODS: A total of 58 patients from 2002 to 2019 underwent radical nephrectomy and IVC thrombectomy at Siriraj Hospital, Bangkok, Thailand, were retrospectively reviewed. Kaplan-Meier analysis was utilized to compare survival benefits between cohorts and Cox regression to evaluate predictors of patient survival. RESULTS: There were 5 (8.6%), 21 (36.2%), 23 (39.7%) and 9 (15.5%) patients with tumor thrombus level I, II, III and IV respectively. The major complications (Clavien 3-5) were observed in 15 patients (25.8%) and 80% were patients with high thrombus level (III-IV). There was 9% mortality (5 patients): 2 intraoperatively and 3 postoperatively. Median follow-up was 15 months (IQR:5-41). Two-year overall survival (OS) was 80% and 75% in all patients and pN0M0 cohort, respectively. There was significant difference in OS among each IVC thrombus level cohort (p<0.02). Two-year OS of metastatic RCC patients was 67% and not significantly different when compared to non-metastatic cohort (p=0.12). On multivariate analysis, only sarcomatoid dedifferentiation was associated with OS (p=0.04). Disease-free survival was not significantly different among thrombus-level cohorts (p=0.65). CONCLUSION: Our study suggested that surgical treatment for RCC with IVC thrombus provided acceptable OS outcomes, even in a small volume experience. Although the survival was significantly reduced with higher IVC thrombus level cohort, the level of thrombus itself was not an independent factor. Only sarcomatoid dedifferentiation was a predictor for OS after radical nephrectomy and tumor thrombectomy.

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Neoadjuvant Sunitinib Decreases Inferior Vena Caval Thrombus Size and Is Associated With Improved Oncologic Outcomes: A Multicenter Comparative Analysis

Cited by 29 publications

References 19 publications

Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus

Robust response to nivolumab in patient with renal cell carcinoma inferior vena cava tumour thrombus

Systemic therapy in the management of localized and locally advanced renal cell carcinoma: Current state and future perspectives

Survival Benefits After Surgery of Renal Cell Carcinoma Patients with Inferior Vena Cava Thrombus

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