The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors

Cost, Nicholas G.; Krabbe, Laura Maria; Bagrodia, Aditya; Margulis, Vitaly

doi:10.1097/mou.0b013e32836320a7

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…However, the surgical benefits after NT in mRCC have generally been observed during the immunotherapy era. While the use of preoperative TT in the setting of locally advanced or metastatic RCC (mRCC) remains in its preliminary stages, with only a few retrospective studies and case reports (2161718), there is a growing body of evidence that may support its role in a select group of patients (8). Therefore, the present study is significant because few studies have evaluated neoadjuvant TT in Asian populations (19), and, to the best of our knowledge, this is the first and only study of NT using a targeted agent in Korean patients with mRCC.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma

et al. 2016

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This study aimed to evaluate the efficacy, safety, and tolerability of 2-cycled neoadjuvant sunitinib therapy (NST) in patients with inoperable metastatic renal cell carcinoma (mRCC). Between 2009 and 2012, 14 patients with inoperable mRCC from 5 Korean academic centers were prospectively enrolled after collecting their clinicopathological data and completing health-related questionnaires. The best overall response (BOR), safety profile, and changes in quality of life during NST were assessed using the RECIST criteria (version 1.0), CTCAE criteria (version 4.0), and the Cancer Quality of Life Questionnaire (QLQ-C30). Among the 14 patients, 9 patients (64.3%) experienced partial response or stable disease state, and 5 patients (35.7%) did not complete treatment, with 1 case of disease progression (7.1%), 3 grade 3 adverse events (21.4%), and 1 voluntary withdrawal (7.1%). Four patients (28.6%) were successfully converted to an operable state and underwent surgery after NST. The BOR for the primary renal lesions was 22.2%, with a median 1.3-cm diameter reduction (range: 0–2.8 cm) from a baseline diameter of 10.3 cm (range: 6.6–15.8 cm). The other 18 measurable metastatic lesions exhibited a BOR of 55.6%. The QLQ-C30 questionnaire results revealed significant improvements in the quality of life domain, although we observed significant increases in the scores for fatigue, nausea and vomiting, and the financial effects of NST (P < 0.05). Two-cycle NST provided limited efficacy for resectability of inoperable mRCC, despite mild improvements in the BOR of the primary lesion and quality of life (Clinical Trial Registry 1041140-1).

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Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma

et al. 2016

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“…Targeted therapy has shown efficacy in the downstaging of locally advanced tumours including those with caval thrombi in anecdotal reports [27]. Current evidence suggests that targeted therapy could be effective in downstaging tumours to allow NSS, especially in those with absolute indications [28,29]. A phase II trial of 25 patients using 8 weeks of neoadjuvant pazopanib in localized RCC (median tumour size 7.3 cm) showed that NSS was possible in 6 out of 13 patients in whom it was not possible at baseline [30].…”

Section: Downstaging Of Tumours With Targeted Therapymentioning

confidence: 99%

Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours

Venkatramani

Swain

Satyanarayana

et al. 2017

Indian J Surg Oncol

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Nephron-sparing surgery has emerged as the surgical treatment of choice for small renal masses over the past two decades, replacing the traditional teaching of radical nephrectomy for renal cell carcinoma. With time, there has been an evolution in the techniques and indications for partial nephrectomy. This review summarizes the current status of nephron-sparing surgery for renal carcinoma and also deals with the future of this procedure.

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“…However, the tumor location and size may make these treatments difficult due to the potential adverse effects on adjacent organs, blood vessels, and the urinary tract. There have been several reports on the efficacy of preoperative molecular-targeted drugs for T1b tumors in nephron-sparing surgery [3,4]. However, only one case report regarding local ablative therapy is available in the literature [5].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Tyrosine Kinase Inhibitors Before Percutaneous Cryoablation for Clinical T1b Renal Tumors

Iwatani,

Kimura,

Urabe

et al. 2024

Cureus

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To treat renal cell carcinoma, local ablative therapy is a viable alternative treatment option. Traditionally, cryoablation has been used for the treatment of T1a renal tumors. However, recent technological developments have expanded its application to encompass select T1b renal tumors. Here, we present a retrospective study of the utilization of preoperative tyrosine kinase inhibitors (TKIs) to induce tumor shrinkage and achieve favorable outcomes in percutaneous cryoablation (PCA). MethodsWe retrospectively evaluated the data from nine patients with clinical T1b renal tumors who underwent PCA. Six patients with TKI pretreatment at our institution between 2016 and 2018 were included in the study. We evaluated the safety and efficacy of preoperative TKIs prior to PCA. ResultsAll patients received axitinib with a median treatment duration of 80.5 days (IQR: 49-85). All patients experienced tumor shrinkage (median: 13.5 mm; IQR: 7-16); five experienced downstaging to T1a following tumor shrinkage. There were no severe adverse events (common terminology criteria for adverse events (CTCAE) grade ≥ 3) in TKIs. After the discontinuation of TKIs for two weeks, all PCA procedures were performed successfully without any severe complications. During a median follow-up of 46 months, no local recurrence was observed in any of these cases. ConclusionIn cases with large renal tumors, TKI pretreatment prior to PCA had potential benefits in terms of tumor shrinkage and long-term local control rate. Further well-designed studies in larger populations are needed to validate our findings.

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The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors

Cited by 5 publications

References 28 publications

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma

Current Status of Nephron-Sparing Surgery (NSS) in the Management of Renal Tumours

Preoperative Tyrosine Kinase Inhibitors Before Percutaneous Cryoablation for Clinical T1b Renal Tumors

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