Efficacy of Pre-surgical Axitinib for Shrinkage of Inferior Vena Cava Thrombus in a Patient with Advanced Renal Cell Carcinoma

Sassa, Naoto; Kato, Masashi; Funahashi, Yasuhito; Maeda, Motohiro; Inoue, Satoshi; Gotoh, Momokazu

doi:10.1093/jjco/hyu014

Cited by 21 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several retrospective studies produced variable results, with the thrombus level decreases observed in 7%–19% of patients. 15 , 19 , 20 Cost et al performed a retrospective study of 25 patients in which 3 (12%) showed a reduction in the level of thrombus and 1 (4%) experienced an increase; 44% of patients had a change in the tumor thrombus height following TMT. However, the impact on tumor thrombus level led to altering the surgical approach in only one patient who was downstaged from level IV to III.…”

Section: Discussionmentioning

confidence: 99%

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

Peng¹,

Gu²,

Wang

et al. 2018

OTT

View full text Add to dashboard Cite

PurposeThe clinical benefit of targeted molecular therapy (TMT) in renal cell carcinoma (RCC) with an inferior vena cava (IVC) tumor thrombus remains controversial. The aim of this study was to investigate the effects of presurgical TMT on the heights and levels of IVC thrombi, and to assess its impact on surgical strategy.Patients and methodsWe retrospectively reviewed data from 18 patients with RCC involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy. The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging. Clinicopathological factors were also evaluated to assess their association with TMT efficacy.ResultsThe tumor thrombus levels before TMT were stage I in 1 patient (5.6%), II in 12 patients (66.7%), III in 4 patients (22.2%), and IV in 1 patient (5.6%). After a median of two treatment cycles (range: 1–3), the thrombus height decreased measurably in 11 patients (61.1%) with an average shrinkage of 17.7%. The thrombus height remained stable in five patients (27.8%) and was enlarged in two (11.1%). Downstaging of the thrombus level occurred in four patients (22.2%); the surgical strategy was modified in three patients (16.7%) to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy. Furthermore, a higher neutrophil count tended to be associated with a worse clinical TMT-associated outcome (P=0.056).ConclusionOur data suggest a limited influence of presurgical TMT with a positive benefit in RCC patients with level III and IV thrombus. Thrombus-level regression may potentially alter the surgical strategy, especially robotic surgery. However, our findings require validation with additional prospective investigations.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

Peng¹,

Gu²,

Wang

et al. 2018

OTT

View full text Add to dashboard Cite

show abstract

“…For example, in a study by Cost and colleagues, the median decrease in tumor thrombus height was 1.5 cm, and one patient was successfully downgraded from level IV to III. However, the results of this approach are variable, with reports of reduction in thrombus height in 5-44% of cases, stable disease in 28-91%, and tumor thrombus progression in 5-28% [Cost et al 2011;Bex et al 2012;Bigot et al 2014;Peters et al 2014;Sassa et al 2014]. As of yet, there is no level one evidence to support the use of targeted agents prior to tumor thrombectomy.…”

Section: Coordination Of the Surgical Team And Preoperative Optimizationmentioning

confidence: 99%

Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma

Psutka

Leibovich

2015

Therapeutic Advances in Urology

125

105

View full text Add to dashboard Cite

Abstract:The diagnosis of renal cell carcinoma is accompanied by intravascular tumor thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and tumor thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered.

show abstract

“…Der Nutzen neoadjuvanter Therapien mit zielgerichteten Substanzen ist gegenwärtig nicht gesichert [59][60][61][62]. Bei lokal fortgeschrittenem, nicht resektablem Tumor kann eine induktive präoperative Therapie mit einer zielgerichteten Substanz erwogen werden -mit dem Ziel, die Resektabilität zu verbessern.…”

Section: Präoperative (Neoadjuvante) Therapieunclassified

Interdisziplinäre Empfehlungen zur Behandlung des metastasierten Nierenzellkarzinoms

et al. 2017

View full text Add to dashboard Cite

Thanks to the use of targeted therapies, the prognosis of patients with metastatic renal cell carcinoma (mRCC) has improved significantly. A median overall survival of more than 2 years is a realistic claim. These improvements are also reflected in recent discussions about 3 and more lines of therapy.Sunitinib, pazopanib, the combination of bevacizumab and interferon alpha, and temsirolimus are approved for first-line therapy of mRCC. Sunitinib and pazopanib are also approved for second-line therapy, which, for pazopanib, is confined to the use after cytokine failure. Everolimus (after tyrosine kinase inhibitor (TKI) treatment), sorafenib (after cytokines) and axitinib (after treatment with sunitinib or cytokines) are other compounds available for second-line therapy.3 new substances have recently been approved for second-line therapy: Nivolumab, cabozantinib, and lenvatinib combined with everolimus can be used after VEGF-targeted treatment has failed. It is for the first time that targeted immunotherapy and a combination of targeted substances are available for the treatment of mRCC.There is no new insight as to an optimal sequence therapy. Study results from a phase III trial suggest that the sequences sorafenib-sunitinib and sunitinib-sorafenib are equally effective.The purpose of an interdisciplinary expert meeting on RCC was to work out joint treatment recommendations based on current data and clinical experience and to integrate them into clinical routine practice. The results are presented in this publication.

show abstract

Efficacy of Pre-surgical Axitinib for Shrinkage of Inferior Vena Cava Thrombus in a Patient with Advanced Renal Cell Carcinoma

Cited by 21 publications

References 10 publications

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma

Interdisziplinäre Empfehlungen zur Behandlung des metastasierten Nierenzellkarzinoms

Contact Info

Product

Resources

About