Pathological complete response of renal cell carcinoma with vena cava tumor thrombus to neoadjuvant TKI/IO combination therapy

Abstract

A 79-year-old female was diagnosed with a right renal tumor with a level II tumor thrombus of the vena cava. presurgical therapy was initiated with a combination of avelumab and axitinib for 3 monthes. Then, she underwent nephrectomy and thrombectomy. Histologically, the primary tumor and tumor thrombus had no viable cells, indicating that pathological complete response was achieved with presurgical tyrosine kinase inhibitor/Immuno-oncology combination therapy. An immunohistological xamination showed very strong staining for tumor-infiltrating lymphocytes in the embolized area of the tumor, with CD8 predominating over CD4.

Neoadjuvant toripalimab combined with axitinib in patients with locally advanced clear cell renal cell carcinoma: a single-arm, phase II trial

“…In addition, a case regarding RCC with TT reported a pCR after a 3-month treatment of avelumab plus axitinib. 41 Overall, ICI-based combination therapy could induce pCR as compared with TKI alone, which may also lead to better survival.…”

Characterizing Tumor Thrombus Arising from Non–Clear Cell Renal Cell Carcinoma

“…With the advent of novel immune checkpoint inhibitors, we are witnessing unparalleled rates of complete pathologic response in the primary tumors of patients undergoing nephrectomy following receipt of systemic immunotherapy, ranging from 10% to 20% [24] , [25] , [26] . Some groups have reported cases of complete pathologic response in the tumor thrombus itself [27] , [28] , [29] . These impressive responses are, however, largely reported in ccRCC and remarkably extend to patients with sarcomatoid features as well [30] , [31] .…”

Pathological Complete Response to Pembrolizumab plus Axitinib Combination following Serious Immune-Related Adverse Events in an Advanced Renal Cell Carcinoma Patient with a History of Rheumatoid Arthritis

“…diagnosis of objective and complete responses is usually based on imaging, and, without pathological examination of tissue from prospective clinical trials, the rate of pCR is unknown. To our knowledge, only few cases of pCR on specimens from resected RCC after ICI-based combinations are described in the literature [16][17][18][19][20][21][22][23][24][25][26] (Table 1). However, since surgical resection of residual disease is rarely performed, the true rate of pCR to ICI-based treatments may be underestimated.…”