Presurgical neoadjuvant targeted molecular therapy for kidney cancer with concomitant vena cava tumor embolus: A clinical study

Abstract

Abstract. The present study aimed to investigate presurgical neoadjuvant targeted therapy for patients with kidney cancer and vena cava tumor embolus, in order to examine its indications, therapeutic effects and optimal timing of surgery. Between June 2009 and June 2014, 12 patients from The People's Liberation Army General Hospital (Beijing, China) were diagnosed with kidney cancer with superior vena cava tumor embolus, and received presurgical neoadjuvant targeted therapy (sorafenib 400 mg twice a day or sunitinib 50 mg/day) for a median of 13.3 weeks. Patients included 8 males and 4 females, with a median age of 49.8 years.Kidney cancer was present on the left side in 3 patients and in the right side in 9 patients. The median tumor embolus length was 9.7 cm (range, 6.5-14.0 cm). Tumor embolus levels II, III and IV, classified by the Mayo Clinic standard, were observed in 2, 6 and 4 patients, respectively. Median treatment time and average targeted therapy discontinuation time were observed to be longer in sunitinib-treated patients compared with sorafenib-treated patients. In total, 2 patients in the present study had partial remission (PR) and 8 patients had stable disease (SD); for tumor embolus, 4 patients had PR and 8 patients had SD. Tumor embolus length decreased by a median value of 18.7% (range, 0.0-42.1%) or 1.8 cm (range, 0.1-5.2 cm). Tumor diameter decreased by a median value of 8.6% (range, 0.0-38.9%) or 0.7 cm (range, 0.0-3.5 cm). The level of the tumor thrombus, classified by the Mayo Clinic standard, was observed to decrease following sunitinib treatment, including two cases downgraded from tumor thrombus level IV to II, one case from level IV to III and two cases from level III to II. Presurgical neoadjuvant targeted molecular therapy may have the potential to reduce the tumor stage of patients, as well as decreasing the surgical difficulty for radical nephrectomy.

Molecular targeted therapy for advanced or metastatic soft tissue sarcoma

“…TKI was the most studied targeted agent for presurgical targeted therapy and applied in the treatment of renal cell carcinoma and breast cancer. [164][165][166][167][168] Favorable results were demonstrated by these case reports and retrospective studies, including tumor or thrombus shrinkage and lower recurrence rates, with deceased surgical difficulty.…”

“…TKI was the most studied targeted agent for presurgical targeted therapy and applied in the treatment of renal cell carcinoma and breast cancer. 164 - 168 Favorable results were demonstrated by these case reports and retrospective studies, including tumor or thrombus shrinkage and lower recurrence rates, with deceased surgical difficulty. Of note, in the aforementioned studies, presurgical targeted therapy was mostly utilized in the treatment of patients with advanced cancer, which was believed to be beneficial for both primary tumorectomy and metastasectomy.…”

Single position with 4-hole laparoscopic radical nephrectomy and tumor thrombectomy for left renal cell carcinoma: a case report and review of the literature

“…For patients with high-grade tumor thrombi, preoperative targeted drug therapy can make the tumor smaller and the TT's grade downgraded, thereby reducing the di culty of surgery. Guo [22] performed preoperative neoadjuvant targeted drug therapy in 12 patients with RCC complicated with vena cava TT. The tumor volume was reduced by an average of 18.7%, and the grade of TT decreased in 5 patients.…”

Neoadjuvant Multikinase Inhibitor in Patients With Locally Advanced Unresectable Thyroid Carcinoma

“…Neoadjuvant therapy refers to the administration of therapeutic agents before a primary treatment, usually surgery, aiming to reduce the size of the tumor (11). The use of MKI as neoadjuvant therapy is a well-established therapeutic tool for several human neoplasias (12–14). However, neoadjuvant treatment is an unusual event in the management of thyroid carcinoma.…”