Sorafenib Neoadjuvant Therapy in the Treatment of High Risk Renal Cell Carcinoma

Abstract

ObjectiveTo evaluate the clinical efficacy of sorafenib as preoperative neoadjuvant therapy in patients with high risk renal cell carcinoma (RCC).Materials and MethodsClinical data of 18 patients with high risk RCC who received surgery done successfully after preoperative neoadjuvant therapy with sorafenib in Peking Union Medical College Hospital (PUMCH) from April 2007 to October 2013 have been reviewed and analyzed in this study.ResultsAmong the 18 patients there were 13 male and 5 female, with a median age of 54.6 years. The objective response rate (ORR) of the operation on the selected patients is very high (94.4%), including 4 cases (22.2%) of partial response (PR) and 13 cases (72.2%) of stable disease (SD). After preoperative sorafenib treatment, the average tumor size of the 18 patients decreased from 7.8 cm (ranging from 3.6 to 19.2 cm) to 6.2 cm (ranging from 2.4 to 16.8 cm), and the median value of average tumor CT value decreased from 61HU to 52 HU. Among the 5 patients who had IVC tumor thrombi, the grades of tumor thrombi in 2 patients who were grade II before sorafenib treatment became grade I and grade 0 respectively, 2 patients of grade III both became grade II.ConclusionPreoperative neoadjuvant therapy with sorafenib for high risk RCC patients can significantly decrease primary tumor volume as well as tumor thrombus, which could help the nephron-sparing surgery (NSS) or radical nephrectomy to be done successfully.

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“…Tumour shrinkage was similar to that of other targeted therapies with which the median reduction of tumour diameter ranged from 8% to 28%, compared with 17% in the present study. The rate of achievement of PN (89%) was higher than in other publications [17][18][19][20][21][22].…”

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“…Furthermore, four of five patients with IVC thrombi had a clinical downstaging. Toxicities were grade ≤3, and there were no findings of delayed wound healing . Field et al .…”

“…Toxicities were grade ≤3, and there were no findings of delayed wound healing. 55 Field et al carried out a multicenter retrospective analysis of 53 patients with IVC thrombus (18 with metastatic disease), comparing 19 patients who received neoadjuvant sunitinib with 34 patients who did not. Recipients of neoadjuvant therapy had a 16.1% median primary tumor diameter decrease (8.1-6.8 cm) and median thrombus size decrease of 1.3 cm in 10 of 19 (52.6%) patients, with a decrease in thrombus level occurring in eight of 19 (42.1%) and PR in five of 19 (26.3%) by RECIST.…”

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“…Bezüglich der Senkung des perioperativen Risikos solcher Patienten durch die neoadjuvante Therapie mittels Sorafenib gibt es bereits positive Daten [[4]].…”