The Effect of Sunitinib on Primary Renal Cell Carcinoma and Facilitation of Subsequent Surgery

Rini, Brian I.; García, Jorge A.; Elson, Paul; Wood, Laura S.; Shah, Shetal N.; Stephenson, Andrew J.; Salem, Mohammed; Gong, Michael C.; Fergany, Amr; Rabets, John; Kaouk, Jihad; Krishnamurthi, Venkatesh; Klein, Eric A.; Dreicer, Robert; Campbell, Steven C.

doi:10.1016/j.juro.2011.12.075

Cited by 78 publications

(51 citation statements)

References 17 publications

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“…However, the median long-axis diameter of the embolus and tumor were only significantly shorter in sunitinib-treated patients compared with sorafenib-treated patients. Pre-surgical downsizing of the tumor embolus may potentially have a clinically significant impact on surgical treatment (12). This effect was observed in the present study, during which, the level of the tumor thrombus was decreased following sunitinib treatment, including two cases that were downgraded from tumor thrombus level IV to II, one case from level IV to III and two cases from level III to II.…”

Section: Discussionsupporting

confidence: 65%

“…Currently, no established protocol for neoadjuvant targeted therapy exists, and the duration of targeted therapy may range from 23 to 262 days (12). This discrepancy may be attributed to variations in the responses of primary RCC and metastatic foci to this type of therapy (23).…”

Section: Discussionmentioning

confidence: 99%

“…Targeted drugs may also affect wound healing; thus, surgery is typically performed several days or weeks following the discontinuation of therapy (12). Generally, the interval between therapy discontinuation and surgery is 2-3 half-lives of the targeted drug (sorafenib, 8-12 days; sunitinib, 12-18 days).…”

Section: Discussionmentioning

confidence: 99%

“…Bex et al (17) reported that the indications for neoadjuvant targeted molecular therapy include RCC with vena cava tumor embolus level III/IV and RCC at the tumor-node-metastasis system stage T1b or T2 as suitable for partial nephrectomy (bilateral RCC or solitary kidney) or as tentative therapy for advanced RCC prior to cytoreductive surgery (18,19). For patients with tumor embolus level III or lower, presurgical neoadjuvant targeted molecular therapy may be considered to reduce tumor size if the imaging examinations suggest that resection is impossible due to the tumor embolus being adhered to the vena cava wall (12). Preoperative evaluation of the disease condition is necessary in all cases, and the dysfunction of vital organs (heart, lung, brain and kidney) or the presence of coagulation disorders are major contraindications to surgical intervention (12).…”

Section: Discussionmentioning

confidence: 99%

“…Further studies applied neoadjuvant targeted molecular therapy successfully in patients with RCC and inferior vena cava tumor embolus (6)(7)(8)(9)(10)(11)(12). The results of these studies indicated that this therapy aids the reduction of tumor embolus size, decreases tumor embolus level and subsequently reduces surgical risk and difficulty (6)(7)(8)(9)(10)(11)(12). However, Cost et al (13) demonstrated that targeted molecular therapy had minimal clinical effects on RCC tumor thrombi.…”

Section: Introductionmentioning

confidence: 99%

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

Guo¹,

Cai²,

Li³

et al. 2017

Oncology Letters

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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.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Guo¹,

Cai²,

Li³

et al. 2017

Oncology Letters

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Immune Checkpoint Inhibitor Therapy Before Nephrectomy for Locally Advanced and Metastatic Renal Cell Carcinoma

Ghoreifi,

Vaishampayan,

Yin

et al. 2024

JAMA Oncol

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ImportanceThe therapeutic landscape of advanced renal cell carcinoma (RCC) has rapidly evolved in the past 2 decades, with the advent of cytokines therapy followed by targeted therapies and novel immune checkpoint inhibitors (ICI). This article aims to review the current evidence and ongoing trials of neoadjuvant or prenephrectomy ICI therapy in patients with locally advanced and metastatic RCC.ObservationsA literature search was performed using the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and PubMed as well as relevant medical society meetings for English-language studies, articles, and abstracts published before January 31, 2023. Currently, level I evidence supports the use of ICI-based combination therapy as the first-line treatment of patients with metastatic RCC with the potential option of deferred nephrectomy in those who respond to treatment. Nevertheless, limited prospective data are available regarding the role and outcomes of nephrectomy (cytoreductive or consolidative) in conjunction with ICI therapy in both metastatic and locally advanced RCC. Although data from retrospective case series confirmed the feasibility and safety of deferred nephrectomy in this setting, the sequence of nephrectomy and whether it should be considered in patients with metastatic RCC is a common clinical dilemma. However, although neoadjuvant targeted therapy for nonmetastatic RCCs has been associated with some advantages yet not accepted as a standard, current data from a phase 3 randomized clinical trial failed to demonstrate the oncologic benefit of neoadjuvant nivolumab for locally advanced RCC.Conclusion and RelevanceThe findings of this review suggest that ICI-based combination therapy is the standard of care as the first-line treatment of patients with metastatic RCC. However, the role of neoadjuvant ICIs in locally advanced RCC is an active area of investigation. Deferred nephrectomy after ICI-based immunotherapy for metastatic RCC is feasible and safe yet should be performed in high-volume health centers by experienced surgeons. The multidisciplinary and careful approach is critical for treatment decisions.

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Renal Cell Carcinoma

Mathias

Rini²

2018

The American Cancer Society's Oncology in Practice

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The Effect of Sunitinib on Primary Renal Cell Carcinoma and Facilitation of Subsequent Surgery

Cited by 78 publications

References 17 publications

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

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

Immune Checkpoint Inhibitor Therapy Before Nephrectomy for Locally Advanced and Metastatic Renal Cell Carcinoma

Renal Cell Carcinoma

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