Progression of a caval vein thrombus in two patients with primary renal cell carcinoma on pretreatment with sunitinib.
Acta oncologica (Stockholm, Sweden) (Impact Factor: 2.27). 05/2010; 49(4):520-3. DOI: 10.3109/02841860903521111
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ABSTRACT: INTRODUCTION: In the era of targeted therapy, management of patients with primary metastatic renal cell carcinoma and the tumour in place is again under investigation in randomized controlled trials. Proper patient selection for cytoreductive nephrectomy (CN) remains challenging. Presurgical targeted therapy may have potential advantages in this setting. MATERIALS AND METHODS: Data on CN and presurgical targeted therapy were reviewed in the literature. RESULTS: Despite validated prognostic scores, outcome after CN is additionally influenced by factors impacting on surgical morbidity and mortality. Patient age, comorbidity, tumour size and extent, metastatic load, surgical approach and skills are not well represented by current prognostic models.The strongest predictor of poor survival following CN is progression within 90 days of surgery. A period of presurgical targeted therapy may identify those patients with rapid disease progression prior to a planned nephrectomy or metastasectomy from which they may not benefit. In nonrandomized prospective studies of presurgical therapy, up to 26 % of patients progressed at metastatic sites prior to planned surgery. Those with intermediate risk and absence of progression had a more than 70 % probability to survive 2 years or longer after CN. CONCLUSION: In the absence of biomarkers, presurgical therapy may contribute to individualizing treatment decisions. The advantages and disadvantages of this concept are investigated in a randomized EORTC trial of upfront CN versus CN after presurgical sunitinib in the absence of progression.World Journal of Urology 02/2013; · 2.89 Impact Factor
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ABSTRACT: Background Previous studies have shown a modest impact of tyrosine kinase inhibitors on primary renal tumors. Those studies were mostly retrospective and heterogeneous in their eligibility criteria with regard to histology, disease stage, duration of therapy, and time off therapy prior to surgery. Objective To prospectively investigate the safety and efficacy of axitinib in downsizing tumors in patients with nonmetastatic biopsy-proven clear cell renal cell carcinoma (ccRCC). Design, setting, and participants This was a single-institution, single-arm phase 2 clinical trial. Patients with locally advanced nonmetastatic biopsy-proven ccRCC were eligible. Intervention Patients received axitinib 5 mg for up to 12 wk. Axitinib was continued until 36 h prior to surgery. Patient underwent partial or radical nephrectomy after axitinib therapy. Outcome measurements and statistical analysis The primary outcome was objective response rate prior to surgery. Secondary outcomes included safety, tolerability, and quality of life. A dedicated radiologist independently reviewed all computed tomography scans to evaluate for response using Response Evaluation Criteria in Solid Tumors (RECIST). Results and limitations A total of 24 patients were treated. Twenty-two patients continued axitinib for 12 wk; 1 patient continued axitinib for 11 wk and underwent surgery as planned. One patient stopped treatment at 7 wk due to adverse events (AEs). Median reduction of primary renal tumor diameter was 28.3%. Eleven patients experienced a partial response per RECIST; 13 had stable disease. There was no progression of disease while on axitinib. The most common AEs were hypertension, fatigue, oral mucositis, hypothyroidism, and hand-foot syndrome. Postoperatively, 2 grade 3 and 13 grade 2 complications were noted. No grade 4 or 5 complications occurred. Functional Assessment of Cancer Therapy-Kidney Specific Index-15 changed over time, with quality of life worsening while on therapy, but by week 19, it was not statistically different from screening. Limitations include single-arm design and small patient numbers. Conclusions Axitinib was clinically active and reasonably well tolerated in the neoadjuvant setting in patients with locally advanced nonmetastatic ccRCC. Patient summary In this prospective clinical trial, we found that axitinib, when given prior to surgery, results in significant shrinking of kidney cancers. Larger studies are needed prior to further clinical use. Trial registration This clinical trial was registered with clinicaltrials.gov (NCT01263769).European Urology 01/2014; · 10.48 Impact Factor
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ABSTRACT: Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients. From February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein (n = 42) and IVC (n = 43) were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not. RCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients (87%). Sixty-five patients (76%) received surgical management (radical nephrectomy with thrombectomy). Distant metastasis was identified in 45 patients (53%). The proportion of patients with tumor thrombus level 0 (renal vein only), I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not. Surgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.BMC Urology 10/2013; 13(1):47. · 1.69 Impact Factor
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