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

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.

Keywords: neoadjuvant therapy; renal cell carcinoma; targeted therapy; tumor embolus.

Figure 1.

Computed tomography scan prior to neoadjuvant therapy revealed a space-occupying mass in the right kidney with inferior vena cava tumor embolus (red arrow). The scan was from a 53-year-old male patient who was diagnosed with right renal carcinoma with vena cava tumor embolus (level III). The Eastern Cooperative Oncology Group score was 0 and the Karnofsky Performance Status score was 90.

Figure 2.

At 4 weeks after targeted therapy, computed tomography revealed that the size of the vena cava tumor embolus (red arrow) and the signals in the vena cava were reduced. The scan was from a 53-year-old male patient who was diagnosed with right renal carcinoma with vena cava tumor embolus (level III). The Eastern Cooperative Oncology Group score was 0 and the Karnofsky Performance Status score was 90.

Figure 3.

At 8 weeks after targeted therapy, computed tomography revealed that the size of vena cava tumor embolus (red arrow) was further reduced. The signals in the vena cava were also reduced. The scan was from a 53-year-old male patient who was diagnosed with right renal carcinoma with vena cava tumor embolus (level III). The Eastern Cooperative Oncology Group score was 0 and the Karnofsky Performance Status score was 90.

Figure 4.

Post-targeted therapy kidney pathology exhibiting atrophy of the capillary sinus in the renal parenchyma, and the nuclear condensation and degeneration of cancer cells. Staining, hematoxylin and eosin; magnification, ×200. The tissue was from a 53-year-old male patient who was diagnosed with right renal carcinoma with vena cava tumor embolus (level III). The Eastern Cooperative Oncology Group score was 0 and the Karnofsky Performance Status score was 90. The patient received a radical nephrectomy and vena cava tumor embolus removal surgery after 8 weeks sorafenib treatment.