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Case Reports
. 2025 Oct;136(4):613-616.
doi: 10.1111/bju.16472. Epub 2024 Jul 16.

'Case of the Month' from Addenbrooke's Hospital, Cambridge, UK: surgery after near complete response to combined immunotherapy and tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma with inferior vena cava tumour thrombus

James P Blackmur  1   2 , James N Armitage  1 , James O Jones  3   2 , Antony C P Riddick  1 , Thomas J Mitchell  1   2 , William H J Ince  3 , Sona Appukutty  4 , Anne Y Warren  4 , Kate Fife  3 , Brent O'Carrigan  3 , Grant D Stewart  1   2
Affiliations
Case Reports

'Case of the Month' from Addenbrooke's Hospital, Cambridge, UK: surgery after near complete response to combined immunotherapy and tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma with inferior vena cava tumour thrombus

James P Blackmur et al. BJU Int. 2025 Oct.
No abstract available

Keywords: Cytoreductive nephrectomy; IVC tumour thrombus; immunotherapy; kidney cancer; metastatic renal cell carcinoma.

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Figures

Fig. 1
Fig. 1
Coronal CT reconstructions at (A) baseline showing large right renal mass and supra‐diaphragmatic extension of tumour thrombus in the IVC (Mayo Level IV) and (B) at 15 months showing shrinkage of renal mass and tumour thrombus to below level of hepatic veins (Mayo Level II).
Fig. 2
Fig. 2
(A) Right renal tumour, with sloops on right renal vein (red), left renal vein (blue) and infrarenal IVC (white), (B) with clamps applied and with tumour thrombus elevated from cavotomy, and (C) right kidney, adrenal gland and tumour thrombus excised in continuity.
Fig. 3
Fig. 3
(A) Haematoxylin and eosin (H&E; ×5) tumour thrombus showing necrosis, fibrosis and microcalcification. (B) H&E (×10) section from kidney showing extensive fibrosis and small foci of residual ccRCC (marked by black arrow) and (C) same area showing ccRCC at high power (×40).
See this image and copyright information in PMC

References

    1. Jones JO, Ince W, Welsh S, Stewart GD. Activity of immunotherapy regimens on primary renal tumours: a systematic review. Kidney Cancer 2022; 6: 221–236
    1. Ljungberg B, Bex A, Albiges L et al. EAU Guidelines on Renal Cell Carcinoma. Edn pres Milan 2023. Arnhem: EAU Guidelines Office, 2024.
    1. Klatte T, Welsh SJ, Riddick ACP, Karam JA, Stewart GD. Tyrosine kinase inhibitor treatment for renal cell carcinoma with inferior vena cava tumour thrombus: a quantitative summary. BJU Int 2023; 131: 566–568 - PubMed
    1. Stewart GD, Welsh SJ, Ursprung S et al. A phase II study of neoadjuvant axitinib for reducing the extent of venous tumour thrombus in clear cell renal cell cancer with venous invasion (NAXIVA). Br J Cancer 2022; 127: 1051–1060 - PMC - PubMed
    1. Tanaka Y, Hatakeyama S, Hosogoe S et al. Presurgical axitinib therapy increases fibrotic reactions within tumor thrombus in renal cell carcinoma with thrombus extending to the inferior vena cava. Int J Clin Oncol 2018; 23: 134–141 - PubMed

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