Efficacy of newer-drugs of tyrosine kinase inhibitor in renal cell carcinoma with inferior vena cava tumor thrombus and the impact on robotic-surgery strategy
Objective To investigate the efficacy of newer-drugs of tyrosine kinase inhibitor(TKI)on renal cell carcinoma(RCC)with inferior vena cava(IVC)tumor thrombus,and the impact of presurgi-cal targeted molecular therapy(TMT)on surgical strategy.Methods From January 2019 to December 2021,11 cases(8 males and 3 females)of RCC with IVC tumor thrombus treated with newer TKI-drugs followed by robot-assisted surgery in the First Affiliated Hospital of Zhengzhou University were reviewed.Among the patients,9 cases involved the right kidney and 2 cases in the left,the median age was 55(35-69)years,and the median body mass index(BMI)was 22.6(18.6-29.2)kg/m2.IVC tumor thrombus levels according to the Mayo clinic classification before TMT were stage-Ⅱ in 3 cases,stage-Ⅲin 7 cases and stage-Ⅳ in 1 case.The oral method of Pazopannib was 800 mg/d or Axitinib 10 mg/d,28 days as one treatment cycle,and the changes of the IVC thrombus level were compared using color Doppler ultrasound,computed tomography(CT)or magnetic resonance imaging(MRI)every two cycles.The surgical method,operational and recovery process of tumor thrombectomy were recorded and analyzed.Results The presurgical TMT inclued Pazopannib in 10 cases and Axitinib in 1 case,down-staging of the IVC thrombus level occurred in 5(45％)cases.During a median 4(2-13)treatment cycles,grade 3 or higher adverse events were experienced in 2 cases.The length of tumor thrombus decreased in 7(64％)cases,remained stable in 3(27％)cases,enlarged in 1(9％)case,and the mean variation of tumor thrombus length was-14.3(-48.1-6.6)mm.Robot-assisted laparoscopic radical nephrectomy and IVC thrombectomy were completed in 11 cases,the surgical strategy was modified in 3 cases given down-staging from level Ⅲ to Ⅱ and 1 case from level Ⅳ to Ⅲ.The median follow-up was 8(6-32)months,and 2 ca-ses died of RCC metastases.Conclusion Newer TKI-drugs are effective in the treatment of RCC with IVC tumor thrombus,and presurgical TMT can shorten the tumor thrombus and reduce the operational difficulty in more than half of the cases.The surgical strategy may be modified in those down-staging patients,and patient security may be improved.
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