Machida Arisa, Ikarashi Daiki, Yanagawa Naoki, Suzuki Masamichi, Kawamura Tatsuya, Sekiguchi Kie, Takahashi Kenta, Kato Renpei, Matsura Tomohiko, Maekawa Shigekatsu, Kanehira Mitsugu, Takata Ryo, Sugai Tamotsu, Obara Wataru
Department of Urology, School of Medicine, Iwate Medical University, Iwate, Japan.
Department of Pathology, School of Medicine, Iwate Medical University, Iwate, Japan.
Cancer Diagn Progn. 2023 Jan 3;3(1):124-129. doi: 10.21873/cdp.10189. eCollection 2023 Jan-Feb.
BACKGROUND/AIM: Surgical treatment of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is associated with high morbidity and mortality rates, therefore presurgical systemic therapies are required in order to improve the safety and feasibility of the surgical procedure by decreasing the thrombus level and burden. The efficacy of presurgical combination therapy of immune checkpoint inhibitors (ICI) and tyrosine kinase inhibitors (TKI) for advanced renal cell carcinoma with IVC thrombus remains unclear.
We report a case of a 69-year-old male with cT3bN0M0 locally advanced RCC. We successfully performed a less invasive nephrectomy with thrombectomy, because nivolumab plus cabozantinib administration remarkably reduced the primary tumor and IVC thrombus, resulting in complete pathological response, as assessed with perioperative immunohistochemistry.
To the best of our knowledge, this is the first report showing that nephrectomy could be safely performed for RCC with IVC thrombus after presurgical nivolumab plus cabozantinib therapy, leading to pathological complete response.
背景/目的：肾细胞癌（RCC）伴下腔静脉（IVC）血栓的手术治疗与高发病率和死亡率相关，因此需要术前全身治疗，以通过降低血栓水平和负荷来提高手术的安全性和可行性。免疫检查点抑制剂（ICI）和酪氨酸激酶抑制剂（TKI）的术前联合治疗对伴IVC血栓的晚期肾细胞癌的疗效仍不明确。
我们报告一例69岁男性cT3bN0M0局部晚期肾细胞癌患者。我们成功实施了微创肾切除术并取出血栓，因为纳武单抗联合卡博替尼治疗显著缩小了原发肿瘤和IVC血栓，通过围手术期免疫组化评估显示为完全病理缓解。
据我们所知，这是首例报告显示术前纳武单抗联合卡博替尼治疗后，可安全地对伴IVC血栓的肾细胞癌实施肾切除术，并实现病理完全缓解。
