Moinard-Butot Fabien, Thouvenin Jonathan, Bigot Pierre, Martinez-Chanza Nieves, Gaillard Victor, Cazzato Roberto Luigi, Boissier Romain, Margue Gaëlle, Boudier Philippe, Maillet Denis, Gross-Goupil Marine, Bernhard Jean-Christophe, Barthélémy Philippe
Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France.
Medical Oncology Department, Hospices Civils de Lyon, Pierre-Bénite, France.
World J Urol. 2025 Jan 10;43(1):66. doi: 10.1007/s00345-024-05428-w.
Surgery remains the cornerstone of localized renal cell carcinoma (RCC) care. Pembrolizumab has recently been recommended as a standard of care for RCC patients who are at high risk of recurrence. Data regarding the efficacy of ICIs either alone or in combination with ICIs or VEGF TKIs for VTT shrinkage are scarce.
In the framework of the French kidney cancer research network UroCCR (NCT03293563), we performed a retrospective multicentric European study to evaluate VTT shrinkage in patients treated with ICIs with metastatic or locally advanced renal cell carcinoma (RCC). The primary endpoint was the objective response rate (ORR) of patients with VTT to ICI-based therapy. Radiological assessment was performed by a treating physician according to the RECISTv1.1 criteria.
We included 44 patients. The median age was 69 years (range 37-88). All patients was intermediate or poor IMDC risk group. Twenty-three patients were treated with anti-PD-1 in combination with anti-CTLA-4 therapy, 13 patients with ICI monotherapy, and 8 patients with ICIs in combination with antiangiogenic TKI. At baseline, the median VTT diameter was 22 mm (range 7-93). After a median duration of treatment of 5.8 months (range 1.8-39.1), the ORR was 38% (n = 17), including 4 complete responses (CRs) and 13 partial responses (PRs). Ten patients had stable disease (SD), and 17 had progressive disease (PD) as the best response of the VTT.
These data highlight the potential efficacy of ICIs to shrink the VTT even if they seem to have little impact on the extent of VTT.
手术仍然是局限性肾细胞癌（RCC）治疗的基石。帕博利珠单抗最近被推荐作为复发高风险RCC患者的标准治疗方法。关于免疫检查点抑制剂（ICI）单独使用或与ICI或血管内皮生长因子酪氨酸激酶抑制剂（VEGF TKI）联合使用对静脉瘤栓（VTT）缩小疗效的数据很少。
在法国肾癌研究网络UroCCR（NCT03293563）的框架内，我们进行了一项回顾性多中心欧洲研究，以评估接受ICI治疗的转移性或局部晚期肾细胞癌（RCC）患者的VTT缩小情况。主要终点是VTT患者接受基于ICI治疗的客观缓解率（ORR）。放射学评估由主治医生根据RECISTv1.1标准进行。
我们纳入了44例患者。中位年龄为69岁（范围37 - 88岁）。所有患者均为中危或低危IMDC风险组。23例患者接受抗PD - 1联合抗CTLA - 4治疗，13例患者接受ICI单药治疗，8例患者接受ICI联合抗血管生成TKI治疗。基线时，VTT中位直径为22毫米（范围7 - 93毫米）。中位治疗持续时间为5.8个月（范围1.8 - 39.1个月）后，ORR为38%（n = 17），包括4例完全缓解（CR）和13例部分缓解（PR）。10例患者病情稳定（SD），17例患者病情进展（PD）为VTT的最佳反应。
这些数据突出了ICI缩小VTT的潜在疗效，即使它们似乎对VTT的范围影响很小。
