Key result
Pembrolizumab plus lenvatinib before surgery achieves complete pathological response in a patient with IVC tumor thrombus.
Why the study?
Renal cell carcinoma with an inferior vena cava tumor thrombus is a challenging disease requiring multimodal treatment, and the efficacy of pembrolizumab plus lenvatinib in this context is of interest.
Does pembrolizumab plus lenvatinib therapy induce a pathological complete response in a patient with metastatic renal cell carcinoma and an inferior vena cava tumor thrombus?
Case Report (n=1)
Does pembrolizumab plus lenvatinib therapy induce a pathological complete response in a patient with metastatic renal cell carcinoma and an inferior vena cava tumor thrombus?
Pembrolizumab plus lenvatinib therapy may induce a pathological complete response in advanced renal cell carcinoma with an inferior vena cava thrombus, and cine MRI is useful for evaluating thrombus adhesion.
May support neoadjuvant use in select RCC with IVC thrombus; leaves open need for prospective trials before practice change.
Introduction: Renal cell carcinoma with an inferior vena cava tumor thrombus is a challenging disease that requires a multimodal treatment approach. Pembrolizumab plus lenvatinib has displayed promising efficacy in metastatic renal cell carcinoma. Case presentation: A 61-year-old man was diagnosed with metastatic renal cell carcinoma and a tumor thrombus adhering to the inferior vena cava wall by cine magnetic resonance imaging. After 6 months of pembrolizumab and lenvatinib therapy, tumor shrinkage was detected, excluding the advanced portion of the inferior vena cava thrombus, and nephrectomy and thrombectomy were performed. Adhesion of the tumor thrombus to the inferior vena cava wall was observed during surgery. Resection produced a remarkable pathological complete response with no viable cells in the resected specimens, including the thrombus site. Conclusion: This case highlights the potential of pembrolizumab plus lenvatinib for treating advanced renal cell carcinoma with an inferior vena cava thrombus and the utility of cine magnetic resonance imaging for evaluating thrombus adhesion to the inferior vena cava.
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Hara et al. (2023) conducted a case report in Metastatic renal cell carcinoma with an inferior vena cava tumor thrombus (n=1). Pembrolizumab plus lenvatinib was evaluated on Pathological complete response. Pembrolizumab plus lenvatinib therapy for 6 months followed by surgery resulted in a pathological complete response in a patient with metastatic renal cell carcinoma and an IVC tumor thrombus.
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