Key result
Presurgical nivolumab plus cabozantinib yields complete pathological response in an RCC patient with IVC thrombus.
Why the study?
The efficacy of presurgical combination therapy of immune checkpoint inhibitors and tyrosine kinase inhibitors for advanced renal cell carcinoma with inferior vena cava thrombus remains unclear.
Does presurgical nivolumab plus cabozantinib therapy reduce tumor and thrombus burden in a patient with locally advanced RCC with IVC thrombus?
Case Report (n=1)
Does presurgical nivolumab plus cabozantinib therapy reduce tumor and thrombus burden in a patient with locally advanced RCC with IVC thrombus?
Presurgical nivolumab plus cabozantinib may enable safe nephrectomy and lead to pathological complete response in patients with renal cell carcinoma and IVC thrombus.
May support neoadjuvant use in select RCC with IVC thrombus; leaves open efficacy and safety pending prospective trials.
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. CASE REPORT: 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. CONCLUSION: 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.
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Machida et al. (2022) conducted a case report in renal cell carcinoma with inferior vena cava thrombus (n=1). nivolumab plus cabozantinib was evaluated on pathological complete response. Presurgical nivolumab plus cabozantinib therapy led to a pathological complete response and enabled less invasive nephrectomy in a patient with RCC and IVC thrombus.
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