Mp10-12 the Efficacy and Safety of Neoadjuvant Immunotherapy Plus Tkis Therapy in Patients With Renal Cell Carcinoma and Inferior Vena Cava Thrombus and Its Impact on Robot-Assisted Surgical Outcomes

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP10)1 May 2024MP10-12 THE EFFICACY AND SAFETY OF NEOADJUVANT IMMUNOTHERAPY PLUS TKIS THERAPY IN PATIENTS WITH RENAL CELL CARCINOMA AND INFERIOR VENA CAVA THROMBUS AND ITS IMPACT ON ROBOT-ASSISTED SURGICAL OUTCOMES Yu Zhang, Min Lu, and LuLin Ma Yu ZhangYu Zhang , Min LuMin Lu , and LuLin MaLuLin Ma View All Author Informationhttps://doi.org/10.1097/01.JU.0001008588.39303.c9.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To provide insight into the efficacy and safety of neoadjuvant anti-PD-1 plus Axitinib therapy in patients with clear cell renal cell carcinoma (ccRCC) and inferior vena cava (IVC) thrombus and to report the surgical outcomes. METHODS: We conducted a prospective registration cohort study since October 2021 and eligible patients received 3 cycles of immunotherapy and 8 weeks of axitinib. We reported the overall response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Drug toxicity is assessed using the Common Terminology Criteria for Adverse Events (CTCAE) and complications using the Clavien-Dindo Classification system. In addition, we reported the robot-assisted surgical outcomes. RESULTS: Twenty-two patients received the neoadjuvant strategy followed by robotic surgery and 17 patients completed the whole cycle. Four patients interrupted neoadjuvant treatment due to elevated thyroid function and creatinine. The ORR of primary tumor and IVC thrombus was 50% and 41.7%, respectively. No radiographic degradation of IVC thrombus was found though the median length of thrombus reduction was 1.2 cm. The median reduction of primary tumor diameter and thrombus were 35.4% and 28.9%, respectively. The pathological complete response of primary tumor and IVC thrombus was 41.7% and 58.3%, respectively. The pathological partial response of primary tumor and IVC thrombus was 16.7% and 25%, respectively. The median operation time was 202 min and the median blood loss was 400 ml. Eight patients (36.4 %) received segmental resection of IVC thrombus due to extensive involvement of IVC wall and 4 patients (18.2%) had open conversion. CONCLUSIONS: Neoadjuvant anti-PD-1 plus TKIs therapy showed acceptable ORR and drug toxicity in clinical use and good response in pathological assessment. The discrepancy of neoadjuvant therapy efficacy between radiographic imaging and pathology in primary tumor and thrombus assessment should be further studied. Tissue edema and adhesion or IVC wall involvement due to neoadjuvant therapy may change the established surgical strategy. Download PPTDownload PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e143 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yu Zhang More articles by this author Min Lu More articles by this author LuLin Ma More articles by this author Expand All Advertisement PDF downloadLoading ...