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Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

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Abstract

Objective

To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management.

Methods

We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick’s classification.

Results

Before TMT, thrombus level was staged I for 1 (7 %), II for 10 (72 %) and III (21 %) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1–5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43 %) patients had a measurable decrease, 6 (43 %) had no change, and 2 (14 %) had an increase in the thrombus. One patient (7 %) had a downstage of thrombus level, 12 (85 %) had stable thrombi, and 1 (7 %) had an upstage. Regarding primary tumor, 7 (50 %), 5 (36 %) and 2 (14 %) patients had a decrease, stabilization and an increase in tumor size, respectively.

Conclusion

Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.

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Conflict of interest

Authors declare that they have no competing interests.

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Authors and Affiliations

  1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France

    Pierre Bigot, Jean Christophe Bernhard, Hervé Baumert, Bernard Escudier, Nicolas Grenier, Jean-François Hétet, Jean-Alexandre Long, Philippe Paparel, Nathalie Rioux-Leclercq, Michel Soulié, Karim Bensalah & Jean-Jacques Patard

  2. Department of Urology, Angers University Hospital, Angers, France

    Pierre Bigot, Souhil Lebdai, Myriam Ammi & Abdel-Rahmène Azzouzi

  3. Department of Urology, Pontchaillou University Hospital, Rennes, France

    Tarek Fardoun & Karim Bensalah

  4. Department of Urology, Pellegrin University Hospital, Bordeaux, France

    Jean Christophe Bernhard & Samuel Lagabrielle

  5. Cochin Hospital, APHP, Paris Descartes University, Paris, France

    Evanguelos Xylinas

  6. Department of Urology, Limoges University Hospital, Limoges, France

    Julien Berger

  7. Department of Urology, La Pitié Salpetrière University Hospital, Paris, France

    Morgan Rouprêt

  8. Department of Urology, Toulouse University Hospital, Toulouse, France

    Jean-Baptiste Beauval & Michel Soulié

  9. Department of Urology, Saint Joseph Hospital, Paris, France

    Hervé Baumert

  10. Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France

    Bernard Escudier

  11. Department of Radiology, Pellegrin University Hospital, Bordeaux, France

    Nicolas Grenier

  12. Department of Urology, Clinique Jules Verne, Nantes, France

    Jean-François Hétet

  13. Department of Urology, Grenoble University Hospital, Grenoble, France

    Jean-Alexandre Long

  14. Department of Urology, Lyon Sud University Hospital, Lyon, France

    Philippe Paparel

  15. Department of Pathology, Pontchaillou University Hospital, Rennes, France

    Nathalie Rioux-Leclercq

  16. Department of Urology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France

    Jean-Jacques Patard

Authors
  1. Pierre Bigot
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  2. Tarek Fardoun
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  3. Jean Christophe Bernhard
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  4. Evanguelos Xylinas
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  5. Julien Berger
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  6. Morgan Rouprêt
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  7. Jean-Baptiste Beauval
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  8. Samuel Lagabrielle
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  9. Souhil Lebdai
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  10. Myriam Ammi
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  11. Hervé Baumert
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  12. Bernard Escudier
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  13. Nicolas Grenier
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  14. Jean-François Hétet
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  15. Jean-Alexandre Long
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  16. Philippe Paparel
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  17. Nathalie Rioux-Leclercq
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  18. Michel Soulié
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  19. Abdel-Rahmène Azzouzi
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  20. Karim Bensalah
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  21. Jean-Jacques Patard
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Correspondence to Pierre Bigot.

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Bigot, P., Fardoun, T., Bernhard, J.C. et al. Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?. World J Urol 32, 109–114 (2014). https://doi.org/10.1007/s00345-013-1088-1

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  • DOI: https://doi.org/10.1007/s00345-013-1088-1

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