Neoadjuvant targeted therapy and advanced kidney cancer: Observations and implications for a new treatment paradigm

Brian Shuch, Stephen B. Riggs, Jeff C. LaRochelle, Fairooz F. Kabbinavar, Raffi Avakian, Allan J. Pantuck, Jean Jacques Patard, Arie S. Belldegrun

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate our early experience with neoadjuvant therapy (sunitinib or sorafenib) in advanced renal cell carcinoma (RCC), to explore the effect on both tumour biology and potential for downstaging advanced tumours, as systemic therapy for RCC has historically resulted in little if any primary tumour response, but recent experience with targeted therapy suggests otherwise. PATIENTS AND METHODS: The preliminary experience with neoadjuvant therapy for the surgical management of RCC was reviewed at two large referral centres. Several unique patients were identified who had a novel response to systemic therapy that altered the surgical strategy. RESULTS: Four patients who had targeted therapy before surgery are described and in whom there were effects on tumour biology not seen previously with chemotherapy and cytokine therapy. The selected patients who had neoadjuvant targeted therapy had shrinkage of a tumour thrombus in the inferior vena cava, nodal involvement, renal fossa recurrence and tumour within a solitary kidney. CONCLUSIONS: The introduction of new molecular agents has revolutionized the treatment of patients with metastatic RCC. Responses to targeted therapy within the primary tumour, tumour thrombus, renal fossa recurrence, and lymph node metastases are novel findings not seen during treatment with immunotherapeutic-based strategies. This might be a signal for urological surgeons to re-evaluate the paradigm for the surgical management of advanced RCC. Potential applications are presented to encourage further investigations with targeted therapy in the neoadjuvant setting.

Original languageEnglish (US)
Pages (from-to)692-696
Number of pages5
JournalBJU International
Volume102
Issue number6
DOIs
StatePublished - Sep 2008
Externally publishedYes

Fingerprint

Neoadjuvant Therapy
Kidney Neoplasms
Renal Cell Carcinoma
Neoplasms
Therapeutics
Kidney
Thrombosis
Recurrence
Inferior Vena Cava
Referral and Consultation
Lymph Nodes
Cytokines
Neoplasm Metastasis
Drug Therapy

Keywords

  • Kidney cancer
  • Locally advanced
  • Neoadjuvant
  • RCC
  • Sunitinib
  • Tyrosine kinase inhibitors

ASJC Scopus subject areas

  • Urology

Cite this

Shuch, B., Riggs, S. B., LaRochelle, J. C., Kabbinavar, F. F., Avakian, R., Pantuck, A. J., ... Belldegrun, A. S. (2008). Neoadjuvant targeted therapy and advanced kidney cancer: Observations and implications for a new treatment paradigm. BJU International, 102(6), 692-696. https://doi.org/10.1111/j.1464-410X.2008.07660.x

Neoadjuvant targeted therapy and advanced kidney cancer : Observations and implications for a new treatment paradigm. / Shuch, Brian; Riggs, Stephen B.; LaRochelle, Jeff C.; Kabbinavar, Fairooz F.; Avakian, Raffi; Pantuck, Allan J.; Patard, Jean Jacques; Belldegrun, Arie S.

In: BJU International, Vol. 102, No. 6, 09.2008, p. 692-696.

Research output: Contribution to journalArticle

Shuch, B, Riggs, SB, LaRochelle, JC, Kabbinavar, FF, Avakian, R, Pantuck, AJ, Patard, JJ & Belldegrun, AS 2008, 'Neoadjuvant targeted therapy and advanced kidney cancer: Observations and implications for a new treatment paradigm', BJU International, vol. 102, no. 6, pp. 692-696. https://doi.org/10.1111/j.1464-410X.2008.07660.x
Shuch, Brian ; Riggs, Stephen B. ; LaRochelle, Jeff C. ; Kabbinavar, Fairooz F. ; Avakian, Raffi ; Pantuck, Allan J. ; Patard, Jean Jacques ; Belldegrun, Arie S. / Neoadjuvant targeted therapy and advanced kidney cancer : Observations and implications for a new treatment paradigm. In: BJU International. 2008 ; Vol. 102, No. 6. pp. 692-696.
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