1) Introduction
Venous tumor thrombosis (VTE) extension occurs in 4-15% of cases of renal cell carcinoma (RCC). The Mayo Clinic classification distinguishes between four levels of VTE extension between the renal vein and the supradiaphragmatic inferior vena cava (IVC). Although surgery is performed with curative intent, mortality is high (5-15%) and complications may increase according to the level of VTE. Sometimes the extension of the tumor thrombus may pose a surgical risk. A phase II study (NAXIVA) has demonstrated that it exists a significat reduction of the extension of the tumor thrombus with neoadjuvant treatment with axitinib.
2) Objectives
According to the recent results of the NAXIVA study, we would like to present our more recent results using axitinib as neoadyuvant treatment.
3) Methods
We present our series of four patients who presented renal tumors with a large cava thrombus, which was unresectable. Neoadjuvant treatment with axitinib was performed.
4) Results
Four patients with supradiaphragmatic tumor thrombus have been treated with neoadjuvant axitinib. Mean patient age was 65 years +/- 2 years. Three patients had neoadjuvant treatment for 6 months and the fourth patient for 3 months. In all four cases the tumor extension descended below the suprahepatics veins prior to surgery. The toxicities presented by 50% were grade I hypertension, 25% presented grade II hypothyroidism requiring treatment with levothyroxine, 25% presented grade II thrombocytosis and grade III hepatotoxicity which required temporary suspension of treatment. The pathological anatomy was clear cell carcinoma ISUP3 in 3 of the patients and a papillary carcinoma grade I pT3b in the remaining one. Unfortunately all of the patients have presented a metastatic recurrence and they are currently under treatment.
5) Conclusions
In patients with unresectable venous tumor thrombus, neoadjuvant axitinib may allow safer surgery and decrease the number of complications.
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