Determination of optimal term of conduction of neoadjuvant targeted therapy in patients with localized reno-cellular carcinoma
Objective. To determine an optimal term of the neoadjuvant targeted therapy (NATTH) conduction in treatment of patients, suffering localized reno-cellular carcinoma (LRCC).
Маterials and methods. Into the randomized prospective investigation 24 patients, suffering clear-celled LRCC (Т1а-2bN0M0), who were divided into two Groups, were included: the 1-st Group - 12 patients, to whom two blocks of NATTH (peroral pazopanib 800 mg daily during 28 days) were conducted; and the 2-nd Group - 12 patients, to whom four blocks of NATTH were conducted.
Results. Stabilization of the process (in accordance to RECIST 1.1 scale) was registered in 9 (75%) patients of the 1-st Group and in 8 (67%) - of the 2-nd Group, while a partial answer - in 3 (25%) and 4 (33%) patients, accordingly (χ2= 0.2; р = 0.65). The medians of tumoral regression in the 1-st and 2-nd Groups were comparable: 18 [2; 27] and 17 [2; 34]%, accordingly. Statistical difference between the adverse effects rate in accordance to the CTC AE scale Degrees 1 - 4, performance of nephrectomy, іntra- and postoperative complications and duration of the hospital stay in the Groups compared was absent (р > 0.05).
Conclusion. An optimal term for the NATTH conduction in patients, suffering LRCC, is application of two blocks. More durable NATTH leads to enhancement of cost of the treatment without further regress of LRCC, what do not impact the choice of the surgical treatment tactics.
2. Silberstein JL, Millard F, Mehrazin R, Kopp R, Bazzi W, DiBlasio CJ, et al. Feasibility and efficacy of neoadjuvant sunitinib before nephron- sparing surgery. BJU Int 2010 Nov;106(9):1270-6. doi: 10.1111/j.1464-410X.2010.09357.x.
3. Rini BI, Plimack ER, Takagi T, Elson P, Wood LS, Dreicer R, et al. A phase II study of pazopanib in patients with localized renal cell carcinoma to optimize preservation of renal parenchyma. J Urol. 2015Aug;194(2):297-303. doi: 10.1016/j.juro.2015.03.096.
4. Lane BR, Derweesh IH, Kim HL, O'Malley R, Klink J, Ercole CE, et al. Presurgical sunitinib reduces tumor size and may facilitate partial nephrectomy in patients with renal cell carcinoma. Urol Oncol. 2015 Mar;33(3):112.e15-21. doi: 10.1016/j.urolonc.2014.11.009.
5. Smith DH, Thorp ML, Gurwitz JH, McManus DD, Goldberg RJ, Allen LA, et al. Chronic Kidney Disease and Outcomes in Heart Failure With Preserved Versus Reduced Ejection Fraction. Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):333-42. doi: 10.1161/CIRCOUTCOMES.113.000221. Epub 2013 May 17.
6. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031.
7. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006 Sep;7(9):735-40. doi: 10.1016/S1470-2045(06)70803-8.
8. Stakhovskiy EO, Voylenko OA, Vitruk YV, Stakhovskiy OE. Application of nephrometry for choice of the treatment tactics in patients, suffering nephrocellular cancer Klin Khir. 2015 Mar;(3):55-60. [in Ukrainian].
9. Tang T, Jiang H, YuY, He F, Ji SZ, Liu YY, et al. A new method of wound treatment: targeted therapy of skin wounds with reactive oxygen species-responsive nanoparticles containing SDF-1α. Int J Nanomedicine. 2015 Oct 19;10:6571-85. doi: 10.2147/IJN.S88384.
10. Sun M, Lughezzani G, Perrotte P, Karakiewicz PI. Treatment of metastatic renal cell carcinoma. Nat Rev Urol. 2010 Jun;7(6):327-38. doi: 10.1038/nrurol.2010.57.
11. Bindayi A, Hamilton ZA, McDonald ML, Yim K, Millard F, McKay RR, et al. Neoadjuvant therapy for localized and locally advanced renal cell carcinoma. Urol Oncol. 2018 Jan;36(1):31-37. doi: 10.1016/j.urolonc.2017.07.015.
12. Porta C, Paglino C, Grünwald V. Sunitinib re-challenge in advanced renal-cell carcinoma. Br J Cancer. 2014 Sep 9;111(6):1047-53. doi: 10.1038/bjc.2014.214.
13. Powles T, Kayani I, Blank C, Chowdhury S, Horenblas S, Peters J, et al. The safety and efficacy of sunitinib before planned nephrectomy in metastatic clear cell renal cancer. Ann Oncol. 2011 May;22(5):1041-7. doi: 10.1093/annonc/mdq564.
14. Jonasch E, Wood CG, Matin SF, Tu SM, Pagliaro LC, Corn PG, et al. Phase II presurgical feasibility study of bevacizumab in untreated patients with metastatic renal cell carcinoma. J Clin Oncol. 2009 Sep 1;27(25):4076-81. doi: 10.1200/JCO.2008.21.3660.
This work is licensed under a Creative Commons Attribution 4.0 International License.