Neoadjuvant targeted therapy as a new approach to the treatment of patients with localized renal cell carcinoma
Voylenko O.A., Stakhovsky O.E., Vitruk Yu.V., Kononenko O.A. , Pikul M.V. , Grechko B.O, Tymoshenko A.V., Shipko A.F., Stakhovskyi E.O.
Summary. The aim of the study was to evaluate efficacy of neoadjuvant targeted therapy (TT) in terms of increasing possibility of nephron-sparing surgery for localized renal cell carcinoma (RCC). Materials and methods. Results of prospective randomized study starting from 2015 and including 118 cases of localized RCC. TT group included 58 (49.2%) patients that were treated with 2 cycles of Pazopanib (800 mg) preoperatively with further investigation of its efficacy. Control group included 60 (50.8%) patients which underwent only surgery. The groups were comparable by age, sex, tumor size, body mass index, hemoglobin and creatinine levels, total GFR (p>0.05). All patient underwent complex clinical examination, that included evaluation of tumor regression according to RECITS 1.1 and remaining functional parenchyma volume according to NCIU-scoring system developed in the department. Results. The use of TT lead to average decrease in tumor size of 12.3 mm, from (M±SD (95% confidence interval)) 60.8±19.7 (55.7–66) to 48.5±16.4 (44.2–52.8) mm (t-test; р<0,001). Neoadjuvant TT prompted RCC regression in 50 (86.3%) cases, with average decrease up to 20.5±14.3 (16.8–24.3)%. In 8 (13.8%) patients tumor size didn’t change. There were no cases of progression during therapy. In 44 (75.9%) tumors regression level reached 30%, in other 14 (24.1%) — was over 30%, with maximum regression at 60%. There was found no dependence between tumor size and regression level (ANOVA, η2=0,01 with power at 0,1 (р=0.72)). The effects of TT prompted to proceed to partial nephrectomy in 53 cases (91.4%) over only 20 (33.3%) in only surgery group (x2=42,1; р<0.0001). Conclusion. The use of neoadjuvant TT in patients with localized RCC showed average tumor size regression of 20.5±14,3 (16.8–24.3)%, that enabled kidney preservation at tumor size 60.7±19.8 mm in 91.4% (x2=42.1; р<0.0001). Positive treatment strategy results suggest applicability of neoadjuvant TT use in localized RCC management.
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