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Authors Cost NG, Delacroix SE, Sleeper JP, Smith PJ, Youssef RF, Chapin BF, Karam JA, Culp SH, Abel EJ, Brugarolas J, Raj G, Sagalowsky AI, Wood CG, Margulis V
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Journal J. Clin. Oncol. Volume: 29 Issue: 15_suppl Pages: e15002
Publish Date 2011 May 20
PubMed ID 28020546
Abstract

e15002 Background: Targeted molecular therapies (TMTs) have demonstrated activity in RCC by reducing the size of primary tumors and metastases. Thus, we assessed the treatment effect of TMTs on IVC tumor thrombi.A multi-institutional database of patients treated with TMTs with in situ RCC was reviewed, patients with an IVC thrombus were assessed for radiographic responses in thrombus size and location. We then described the pre- and post-treatment characteristics of this group.In the 25 patients meeting inclusion criteria, pre-therapy biopsy showed ccRCC in 19 and unclassified RCC in 6. Prior to TMT, the thrombus level was II in 18 (72%), III in 5 (20%), and IV in 2 (8%). The TMT was sunitinib in 12 cases and non-sunitinib in the other 13. Median duration of TMT was 2mo (1-9). Following TMT, 7 (28%) had an increase (↑) in the thrombus height above the renal vein (RV), 7 (28%) had no change and 11 (44%) had a decrease (↓). The median Δ of the thrombus height was 0cm (-8.5-5), and the median Δ of the thrombus diameter was -0.1cm (-1.6-0.9). The Δ in the tumor thrombus level classification after TMT was: 1 (4%) had an ↑, 21 (84%) were stable and 3 (12%) had a ↓. In only 1 case (4%) the surgical approach was potentially affected by regression (level IV → III). Regression resulting in a Δ in the clinical level of the thrombus was only seen in the sunitinib cohort. Yet, the Δ in thrombus height, diameter or clinical level classification between sunitinib and non-sunitinib cohorts did not reach statistical significance (Table). No significant predictors of thrombus response to TMT were found.TMTs had minimal clinical effect on RCC tumor thrombi. Only patients treated with sunitinib had measurable thrombus regression; however, the magnitude of this effect was not statistically significant and is of unclear clinical relevance. [Table: see text].


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