title: Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?
abstract: OBJECTIVE
  To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management.
  
  
  METHODS
  We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification.
  
  
  RESULTS
  Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively.
  
  
  CONCLUSIONS
  Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France, pibigot@chu-angers.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.forename: Tarek
authors.initials: T
authors.lastname: Fardoun
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Julien
authors.initials: J
authors.lastname: Berger
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.forename: Samuel
authors.initials: S
authors.lastname: Lagabrielle
authors.forename: Souhil
authors.initials: S
authors.lastname: Lebdai
authors.forename: Myriam
authors.initials: M
authors.lastname: Ammi
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grenier
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hétet
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Philippe
authors.initials: P
authors.lastname: Paparel
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.forename: Abdel-Rahmène
authors.initials: AR
authors.lastname: Azzouzi
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009392:Nephrectomy; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib; D000077210:Sunitinib; D017131:Thrombectomy; D013927:Thrombosis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077210:Sunitinib