EFFICACY OF NEOADJUVANT TARGETED THERAPY IN TREATMENT OF PATIENTS WITH LOCALISED CLEAR-CELL RENAL CELL CARCINOMA

MH BANGASH; J ALI; K CHANDIO; M HAMMAD; SR RIND

doi:10.54112/bcsrj.v2024i1.1197

Authors

MH BANGASH Khattak Medical Centre Dabgari Garden Ex Urology Registrar Mardan Medical Complex, Pakistan
J ALI RHC Ahmad Abad Karak and Privat Clinic in Itehad Medical And Diagnostic Complex Karak, Pakistan
K CHANDIO People’s Nursing School LUMHS Jamshoro, Pakistan
M HAMMAD Shifa College of Pharmaceutical Sciences Shifa Tameer-e-millat University, Islamabad Pakistan, School of business and Management, Riphah International University, Islamabad, Pakistan
SR RIND People’s Nursing School LUMHS Jamshoro, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1197

Keywords:

Disease Management, Drug Therapy, Prospective Studies, Targeted Molecular Therapy

Abstract

Clear-cell renal cell carcinoma (ccRCC) is the most common subtype of kidney cancer, accounting for approximately 75-80% of all renal malignancies. Objectives: The main objective of the study is to find the efficacy of neoadjuvant targeted therapy in the treatment of patients with localised clear-cell renal cell carcinoma. Methods: This prospective study was conducted at Mardan Medical Complex from June 2023 to January 2024. Data were collected from 85 patients. Patients aged>18 years and have a histologically confirmed diagnosis of localized ccRCC were included in the study. Tumor size was required to be 4 cm or larger, but confined to the kidney, corresponding to Stage I to III disease. Results: Data were collected from 85 patients with an average baseline tumour size for the entire cohort was 7.5 cm, and after 12 weeks of treatment, tumours shrank to an average of 5.6 cm, resulting in a mean tumour reduction of 25%. In the sunitinib group, the tumour size decreased from 7.5 cm to 5.55 cm, reflecting a 26% reduction. Similarly, in the pazopanib group, the tumour size was reduced from 7.5 cm to 5.65 cm, with an average reduction of 24%. Conclusion: It is concluded that neoadjuvant targeted therapy, using agents such as sunitinib and pazopanib, effectively reduces tumour size and improves surgical outcomes in patients with localized clear-cell renal cell carcinoma.

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References

Karam JA, Devine CE, Urbauer DL, Lozano M, Maity T, Ahrar K, et al. Phase 2 trial of neoadjuvant axitinib in patients with locally advanced nonmetastatic clear cell renal cell carcinoma. European urology. 2014;66(5):874-80.

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA: a cancer journal for clinicians. 2022;72(1).

Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer. 2008;113(1):78-83.

Lam JS, Shvarts O, Leppert JT, Pantuck AJ, Figlin RA, Belldegrun AS. Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system. The Journal of urology. 2005;174(2):466-72.

Leibovich BC, Lohse CM, Cheville JC, Zaid HB, Boorjian SA, Frank I, et al. Predicting oncologic outcomes in renal cell carcinoma after surgery. European urology. 2018;73(5):772-80.

Figlin R, Leibovich B, Stewart G, Negrier S. Adjuvant therapy in renal cell carcinoma: does higher risk for recurrence improve the chance for success? Annals of Oncology. 2018;29(2):324-31.

Dabestani S, Thorstenson A, Lindblad P, Harmenberg U, Ljungberg B, Lundstam S. Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study. World journal of urology. 2016;34:1081-6.

Kosary C. Kidney and renal pelvis. SEER Cancer Statistics Review, 1973-1990. 1993.

Gulati S, Vaishampayan U. Current state of systemic therapies for advanced renal cell carcinoma. Current Oncology Reports. 2020;22:1-10.

Rappold PM, Silagy AW, Kotecha RR, Hakimi AA. Immune checkpoint blockade in renal cell carcinoma. Journal of surgical oncology. 2021;123(3):739-50.

Ravaud A, Motzer RJ, Pandha HS, George DJ, Pantuck AJ, Patel A, et al. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. New england journal of medicine. 2016;375(23):2246-54.

Haas NB, Manola J, Uzzo RG, Flaherty KT, Wood CG, Kane C, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. The Lancet. 2016;387(10032):2008-16.

Eisen T, Frangou E, Oza B, Ritchie AW, Smith B, Kaplan R, et al. Adjuvant sorafenib for renal cell carcinoma at intermediate or high risk of relapse: results from the SORCE randomized phase III intergroup trial. Journal of Clinical Oncology. 2020;38(34):4064-75.

Motzer RJ, Russo P, Haas N, Doehn C, Donskov F, Gross-Goupil M, et al. Adjuvant pazopanib versus placebo after nephrectomy in patients with localized or locally advanced renal cell carcinoma: final overall survival analysis of the phase 3 PROTECT trial. European urology. 2021;79(3):334-8.

Javier-DesLoges J, Derweesh I, McKay RR. Targeted Therapy for Renal Cell Carcinoma. Urologic Oncology: Multidisciplinary Care for Patients. 2022:263-83.

Choueiri TK, Tomczak P, Park SH, Venugopal B, Lipatov O. Адьювантная терапия пембролизумабом у больных раком почки после нефрэктомии. New England Journal of Medicine. 2021;385(9):683-94.

Thillai K, Allan S, Powles T, Rudman S, Chowdhury S. Neoadjuvant and adjuvant treatment of renal cell carcinoma. Expert Review of Anticancer Therapy. 2012;12(6):765-76.

Timsit M-O, Albiges L, Méjean A, Escudier B. Neoadjuvant treatment in advanced renal cell carcinoma: current situation and future perspectives. Expert Review of Anticancer Therapy. 2012;12(12):1559-69.

Westerman ME, Shapiro DD, Wood CG, Karam JA. Neoadjuvant therapy for locally advanced renal cell carcinoma. Urologic Clinics. 2020;47(3):329-43.

Bex A, Powles T, Karam JA. Role of targeted therapy in combination with surgery in renal cell carcinoma. International Journal of Urology. 2016;23(1):5-12.

Hellenthal NJ, Underwood W, Penetrante R, Litwin A, Zhang S, Wilding GE, et al. Prospective clinical trial of preoperative sunitinib in patients with renal cell carcinoma. The Journal of urology. 2010;184(3):859-64.

Cowey CL, Amin C, Pruthi RS, Wallen EM, Nielsen ME, Grigson G, et al. Neoadjuvant clinical trial with sorafenib for patients with stage II or higher renal cell carcinoma. Journal of Clinical Oncology. 2010;28(9):1502-7.