Neoadjuvant pembrolizumab and tyrosine kinase inhibitor to facilitate imperative partial nephrectomy for renal cell carcinoma.

OBJECTIVE: To describe clinical outcomes of patients who received neoadjuvant therapy for tumor downsizing to facilitate imperative partial nephrectomy (PN), including patients with a solitary kidney, bilateral complex renal masses, or chronic kidney disease. PATIENTS AND METHODS: All patients who received neoadjuvant immunotherapy (IO) prior to planned surgery were reviewed and data extracted from chart review, including neoadjuvant regimen, patient characteristics, tumor characteristics, medication adverse events, and peri‑operative outcomes. Choice of neoadjuvant IO regimen was selected at the discretion of the medical oncologist-all were IO-tyrosine kinase inhibitor regimens. RESULTS: A case series of nine patients and 11 tumors was identified, with median pretherapy tumor size of 7.6 cm and RENAL score 10. Of nine patients (11 tumors) who completed at least 1 month of therapy, 90% responded with measurable tumor size decrease, and all were able to undergo surgery, without stage progression on therapy. Median tumor diameter was decreased by 2.1 cm following neoadjuvant therapy, and RENAL nephrometry score was reduced by a median 1 point. Pathologic complete response rate was 27%. CONCLUSIONS: Neoadjuvant IO-based combinations result in a significant decrease in primary renal tumor size that may facilitate nephron-sparing surgery for those patients with an imperative indication and otherwise infeasible PN prior to treatment.

Duke Scholars

Author Tian Zhang Medicine, Medical Oncology