Elective Cytoreductive Nephrectomy After Checkpoint Inhibitor Immunotherapy in Patients With Initially Unresectable Metastatic Clear Cell Renal Cell Carcinoma.
Elective Cytoreductive Nephrectomy After Checkpoint Inhibitor Immunotherapy in Patients With Initially Unresectable Metastatic Clear Cell Renal Cell Carcinoma.
复制标题
DOI：
10.1016/j.clgc.2020.04.002
复制
发表时间：
2020-10
影响因子：
3.2
通讯作者：
Hsieh JJ
中科院分区：
文献类型：
--
作者：
Reimers MA;Figenshau RS;Kim EH;Tucker J;Kasten N;Khan AS;Hanneken JM;Smith ZL;Hsieh JJ
联合检查点抑制剂免疫疗法最近已成为转移性肾细胞癌（mRCC）的新一线治疗标准。先前发表的数据已证明细胞减灭性肾切除术 (CN) 在干扰素时代具有生存获益，但 CN 与酪氨酸激酶抑制剂 (TKI) 联合使用的效用一直存在争议。在当前的病例系列中，我们报告了 5 名 IMDC 中危或低危最初不可切除的转移性肾细胞癌患者，他们成功接受了 CN。所有患者均接受诱导联合检查点抑制剂免疫治疗 (CPI) 伊匹单抗-纳武单抗联合或不联合派姆单抗-阿西替尼。 3 名患者接受了机器人 CN，1 名患者分别接受了开放和腹腔镜 CN。 5名患者中的3名在肾切除时发现有明显的纤维化和促纤维增生反应，需要手术专业知识并增加手术时间。在此，我们强调了这种方法的可行性以及 CN 术后 CPI 手术的挑战。 CN 在接受 CPI 全身治疗的患者中的作用尚未明确，并且正在迅速发展。
Combination checkpoint inhibitor immunotherapy has recently become a new frontline standard of care for metastatic renal cell carcinoma (mRCC). Previously published data has demonstrated a survival benefit of cytoreductive nephrectomy (CN) in the interferon era, but the utility of CN in conjunction with the use of tyrosine kinase inhibitors (TKIs) has been controversial. In the current case series, we report on five patients with IMDC intermediate- or poor-risk initially unresectable metastatic renal cell carcinoma who successfully underwent CN. All patients received induction combination checkpoint inhibitor immunotherapy (CPI) ipilimumab-nivolumab with or without pembrolizumab-axitinib. Three patients underwent robotic CN, and one patient underwent open and laparoscopic CN, respectively. Three of the five patients were found to have significant fibrosis and desmoplastic reaction at the time of nephrectomy, requiring surgical expertise and increased operative time. Herein we highlight the feasibility of this approach and the post-CPI surgical challenge of CN. The role of CN in patients receiving systemic therapy with CPI is not yet defined and is quickly evolving.
登录
查看更多内容
影响因子：
3.2
作者：
Saad AM;Gad MM;Al-Husseini MJ;Ruhban IA;Sonbol MB;Ho TH
通讯作者：
Ho TH
影响因子：
168.9
作者：
Mickisch, GHJ;Garin, A;Sylvester, R
通讯作者：
Sylvester, R
影响因子：
45.3
作者：
Motzer, RJ;Mazumdar, M;Ferrara, J
通讯作者：
Ferrara, J
影响因子：
28.4
作者：
Bex, Axel;Mulders, Peter;Haanen, John
通讯作者：
Haanen, John
影响因子：
3.3
作者：
Huang JJ;Hsieh JJ
通讯作者：
Hsieh JJ