Neoadjuvant sorafenib helps shrink kidney cancer

NEW YORK (Reuters Health) - Preoperative treatment with sorafenib can reduce the size and density of renal cell carcinoma, according to an online report February 16th in the Journal of Clinical Oncology.

"This study opens the door for studies that will be able to explore clinical benefit, but in the meantime provides data to turn to for difficult cases where it might seem that systemic treatment would be beneficial prior to surgery," senior author Dr. W. Kimryn Rathmell from The University of North Carolina at Chapel Hill told Reuters Health by email.

Dr. Rathmell and colleagues evaluated preoperative sorafenib in 30 patients with renal cell carcinoma at high risk for recurrence or undergoing cytoreductive nephrectomy. The primary objective was to determine the safety and feasibility of adjunctive systemic treatment before planned surgery.

The adverse event profile was similar to that expected for sorafenib, but there were no grade 4 toxicities attributable to therapy.

Most patients had shrinkage of the primary tumor, although 5 patients showed slight growth of the tumor.

Of the 28 patients evaluable for response, all but 2 patients (93%) met criteria for stable disease. Two patients had a partial response; none had confirmed progressive disease or complete response.

Seventeen patients had contrast-enhanced computed tomography done before and after sorafenib treatment. Fifteen had loss of contrast enhancement centrally within the tumor (consistent with intratumoral necrosis), with a median decrease in enhancement of 13%.

After laparoscopic radical nephrectomy (16 patients) or open nephrectomy (14 patients), there were no complications of delayed wound healing, surgical dehiscence, or excessive bleeding.

At the time of the report, 2 of 15 patients with localized disease had relapsed after a median follow-up of 217 days after surgery.

"Further studies are still in development," Dr. Rathmell added, "but important questions will need to investigate the optimal duration of treatment before surgery and define the benefit to patients, whether that is in terms of lower morbidity surgical procedures, or for patients who have high risk, but localized disease, if neoadjuvant therapy can decrease the overall risk of recurrence."

Dr. Rathmell has received support from Bayer and Onyx Pharmaceuticals, manufacturer of sorafenib and cosponsor of this study.

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