Tyrosine kinase inhibition may be beneficial before debulking nephrectomy

NEW YORK (Reuters Health) - Tyrosine kinase inhibition (TKI) provides significant cytoreduction of renal cell carcinoma (RCC) prior to debulking nephrectomy, according to a report in the October issue of Urology.

"Preoperative treatment of renal cell carcinoma has the potential to be safely used as an adjunct to surgery," Dr. W. Kimryn Rathmell from the University of North Carolina at Chapel Hill told Reuters Health.

Dr. Rathmell and colleagues report on nine patients with locally advanced or metastatic RCC treated with TKI therapy before nephrectomy. Most of them, the investigators say, were initially considered to have unresectable disease because of the bulk of the disease or had another contraindication to immediate surgical resection.

Treatment with TKI produced a modest decrease in the size of the primary tumor before surgery (mean, 12.9%; median, 8%), the authors report, but the responses varied widely, ranging from 0.82% for essentially stable disease to 54% with a partial response.

Two patients who initially presented with bulky retroperitoneal lymphadenopathy experienced sufficient reductions with TKI to enable them to undergo a complete resection of all disease, the researchers note, and both patients remained free of recurrence without systemic therapy more than a year after nephrectomy.

Four patients required dose reductions for adverse events.

TKI had no apparent detrimental effect on the debulking nephrectomy, and no patient had issues with wound healing.

"More studies are needed to fully evaluate safety, but there are potential benefits to this treatment for patients with either high risk or metastatic disease," Dr. Rathmell said. "We have a prospective neoadjuvant study currently ongoing to further address issues of safety and feasibility for this treatment strategy as an adjunct to surgery."

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