Lenvatinib合併Pembrolizumab作為進展性腎細胞癌手術前輔助性治療之治療結果

梁柏崧、林仁泰

高雄榮民總醫院 外科部 泌尿外科

Results of Lenvatinib plus Pembrolizumab as Neoadjuvant Therapy before Definite Surgery in Patients with Advanced Renal Cell Carcinoma

Po-Sung Liang, Jen-Tai Lin

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

Purpose: It had been reported that the combination of lenvatinib and pembrolizumab led to a significantly longer progression-free survival and overall survival in metastatic clear cell renal cell carcinoma (RCC). About 80 percent response rate of primary tumor was noted from the report. Here we reported the clinical efficacy of lenvatinib plus pembrolizumab as neoadjuvant therapy for two patients with advanced RCC.

Materials and Methods: A 50 y/o man with MiT-family translocation RCC with multiple bulky lymph nodes metastases over retroperitoneum and neck areas and another 57 y/o woman with clear cell RCC (ccRCC) with bulky inferior venous caval (IVC) tumor thrombus up to diaphragm level were administered with lenvatinib plus pembrolizumab until safely removal of the primary tumor, metastatic tumors and IVC tumor thrombus.

Results:

The man with multiple bulky lymph nodes metastases had the primary tumor diameter reduction from 93 to 59 mm, the largest retroperitoneal lymph node diameter shrinkage from 40 to 22 mm and the neck lymph node diameter decreased from 29 to 24 mm. The tumor was originally encasing the renal pedicle and shrank after the neoadjuvant therapy so as to perform nephrectomy with retroperitoneal lymph node dissection smoothly. Radical neck dissection for the neck node was also performed.

The woman with IVC tumor thrombus had the primary tumor diameter reduction from 103 to 75 mm and the thrombus height shrinkage from 221 to 93 mm. The IVC tumor thrombus was originally extended above the diaphragm (level IV) and might be resected through thoraco-abdominal approach and operated both in thoracic and abdominal cavity. The thrombus level was below hepatic vein (level II) after the neoadjuvant therapy so that the definite surgery could be feasible through a midline incision with extension to the flank, and the thrombus was resected by lifting the liver.

Conclusions: In patients with advanced RCC, neoadjuvant lenvatinib plus pembrolizumab followed by definite surgery resulted in a feasible strategy to reduce the operative risk.