減積性腎臟切除術應於以Nivolumab合併Cabozantinib治療之新診斷的轉移性腎細胞癌患者

張家郡、張兆祥、楊啟瑞

中國醫藥大學附設醫院泌尿部

Cytoreductive nephrectomy in patients with newly diagnosed metastasis renal cell carcinoma treated with Nivolumab+Cabozantinib

Jia-Jyun Jhang, Chao-Hsiang Chang, Chi-Rei Yang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose: Recent trials of immune checkpoint inhibitor-based therapy have brought the treatment of mRCC into a new era. Yet, the role of cytoreductive nephrectomy in synchronous mRCC patient receiving immunotherapy is still inconclusive. Most published studies focus on patients who receive systemic therapy with Nivolumab plus Ipilimumab. Little is known about cytoreductive nephrectomy in patients treated with other immune checkpoint inhibitor-based therapy. We aim to study the outcome of cytoreductive nephrectomy in newly diagnosed mRCC patient who are treated with Nivolumab+Cabozantinib.

Materials and Methods: Our study included 3 patients with newly diagnosed synchronous mRCC without receiving previously systemic therapy. All of the patients received systemic therapy with  Nivolumab+Cabozantinib and underwent cytoreductive nephrectomy.

Results: Among the 3 patients, two was IMDC intermediate risk (1) and one was IMDC poor risk (4). The IMDC poor risk patient received 5 months of Nivolumab+Cabozantinib therapy then received open nephrectomy with extended node dissection. CT performed 18 months after diagnosis showed complete response without evidence of tumor recurrence. For the two IMDC intermediate risk patients, one received immediate cytoreductive nephrectomy and the other received operation after 6 weeks of Nivolumab+Cabozantinib therapy. Both of the patients showed partial response after one year follow up without evidence of local recurrence or disease progression.

Conclusions: The combination of Cytoreductive nephrectomy with Nivolumab+Cabozantinib in newly diagnosed synchronous mRCC patient may provide benefit for patients with IMDC intermediate and even in selected poor-risk patients. Further study is required to define the suitable candidates for the operation and the ideal timing for the operation.