Presurgical treatment with axitinib in renal cell carcinoma patients with venous extension

In renal cell carcinoma patients with inferior vena cava (IVC) extension, the difficulty of resection increases with the degree of venous extension, which in turn increases the risk of perioperative morbidity and mortality. In addition, the degree of IVC occlusion and associated bland thrombus are reported to be important factors in the choice of operative procedure and in the risk of perioperative complications. Therefore, presurgical treatment to decrease the extent of tumor thrombus would be of significant benefit. Three renal cell carcinoma patients with IVC extension were treated presurgically with axitinib at our institution between September 2012 and November 2013. All patients received axitinib at an initial dose of 5 mg twice daily for 12 weeks. Objective response to treatment was assessed with enhanced computed tomography at 4 and 12 weeks, and therapeutic value was evaluated. Level of inferior vena cava thrombus, according to the classification of Neves et al., and degree of occlusion, according to the classification of Blute et al., were evaluated. Drug-related adverse events and perioperative complications were also investigated. Reduction in primary tumor size was observed in all cases. Two patients showed shortening of tumor thrombus, and a patient with complete occlusion of the IVC by tumor thrombus showed substantial improvement. No grade 3 or greater adverse events and no perioperative complications were observed during treatment. Axitinib may have benefits as a presurgical treatment for renal cell carcinoma patients with IVC extension.