|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 403-404
Neoadjuvant cabozantinib in metastatic and locally advanced renal cell carcinoma
Arya Mariam Roy1, Andrew Briggler2
1 Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
2 Division of Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
|Date of Submission||03-May-2021|
|Date of Decision||05-May-2021|
|Date of Acceptance||16-May-2021|
|Date of Web Publication||30-Jun-2021|
Arya Mariam Roy
3400 S Bowman Road, Apt 1910, Little Rock, AR 72211
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy AM, Briggler A. Neoadjuvant cabozantinib in metastatic and locally advanced renal cell carcinoma. Cancer Res Stat Treat 2021;4:403-4
We applaud Abbas et al. for reporting the real-world data on the use of nivolumab as a second-line immunotherapy option in Indian patients with metastatic renal cell carcinoma (mRCC) treated with a tyrosine kinase inhibitor in the first line. The article was very well written and provided insights into the accessibility and efficacy of nivolumab in patients with mRCC in low- and middle-income countries. In the accompanying editorial, Kapoor has highlighted the benefits of the combination of nivolumab and cabozantinib in advanced renal cell carcinoma (RCC) based on the phase III, randomized trial by Choueiri et al. that reported a significant survival benefit of the combination of nivolumab and cabozantinib over sunitinib in patients with previously untreated advanced RCC., The CABOSUN trial showed a benefit of cabozantinib over sunitinib making cabozantinib the preferred first-line oral therapy in patients with RCC. However, the use of cabozantinib in the neoadjuvant setting for metastatic and locally advanced RCC is not very well studied.
We studied the neoadjuvant use of cabozantinib in patients with advanced inoperable RCC. One of our patients with a tumor in the right upper pole of the kidney with an associated thrombus within the right renal vein extending to the inferior vena cava was started on cabozantinib 60 mg once daily. A computed tomography (CT) scan after 4 months showed more than 50% reduction in the tumor size and complete regression of the tumor thrombus in the inferior vena cava; this was followed by a nephrectomy without any complications [Figure 1]. Another patient with RCC that had metastasized to the head of the pancreas and initially appeared to be unresectable due to its proximity to the superior mesenteric artery and vein was started on cabozantinib. After 4 months of treatment, a repeat CT scan showed marked downsizing of the tumor which led to successful tumor resection. Downsizing of the tumor was observed even at reduced doses of cabozantinib.
|Figure 1: Renal cell carcinoma of the right kidney coronal view (a) pretreatment (b) post-treatment with cabozantinib. Arrows indicate the tumor|
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There are no published randomized controlled trials supporting the benefit of neoadjuvant treatment in RCC. There are some case reports and case series that describe the use of sunitinib and pazopanib as neoadjuvant treatment options in RCC; however, nephrectomy could be performed only in a few of these cases. A phase II clinical trial is currently recruiting patients to study the use of neoadjuvant cabozantinib in locally advanced RCC (NCT04022343).
The limited availability of cabozantinib in India makes it difficult to conduct clinical trials for this drug in the Indian population, both as a first-line treatment option and in the neoadjuvant setting. More trials are warranted for the neoadjuvant use of drugs in RCC as radical nephrectomy plays a prominent role in reducing the mortality and improving the long-term disease-free survival.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Abbas W, Aggarwal A, Pankaj P, Jain R. Real-world data of second-line immunotherapy in metastatic clear cell renal cell carcinoma: A retrospective study. Cancer Res Stat Treat 2021;4:55-60. [Full text]
Kapoor A. Current systemic therapy options in advanced clear cell renal cell cancer. Cancer Res Stat Treat 2021;4:124-6. [Full text]
Choueiri TK, Powles T, Burotto M, Escudier B, Bourlon MT, Zurawski B, et al.
Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 2021;384:829-41.
Choueiri TK, Halabi S, Sanford BL, Hahn O, Michaelson MD, Walsh MK, et al.
Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk: The Alliance A031203 CABOSUN Trial. J Clin Oncol 2017;35:591-7.
Roy AM, Briggler A, Tippit D, Dawson K, Verma R. Neoadjuvant cabozantinib in renal-cell carcinoma: A brief review. Clin Genitourin Cancer 2020;18:e688-91.
Chin AI, Lam JS, Figlin RA, Belldegrun AS. Surveillance strategies for renal cell carcinoma patients following nephrectomy. Rev Urol 2006;8:1-7.