Targeted Molecular Therapies Research Articles

Identifying objective risk factors of financial toxicity in patients with cancer.

e24116 Background: Current financial toxicity (FT) screening tools rely on patient-reported risk factors (RF)1. Underrepresented populations may not be forthcoming about FT fears due to cultural concerns of treatment withholding or migratory repercussions, if applicable1–4. Identifying objective RF, such as social determinants of health (SDH) and disease-specific factors (DSF), could reduce FT in cancer patients and healthcare systems. Methods: This was a multi-center retrospective study evaluating SDH and DSF associated with FT (defined as ≥$15,000 owed) related to cancer treatment. Inferential statistics were used to evaluate differences between the FT cohort and those who owed < $15,000. Continuous data were compared with a Student’s t or Mann-Whitney U test, depending on distribution. Categorical outcomes were compared with a chi square test. A logistic regression model was used to evaluate multivariate associations with FT, using p < 0.05 to define significant results. Results: The sample comprised 162 records, 81 in each group. Univariate analyses demonstrated differences in age, lack of PCP, non-US country of origin, lack of insurance, lower education levels, need for an English interpreter, stage 4 at diagnosis, recurrent or metastatic disease, use of immune checkpoint inhibitors (ICI), and use of targeted molecular therapy (TMT) (Table 1). Employment status and marital status were not statistically different. The logistic regression model showed that lack of insurance and stage 4 at diagnosis were significantly associated with FT (p = 0.001 and p = 0.0495, resp.). Conclusions: Objective FT screening can minimize response bias and incidence in those at increased risk. Non-US country of origin and lack of English proficiency suggests that first-generation Hispanics may not be appropriately navigated for FT. These findings identify specific subpopulations at risk for FT and will guide prospective interventions looking to minimize FT. Healthcare systems should analyze objective measures of FT while considering loco-regional and subcultural SDH/DSF in order to overcome response bias. Ref. Witte J et al. Methods for measuring financial toxicity after cancer diagnosis and treatment. Annals of Oncology. 2019;30(7) Strasser-Weippl K et al. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol. 2015;16(14) Zhu Z et al. Cancer survivors’ experiences with financial toxicity. Psychooncology. 2020;29(6) Chebli P et al. Multilevel determinants of financial toxicity in breast cancer care. Supportive Care in Cancer. 2020;28(7). [Table: see text]

Tumor diameter response in patients with metastatic clear cell renal cell carcinoma is associated with overall survival.

Tumor shrinkage of at least 10% after presurgical targeted molecular therapy (TMT) in renal cell carcinoma (RCC) patients has been associated with better overall survival (OS) outcomes. We characterized primary and metastatic tumor diameter response and OS in patients with metastatic clear cell RCC (ccRCC) who received preoperative TMT, immunotherapy, or both followed by deferred cytoreductive nephrectomy (dCN). Patients with metastatic ccRCC (n = 198) who underwent preoperative therapy and dCN from 2005 to 2019 were identified retrospectively. Longest primary and metastatic tumor diameters were calculated using cross-sectional images obtained before systemic therapy and dCN using the Response Evaluation Criteria in Solid Tumors. Patients were stratified by tumor shrinkage of at least 10% in the primary and/or metastatic tumors after systemic therapy. The Kaplan-Meier method was used to estimate OS, and Cox proportional hazards models were used to assess the association of patient characteristics with OS. In total, 31.31% of patients had only metastatic tumor shrinkage (MTS) ≥ 10%, 8.08% had only primary tumor shrinkage (PTS) ≥ 10%, 32.32% had PTS and MTS ≥ 10%, and 28.28% had PTS/MTS < 10%. The median OS, number of patients with tumor shrinkage ≥ 10%, and International Metastatic Database Consortium (IMDC) scores were similar among the 3 systemic therapy groups (all P ≥ 0.80). Patients with MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% had significantly longer median OS compared to patients with PTS/MTS < 10% (P < 0.01). Patients with intermediate-risk IMDC scores had significantly longer median OS compared to patients in the poor-risk group. After adjusting for preoperative therapy and IMDC risk group, MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% were associated with better OS outcomes (HR 0.48 95% CI 0.32-0.73, P < 0.001; HR 0.48, 95% CI 0.23-0.98, P = 0.04; HR 0.44, 95% CI 0.29-0.67, P < 0.001, respectively). Intermediate risk score and shrinkage of at least 10% in the primary tumor, metastases, or both were associated with better OS outcomes in patients with metastatic ccRCC who underwent dCN independent of the type of preoperative systemic therapy.

An intelligent hypoxia-relieving chitosan-based nanoplatform for enhanced targeted chemo-sonodynamic combination therapy on lung cancer

The clinical efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs)-based targeted molecular therapies (TMT) is inevitably hampered by the development of acquired drug resistance in non-small cell lung cancer (NSCLC) treatment. Sonodymanic therapy (SDT) is a promising new cancer treatment approach, but its effects are restricted by tumor hypoxia. Herein, a nanoplatform fabricated by erlotinib-modified chitosan loading sonosensitizer hematoporphyrin (HP) and oxygen-storing agent perfluorooctyl bromide (PFOB), namely CEPH, was developed to deliver HP to erlotinib-sensitive cells. CEPH with ultrasound could alleviate hypoxia inside the three-dimensional multicellular tumor spheroids, suppress NSCLC cell growth under normoxic or hypoxic condition, and enhance TMT/SDT synergistic effects through elevated production of reactive oxygen species, decrease of mitochondrial membrane potential, and down-regulation of the expression of the proteins EGFR, p-EGFR, and HIF-1α. Hence, CEPH could be a potential nanoplatform to improve the efficacy of oxygen-dependent SDT and overcome hypoxia-induced TMT resistance for enhanced synergistic TMT/SDT.

PD40-06 METASTATIC TUMOR DIAMETER RESPONSE IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA IS ASSOCIATED WITH OVERALL SURVIVAL

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II (PD40)1 Sep 2021PD40-06 METASTATIC TUMOR DIAMETER RESPONSE IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA IS ASSOCIATED WITH OVERALL SURVIVAL Alberto Pieretti, Daniel Shapiro, Mary E Westerman, Hyunsoo Hwang, Xuemei Wang, Luis A Segarra, Matthew T Campbell, Nizar Tannir, Eric Jonasch, Christopher G Wood, and Jose Karam Alberto PierettiAlberto Pieretti More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Mary E WestermanMary E Westerman More articles by this author , Hyunsoo HwangHyunsoo Hwang More articles by this author , Xuemei WangXuemei Wang More articles by this author , Luis A SegarraLuis A Segarra More articles by this author , Matthew T CampbellMatthew T Campbell More articles by this author , Nizar TannirNizar Tannir More articles by this author , Eric JonaschEric Jonasch More articles by this author , Christopher G WoodChristopher G Wood More articles by this author , and Jose KaramJose Karam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002050.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Tumor shrinkage of ≥10% with presurgical targeted molecular therapy (TMT) in renal cell carcinoma (RCC) was associated with improved overall survival (OS). We characterized primary and metastatic tumor diameter response and OS in patients with metastatic clear cell RCC (ccRCC) who received preoperative therapy with TMT, immunotherapy (IO), or IO+TMT followed by deferred cytoreductive nephrectomy (dCN). METHODS: We identified 211 patients with metastatic ccRCC who received preoperative therapy followed by dCN between 2005 and 2019. Primary and metastatic tumor longest diameters were calculated from cross-sectional images obtained before systemic therapy and before dCN with validated RECIST 1.1. Kaplan-Meier method was used to estimate OS, and Cox proportional hazards models to assess the association between patient characteristics and OS. RESULTS: A total of 41.4 % of patients had primary tumor shrinkage (PTS) of ≥10%, and 64.1% had metastatic tumor shrinkage (MTS) of ≥10%. Median OS, PTS of ≥10%, and MTS of ≥10% were similar among the 3 groups (p=0.53; p=0.18; p=0.44, respectively). For patients with MTS of ≥10%, the median OS was 44 months compared with 19.1 months in the group with MTS of <10% (p<0.001). On univariable analysis, PTS and MTS of ≥10% were associated with better OS (HR 0.67, CI 0.4-0.9, p=0.02; HR 0.57, CI 0.4-0.7, p<0.001). On multivariable analysis, MTS of ≥10% was associated with improved OS (HR 0.61, CI 0.4-0.8, p=0.01). CONCLUSIONS: In patients with metastatic ccRCC, MTS of ≥10% was associated with better OS in patients who underwent dCN, independent of the type of preoperative systemic therapy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e676-e676 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Pieretti More articles by this author Daniel Shapiro More articles by this author Mary E Westerman More articles by this author Hyunsoo Hwang More articles by this author Xuemei Wang More articles by this author Luis A Segarra More articles by this author Matthew T Campbell More articles by this author Nizar Tannir More articles by this author Eric Jonasch More articles by this author Christopher G Wood More articles by this author Jose Karam More articles by this author Expand All Advertisement Loading ...

Development and Validation of an Individualized Immune Prognostic Signature for Recurrent Prostate Cancer.

Immune-related genes possess promising prognostic potential in multiple cancer types. Here, we describe the development of an immune-related prognostic signature for predicting prostate cancer recurrence. Prostate cancer gene expression profiles for 477 prostate cases, as well as accompanying follow-up information were downloaded from The Cancer Genome Atlas (TCGA) and GEO. The samples were divided into 3 groups and immune gene sets significantly associated with prognosis were identified by evaluating the relationship between the expression of 1039 immune genes and prognosis in the training set. Relative expression levels of these genes were used to identify prognostic gene pairs. LASSO was used for feature selection and robust biomarkers selected. Finally, the identified immune prognostic markers were validated using dataset and GEO validation dataset and their performance compared with existing prognostic models. In total, 87 immune genes, significantly associated with prognosis, were identified and 2447 immune gene pairs (IRGPs) established. Univariate survival analysis identified 641 prognosis-associated immune gene pairs. 8-IRGPs were obtained via LASSO feature selection and an 8-IRGPs signature established. The 8-IRGPs signature exhibited an independent prognosis value in prostate cancer of the training set, test set, and external validation set (p = <0.001). The 5- year survival AUC in both the training set and the validation set was >0.7. The 8-IRGPs outperformed clinical tumor classification features, including T, N, radiation therapy (RT) and targeted molecular therapy (TMT) (p <0.01). In addition, we compared the prognostic characteristics of 8-IRGPs with 3 reported prostate cancers and found that 8-IRGPs achieved a high C index (0.85) and had the highest predictive performance within 10 years of follow-up (HR: 10.5). Finally, we integrated T, N, RT, TMT, and 8-IRGPs and generated a novel alignment chart to aid the prediction of prostate cancer recurrence in individual patients (p <0.01). Here, we identified an 8-IRGP novel prognostic signature for the prediction of prostate cancer recurrence.

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus.

PurposeThe clinical benefit of targeted molecular therapy (TMT) in renal cell carcinoma (RCC) with an inferior vena cava (IVC) tumor thrombus remains controversial. The aim of this study was to investigate the effects of presurgical TMT on the heights and levels of IVC thrombi, and to assess its impact on surgical strategy.Patients and methodsWe retrospectively reviewed data from 18 patients with RCC involving IVC tumor thrombi who were treated at our hospital with presurgical TMT followed by an IVC thrombectomy. The changes in heights and levels of the IVC thrombi were compared using computed tomography or magnetic resonance imaging. Clinicopathological factors were also evaluated to assess their association with TMT efficacy.ResultsThe tumor thrombus levels before TMT were stage I in 1 patient (5.6%), II in 12 patients (66.7%), III in 4 patients (22.2%), and IV in 1 patient (5.6%). After a median of two treatment cycles (range: 1–3), the thrombus height decreased measurably in 11 patients (61.1%) with an average shrinkage of 17.7%. The thrombus height remained stable in five patients (27.8%) and was enlarged in two (11.1%). Downstaging of the thrombus level occurred in four patients (22.2%); the surgical strategy was modified in three patients (16.7%) to avoid cardiopulmonary bypass and complicated liver mobilization under robot-assisted laparoscopy. Furthermore, a higher neutrophil count tended to be associated with a worse clinical TMT-associated outcome (P=0.056).ConclusionOur data suggest a limited influence of presurgical TMT with a positive benefit in RCC patients with level III and IV thrombus. Thrombus-level regression may potentially alter the surgical strategy, especially robotic surgery. However, our findings require validation with additional prospective investigations.

Cytoreductive nephrectomy with thrombectomy before targeted therapy improves survival for metastatic renal cell carcinoma with venous tumor thrombus: a single-center experience

BackgroundThe aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus.MethodsWe performed a retrospective analysis of 47 patients treated in our center from April 2008 to October 2014. In the study, 20 patients underwent CN with thrombectomy followed by targeted therapy (group 1); 15 patients received targeted therapy alone (group 2); and 12 patients underwent CN with thrombectomy alone (group 3). The overall survival (OS) and cancer-specific survival (CSS) were calculated according to the Kaplan-Meier survival curve method, and prognostic variables were assessed by Cox regression analyses.ResultsThe median follow-up times of group 1, group 2, and group 3 were 24.5, 12, and 6.5 months, respectively. During follow-up, in both group 1 and group 3, 12 patients died. In group 2, 14 patients died. The median OS of group 1, group 2, and group 3 was 22, 12, and 6 months, respectively (P < 0.001). Compared with surgery alone and targeted therapy alone, patients with cytoreductive surgery before targeted therapy had statistically better survival benefits (P < 0.001, P = 0.009, respectively). On univariate analysis, the number of metastatic sites (P = 0.004) was a statistically significant prognostic factor influencing OS.ConclusionsOur single-center experience showed that CN with thrombectomy before targeted therapy improved the survival of patients with mRCC with venous tumor thrombus. The number of metastatic sites was an independent prognostic factor influencing OS.

Surgical management of metastatic renal cell carcinoma in the era of targeted therapies

Cytoreductive nephrectomy (CN) has been considered standard management for patients with metastatic renal cell carcinoma (mRCC) for over a decade. This practice, based on evidence from the immunotherapy era, has now come into question with the dramatic shift in management of mRCC patients due to the development and approval of several targeted molecular therapies (TMT). A comprehensive English language literature review was performed using MEDLINE/PubMed to identify articles and guidelines pertinent to CN in mRCC. Retrospective studies have demonstrated improved survival for patients who underwent CN compared to those that did not; however, these studies suffer from heavy selection bias. Furthermore, the optimal timing of TMT, before or after surgery is not known. Pre-surgical TMT has the advantage of early treatment of metastases, downsizing of the primary, and may be an effective 'litmus test' for the selection of patients for CN based on response to TMT. The results of two ongoing phase III trials (CARMENA and SURTIME) will address much of the controversy on the role of CN and the timing of systemic therapy in the TMT era. In this review, we aim to present the evidence that lead to adoption of CN in the era of immunotherapies as well as the available data about the oncologic benefit of CN in patients with mRCC who receive TMT as their primary systemic therapy. There seems to be an important role for CN in the era of TMT, mostly in patients with favorable risk and where a high percentage of tumor burden can be removed by cytoreductive surgery.

MP57-06 LIMITED BENEFIT OF TARGETED THERAPIES ON IVC THROMBUS IN RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVES: The standard treatment for patients with renal cell carcinoma extending into the inferior vena cava is radical nephrectomy and tumor thrombectomy. However, not all patients are eligible for surgery, and in some cases targeted therapies are needed because of their potential to downsize the tumor. But the clinical benefit of targeted therapies on vena caval tumor thrombus of RCC remains unclear. Objective: To evaluate the cytoreductive effects of targeted therapies on renal cell carcinoma with inferior vena caval tumor thrombus (IVC thrombus). METHODS: 19 patients with IVC thrombus who were treated with targeted molecular therapies (TMT) at our hospital were retrospectively analyzed. Sunitinib was administered in 17 patients, sorafenib in 1, and temsirolimus in 1. Thrombus size and level before and after TMT were measured by enhanced CT or MRI. Patients and tumor characteristics were compared between the patients who showed decrease of IVC thrombus height with TMT and those who did not show any decrease. RESULTS: 14 (74%) of the patients were male, and the mean age of the group was 66 years. The left side of the kidney had primary tumors in 11 patients and the right side in 8. Before the therapy thrombus level waszTin 2 patients (11%), zU in 9 (47%), zV in 4 (21%), and zW in 4 (21%). The median duration of therapy was 2 cycles. Following therapy, the tumor thrombus increased in height in 4 patients (21%), remained the same in 1 casei5%j, and decreased in 14 (74%). However, the mean reduction of the thrombus height was only 14mm. The thrombus level decreased only in 3 patients (16%), all of whom were treated with sunitinib. After TMT, 10 patients (43%) received thrombectomy. Comparison of all the data collected between the two groups failed to demonstrate any statistically significant factors, although a high neutrophil count and clinical node metastases were marginally statistic. CONCLUSIONS: Our study showed the clinical benefit of targeted therapies on IVC thrombus of the renal cell carcinoma was limited. Thus targeted therapy in the neoadjuvant setting can be considered in selected patients.

Primary Anorectal Melanomas Interest of Targeting C-KIT in Two Cases from a Series of 11 Patients

Background: The anorectal location of melanomas is extremely rare (1% - 3% of all melanomas), and the prognosis remains poor because of the aggressiveness and the high metastatic potential of those tumors. The discovery that the KIT oncogene may be aberrantly activated in a subset of patients with anorectal melanoma creates a realm of possibility for the development of targeted molecular therapy. Aim: to show the epidemiologic, clinico-radiological, histological features and treatment management especially in patients with over-expression of C-KIT treated by Imatinib. Methods: It is a retrospective study conducted in the department of medical oncology at Hassan II University Hospital between January 2007 and January 2012, including all patients with histologically proven melanoma of the anorectal area. Results: 11 cases were collected, with slight female predominance. Nine patients were metastatic at the moment of diagnosis, and only two with local stage, but evolution was marked by local and distant recurrence less than 12 months after abdo-minoperineal resection. First line of chemotherapy was based mainly on paclitaxel, carboplatine and dacarbazine. Response was modest with only 3 partial responses, 4 patients with disease stability, and 4 patients with disease progression. Two patients, with over expression of C-KIT, received Imatinib as second line of treatment with significant improvement of symptoms and radiological response reaching 50%. Seven patients died with a median survival of 11 months from diagnosis to the date of death. Conclusion: Primary anorectal melanomas are very rare, with high aggressiveness and poor prognosis. Treatment management is still a big challenge given to the modest efficacy of conventional chemotherapy. Better understanding of carcinogenesis and signaling pathways will allow development of new targeted therapies.

The use of preoperative targeted molecular therapy to allow nephron sparing for T1b tumors

To give insight into the current literature on feasibility, safety and outcome of presurgical targeted molecular therapies (TMTs) before nephron-sparing surgery (NSS) in patients with renal cell carcinoma. Presurgical TMTs have been proven to be effective and well tolerated for patients with previously unresectable primary tumors and known metastatic disease. Current evidence suggests that this also is true for patients with bulky tumors not amenable to NSS, but with imperative indications for NSS like solitary kidney, bilateral tumors, pre-existing chronic kidney disease, or tumor predisposing syndromes. TMT is generally well tolerated in this regimen and complication rates around surgery are low when TMT is withheld around the half-life time of the agent used. In selected cases, TMT before NSS is well tolerated, effective and feasible. Still, this topic is considered experimental because it has not been thoroughly studied to fully assess the indications, the timing of therapy, and its effect on outcomes. Further evidence is needed to draw definitive conclusions.

Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management. We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification. Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively. Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.

The impact of targeted molecular therapy on the level of renal cell carcinoma (RCC) venous tumor thrombus.

e15002 Background: Targeted molecular therapies (TMTs) have demonstrated activity in RCC by reducing the size of primary tumors and metastases. Thus, we assessed the treatment effect of TMTs on IVC tumor thrombi. Methods: A multi-institutional database of patients treated with TMTs with in situ RCC was reviewed, patients with an IVC thrombus were assessed for radiographic responses in thrombus size and location. We then described the pre- and post-treatment characteristics of this group. Results: In the 25 patients meeting inclusion criteria, pre-therapy biopsy showed ccRCC in 19 and unclassified RCC in 6. Prior to TMT, the thrombus level was II in 18 (72%), III in 5 (20%), and IV in 2 (8%). The TMT was sunitinib in 12 cases and non-sunitinib in the other 13. Median duration of TMT was 2mo (1-9). Following TMT, 7 (28%) had an increase (↑) in the thrombus height above the renal vein (RV), 7 (28%) had no change and 11 (44%) had a decrease (↓). The median Δ of the thrombus height was 0cm (-8.5-5), and the median Δ of the thrombus diameter was -0.1cm (-1.6-0.9). The Δ in the tumor thrombus level classification after TMT was: 1 (4%) had an ↑, 21 (84%) were stable and 3 (12%) had a ↓. In only 1 case (4%) the surgical approach was potentially affected by regression (level IV → III). Regression resulting in a Δ in the clinical level of the thrombus was only seen in the sunitinib cohort. Yet, the Δ in thrombus height, diameter or clinical level classification between sunitinib and non-sunitinib cohorts did not reach statistical significance (Table). No significant predictors of thrombus response to TMT were found. Conclusions: TMTs had minimal clinical effect on RCC tumor thrombi. Only patients treated with sunitinib had measurable thrombus regression; however, the magnitude of this effect was not statistically significant and is of unclear clinical relevance. Sunitinib Non-sunitinib Initial thrombus level II III IV 8 pts 2 pts 2 pts 10 pts 3 pts 0 pts 0.5 Δ in thrombus level ↑ - 0 (0%) Stable - 9 (75%) ↓ - 3 (25%) (1 – level IV → III, 1 – III → II, 1 – II → 0) ↑ - 1 (7.7%) (II → III) Stable - 12 (92.3%) ↓ - 0 (0%) 0.1 Median initial height above RV 3.9 (2 - 14.5) 3.5 (0 - 8.5) 0.2 Median Δ in height above RV 0.28 (-8.5 - 0.5) 0 (-4 to 5) 0.2 Median Δ in max diameter -0.66 (-1.5 - 0.64) 0 (-1.6 - 0.9) 0.1

POD-6.07: Surgical Morbidity Associated with Administration of Targeted Molecular Therapies Prior to Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma

The use of targeted molecular therapies (TMT) such as bevacizumab, sunitinib, and sorafenib prior to cytoreductive nephrectomy (CN) holds promise as a rational treatment paradigm for patients with metastatic renal cell carcinoma (mRCC). To analyze their safety in pre-surgical setting, we evaluated surgical parameters and perioperative complications in patients treated with TMTs prior to CN and compared them to a matched patient cohort who underwent initial CN.