You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20111771 THE IMPACT OF TARGETED MOLECULAR THERAPIES ON THE LEVEL OF RENAL CELL CARCINOMA VENA CAVAL TUMOR THROMBUS Nicholas Cost, Scott Delacroix, Joshua Sleeper, Paul Smith, Ramy Youssef, Brian Chapin, Jose Karam, Stephen Culp, E. Jason Abel, James Brugarolas, Ganesh Raj, Arthur Sagalowsky, Christopher Wood, and Vitaly Margulis Nicholas CostNicholas Cost Dallas, TX More articles by this author , Scott DelacroixScott Delacroix Houston, TX More articles by this author , Joshua SleeperJoshua Sleeper Dallas, TX More articles by this author , Paul SmithPaul Smith Dallas, TX More articles by this author , Ramy YoussefRamy Youssef Dallas, TX More articles by this author , Brian ChapinBrian Chapin Houston, TX More articles by this author , Jose KaramJose Karam Houston, TX More articles by this author , Stephen CulpStephen Culp Houston, TX More articles by this author , E. Jason AbelE. Jason Abel Houston, TX More articles by this author , James BrugarolasJames Brugarolas Dallas, TX More articles by this author , Ganesh RajGanesh Raj Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , Christopher WoodChristopher Wood Houston, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2099AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tyrosine kinase inhibitors (TKIs) have demonstrated activity in RCC by reduction of the size of primary tumors and metastases. In this study, we assessed treatment effect of TKIs on IVC tumor thrombi. METHODS A multi-institutional database of patients treated with TKIs with in-situ primary RCC was reviewed, defining the thrombus level as: I = Renal Vein, II = IVC below hepatic veins, III = Intra-hepatic IVC below atrium, IV = Atrial. The subset of patients with an IVC thrombus (≥ Level II) was assessed for radiographic responses in thrombus size and location. We then described the pre and post-treatment characteristics of these patients. RESULTS In the 25 patients meeting our inclusion criteria, pre-therapy biopsy showed clear cell RCC in 19 and unclassified RCC in 6. Prior to initiation of targeted therapy, the tumor thrombus level was II in 18 (72%), III in 5 (20%) and IV in 2 (8%). The targeted therapy was Sunitinib in 12 cases and a combination of other agents in the remaining 13. Median duration of therapy was 2 months (range 1 to 9). Following systemic therapy, 7 (28%) had a measureable increase in the thrombus height above the renal vein, 7 (28%) had no change and 11 (44%) had a decrease. The mean change of the thrombus height was −0.6cm, median 0cm (−8.5 to 5), and the mean change of the thrombus diameter was −0.3cm, median −0.1cm (−1.6 to 0.9). The change in the tumor thrombus level classification after therapy was: 1 patient (4%) had an increase, 21 (84%) had stable thrombi and 3 (12%) had a decrease. In only 1 case (4%) the surgical approach was potentially affected by thrombus regression (level IV to III). Regression resulting in a change in the clinical level of the tumor thrombus was only seen in patients treated with Sunitinib. Yet, the change in thrombus height, diameter or clinical level classification between Sunitinib and non-Sunitinib patient cohorts did not reach statistical significance (Table). No statistically significant predictors of tumor thrombus response to targeted therapy were found. CONCLUSIONS Targeted therapy had minimal clinical effect on RCC tumor thrombi. Only patients treated with Sunitinib had measurable thrombus regression; however, the magnitude of this effect on the thrombus between the two groups was not statistically significant and is of unclear clinical relevance. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e710-e711 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Cost Dallas, TX More articles by this author Scott Delacroix Houston, TX More articles by this author Joshua Sleeper Dallas, TX More articles by this author Paul Smith Dallas, TX More articles by this author Ramy Youssef Dallas, TX More articles by this author Brian Chapin Houston, TX More articles by this author Jose Karam Houston, TX More articles by this author Stephen Culp Houston, TX More articles by this author E. Jason Abel Houston, TX More articles by this author James Brugarolas Dallas, TX More articles by this author Ganesh Raj Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Christopher Wood Houston, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...