TITLE:
Neoadjuvant Therapy for Locally Advanced Renal Cell Carcinoma with Sorafenib in a Reference Center in Mexico
AUTHORS:
Axel Costilla-Montero, Benjamín Guadarrama-Benítez, Marco A. Aragón-Castro, Omar Morales-Ordaz, Rubén Gutiérrez-Rosales, Claudia Carrillo-Ponce, Marcela Janka-Zires, Luis Gabriel Vázquez-Lavista
KEYWORDS:
Renal Cell Carcinoma, Antiagiogenic Drugs, Neoadyvant Therapy, Sorafenib
JOURNAL NAME:
Surgical Science,
Vol.2 No.6,
August
16,
2011
ABSTRACT: Background: neo - adjuvant therapy is usually indicated in locally advanced tumors, the aim is to decrease the tumoral burden and enhance overall survival. Renal cell carcinoma is a chemo and radio resistant neoplasm and this type of approach is not as effective as in other solid tumors. On the other hand immunotherapy is indicated in metastatic disease, demonstrating a better overall survival. Sorafenib is an antiangiogenic drug approved for locally advanced or metastatic RCC. We postulated that it can be used in a neoadjuvant way to decrease the vascularization of selected tumors. Report of the case: 57 years old male referred to our service with a right renal mass and metastatic disease to lumbar spine and suprarenal gland. He was treated with three months of sorafenib previous to the surgery. Results: The patient went into surgery three months after initiating the antiangiogenic drug, during the surgery we found less neo-formance vessels; the dissection was subjectively easier, due to peri-renal edema. The pathologic analysis of the specimen was renal cell carcinoma. Interestingly, 40% of central ischemic (coagulative) necrosis was found. Conclusion: There are no neoadjuvant drugs accepted for the treatment of renal cell carcinoma; using an antiagiogenic drug to decrease the vascular burden characteristic of this type of tumors could be a viable option in selected cases. We used a lower dose of the drug with an acceptable safety profile.