'Case of the Month' from Addenbrooke's Hospital, Cambridge, UK: surgery after near complete response to combined immunotherapy and tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma with inferior vena cava tumour thrombus.

Abstract

While systemic anti-cancer therapy (SACT) has become the principal management option for many patients with metastatic renal cell carcinoma (RCC), there remains debate on the benefits of delayed cytoreductive nephrectomy (CN), and on whether immediate CN and tumour thrombectomy is the correct strategy when there is venous tumour thrombus (VTT) extending into the IVC. Given the poor prognosis associated with untreated VTT, the risks of rapid progression and the sequalae from venous congestion or distal embolism, urgent extirpative surgery may be beneficial, dependent on patient fitness. Alternatively, given the high clinical response rates of modern immunotherapy (IO)-based systemic treatment, there has been interest in downstaging cases of locally advanced RCC (including those with VTT) with neoadjuvant therapy(1).