Neoadjuvant Therapy Of Molecular Targeted Drug On Patients With Advanced Renal Cell Carcinoma

In this research, we study the feasibility and safety of sunitinib and sorafenib taken as new auxiliary drugs to treat renal cell carcinoma(RCC) on late radical resection surgery. Fifty patients who could not be performed primary lesion resection due to advanced tumor or transitivity were screened and neoadjuvant therapy was conducted with molecular targeted drug. Among them, 28 cases were treated with 50 mg sunitinib 50 mg/d and 22 cases were treated with sorafenib 800 mg/d. It went go for 4 weeks and followed by 2 weeks off, which was one cycle. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors(RECIST) every 2 cycles and the rate of conversion to respectable status was estimated. Average age of patients was 54.5±0.5 years and initial median radiographic renal tumor size was 10.7±0.08 cm. No patients experienced a complete response(CR). Partial responses(PR) of the primary tumor were noted in 19 patients(38%), 27 had stable disease(SD, 54%) and 4 had disease progression(PD, 8%) in the primary tumor. The objective response rate(ORR)(CR+PR) and dynamic contrast ratio(CR+PR+SD) was 38% and 92%, respectively. At a median follow up of 10 months, 38 patients reached to the surgery standard and 34 patients had undergone nephrectomy(68%). Moreover, 34 patients whose sex ratio, tumor staging and general conditions were almost the same were selected as the control. Patients in the control were not performed neoadjuvant therapy. Among them, 28 cases were performed curative resection and 6 cases treated with palliative operation. Patients in experimental group and the control were followed up for 3 years. Three-year survival rate of patients in experimental group(41.18%) was evidently higher than that in the control(26.47%)(P=0.027) and three-year progression-free survival in experimental group(5.9%) was also markedly higher than that in the control(2.9%)(P=0.023). Therefore, we concluded that the administration of sunitinib in patients of advanced renal cell carcinoma with the primary tumor in place could reduce the size of tumor and thus further facilitated subsequent surgical resection.