Preoperative ipilimumab/nivolumab combination therapy reduced operation risk by downstaging the inferior vena cava tumor thrombus extending to the right atrium in a metastatic renal cell carcinoma: A case report

Hikari Otsuka; Kimihiko Masui; Toshihide Hosomi; Yuki Makino; Noboru Shibasaki; Yasumasa Shichiri

doi:10.1016/j.eucr.2021.101912

Preoperative ipilimumab/nivolumab combination therapy reduced operation risk by downstaging the inferior vena cava tumor thrombus extending to the right atrium in a metastatic renal cell carcinoma: A case report

Urol Case Rep. 2021 Oct 23:40:101912. doi: 10.1016/j.eucr.2021.101912. eCollection 2022 Jan.

Authors

Hikari Otsuka¹, Kimihiko Masui², Toshihide Hosomi¹, Yuki Makino¹, Noboru Shibasaki¹, Yasumasa Shichiri¹

Affiliations

¹ Department of Urology, Otsu City Hospital, Japan.
² Department of Urology, Kyoto University Hospital, Japan.

Abstract

The success of immune checkpoint inhibitors in metastatic renal cell carcinoma (RCC) has renewed interest in studying these agents in preoperative settings. Here, we present a case of metastatic RCC with an inferior vena cava (IVC) tumor thrombus extending to the right atrium. Preoperative systemic therapy with ipilimumab/nivolumab was initiated for four cycles. The IVC tumor thrombus level was significantly downstaged from IV to I according to the Mayo classification, which enabled us to perform cytoreductive nephrectomy and IVC thrombectomy without extracorporeal circulation. Preoperative ipilimumab/nivolumab may lead to significant downstaging of caval tumor thrombus in metastatic RCC.

Keywords: Ipilimumab/nivolumab; Preoperative treatment; Renal cell carcinoma; Tumor thrombus; computed tomography, CT; cytoreductive nephrectomy, CN; immune checkpoint inhibitors, ICIs; inferior vena cava, IVC; magnet resonance imaging, MRI; overall survival, OS; renal cell carcinoma, RCC.

Publication types

Case Reports