Pathologic response and surgical outcomes in patients undergoing nephrectomy following receipt of immune checkpoint inhibitors for renal cell carcinoma.
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Immunological
/ therapeutic use
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Biopsy
CTLA-4 Antigen
/ antagonists & inhibitors
Carcinoma, Renal Cell
/ immunology
Feasibility Studies
Female
Humans
Ipilimumab
/ therapeutic use
Kidney
/ pathology
Kidney Neoplasms
/ immunology
Male
Middle Aged
Neoadjuvant Therapy
/ methods
Nephrectomy
Nivolumab
/ therapeutic use
Programmed Cell Death 1 Receptor
/ antagonists & inhibitors
Retrospective Studies
Time-to-Treatment
Treatment Outcome
Complications
Immune checkpoint inhibitors
Nephrectomy
Renal cell carcinoma
Safety
Journal
Urologic oncology
ISSN: 1873-2496
Titre abrégé: Urol Oncol
Pays: United States
ID NLM: 9805460
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
19
04
2019
revised:
26
06
2019
accepted:
19
08
2019
pubmed:
17
9
2019
medline:
29
8
2020
entrez:
17
9
2019
Statut:
ppublish
Résumé
To evaluate the pathologic response, safety, and feasibility of nephrectomy following receipt of immune checkpoint inhibition (ICI) for renal cell carcinoma (RCC). Patients who underwent nephrectomy for RCC after exposure to nivolumab monotherapy or combination ipilimumab/nivolumab were reviewed. Primary surgical outcomes included operative time (OT), estimated blood loss (EBL), length of stay (LOS), readmission rates, and complication rates. Pathologic response in the primary and metastatic sites constituted secondary outcomes. Eleven nephrectomies (10 radical, 1 partial) were performed in 10 patients after ICI with median postoperative follow-up 180 days. Six patients received 1 to 4 cycles of ipilimumab/nivolumab, while 5 received 2 to 12 infusions of nivolumab preoperatively. Five surgeries were performed laparoscopically, and 4 patients underwent concomitant thrombectomy. One patient exhibited complete response (pT0) to ICI, and 3/4 patients who underwent metastasectomy for hepatic, pulmonary, or adrenal lesions exhibited no detectable malignancy in any of the metastases resected. No patients experienced any major intraoperative complications, and all surgical margins were negative. Median OT, EBL, and LOS were 180 minutes, 100 ml, and 4 days, respectively. Four patients experienced a complication, including 3 that were addressed with interventional radiology procedures. One patient died of progressive disease >3 months after surgery, and 1 patient succumbed to pulmonary embolism complicated by sepsis. No complications or readmissions were noted in 6 patients. Nephrectomy following ICI for RCC is safe and technically feasible with favorable surgical outcomes and pathologic response. Timing of the nephrectomy relative to checkpoint dosing did not seem to impact outcome. Biopsies of lesions responding radiographically to ICI may warrant attention prior to surgical excision.
Identifiants
pubmed: 31522865
pii: S1078-1439(19)30330-8
doi: 10.1016/j.urolonc.2019.08.012
pmc: PMC9489229
mid: NIHMS1835028
pii:
doi:
Substances chimiques
Antineoplastic Agents, Immunological
0
CTLA-4 Antigen
0
CTLA4 protein, human
0
Ipilimumab
0
PDCD1 protein, human
0
Programmed Cell Death 1 Receptor
0
Nivolumab
31YO63LBSN
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
924-931Subventions
Organisme : NCI NIH HHS
ID : T32 CA136515
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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