Pulmonary Metastasectomy after Immune Checkpoint Inhibitors in Renal Cell Carcinoma

Abstract

The management of oligometastatic renal cell carcinoma with pulmonary metastases is controversial and occasionally requires multimodality management, including salvage pulmonary metastasectomy after immune checkpoint inhibitors (ICIs). However, limited data are available on these patients. We describe a case series of three consecutive patients who underwent salvage pulmonary metastasectomy after ICIs for oligometastatic renal cell carcinoma and discussed the important characteristics of these patients. After salvage pulmonary metastasectomy, none of the patients had recurrent pulmonary metastases, although one of them developed a brain metastasis postoperatively. Our case series suggests that salvage pulmonary metastasectomy after ICIs may control pulmonary metastases in carefully selected patients with oligometastatic renal cell carcinoma, although the management of extrapulmonary metastases may be required after salvage pulmonary metastasectomy.

Keywords

immune checkpoint inhibitors - metastatic tumor - surgery

Ethical Approval Statement

All the in the study procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all the patients for publication.

Publikationsverlauf

Eingereicht: 01. Juli 2024

Angenommen: 06. September 2024

Accepted Manuscript online:
09. September 2024

Artikel online veröffentlicht:
10. Oktober 2024

• References

• 1 National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Kidney cancer version 3. 2023 . Accessed January 8, 2023 at: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf
• 2 Japanese Urological Association. Clinical Practice Guideline for Renal Cancer. Accessed April 10, 2023 at: https://www.urol.or.jp/lib/files/other/guideline/33_renal_cancer_2017_rev2019.pdf
• 3 Escudier B, Porta C, Schmidinger M. et al; ESMO Guidelines Committee. Electronic address: [e-mail]. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019; 30 (05) 706-720
• 4 Chen F, Fujinaga T, Shoji T. et al. Pulmonary resection for metastasis from renal cell carcinoma. Interact Cardiovasc Thorac Surg 2008; 7 (05) 825-828
• 5 Murakami K, Hamaji M, Yoshizawa A, Date H. Salvage pulmonary metastasectomy with auto-transplantation after nivolumab. Eur J Cardiothorac Surg 2020; ezaa297
• 6 Kudelin N, Bölükbas S, Eberlein M, Schirren J. Metastasectomy with standardized lymph node dissection for metastatic renal cell carcinoma: an 11-year single-center experience. Ann Thorac Surg 2013; 96 (01) 265-270 , discussion 270–271
• 7 Cheung FP, Alam NZ, Wright GM. The past, present and future of pulmonary metastasectomy: a review article. Ann Thorac Cardiovasc Surg 2019; 25 (03) 129-141
• 8 Motzer RJ, Escudier B, McDermott DF. et al; CheckMate 025 Investigators. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med 2015; 373 (19) 1803-1813
• 9 George S, Motzer RJ, Hammers HJ. et al. Safety and efficacy of nivolumab in patients with metastatic renal cell carcinoma treated beyond progression: a subgroup analysis of a randomized clinical trial. JAMA Oncol 2016; 2 (09) 1179-1186
• 10 Ishihara H, Takagi T, Kondo T. et al. Prognostic impact of metastasectomy in renal cell carcinoma in the postcytokine therapy era. Urol Oncol 2021; 39 (01) 77.e17-77.e25
• 11 Mikhail M, Chua KJ, Khizir L, Tabakin A, Singer EA. Role of metastasectomy in the management of renal cell carcinoma. Front Surg 2022; 9: 943604