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Case Report

The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature

1
Department of Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, 771 47 Olomouc, Czech Republic
2
Department of Urology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, 771 47 Olomouc, Czech Republic
3
Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, 771 47 Olomouc, Czech Republic
4
Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, 771 47 Olomouc, Czech Republic
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(8), 5475-5488; https://doi.org/10.3390/curroncol29080433
Received: 11 July 2022 / Accepted: 2 August 2022 / Published: 3 August 2022
(This article belongs to the Section Genitourinary Oncology)
Background: Renal cell carcinoma with sarcomatoid dedifferentiation represents a rare histological entity characterized by aggressive behavior, limited efficacy of tyrosine kinase inhibitors or mTOR inhibitors, and poor outcome. The immune checkpoint inhibitor therapy regimen combining ipilimumab with nivolumab represents a new standard of care for this patient population due to a hitherto unprecedented response rate and overall survival. On the other hand, the role of cytoreductive nephrectomy in metastatic renal cell carcinoma, in particular, with sarcomatoid histology, remains controversial. Patient and Methods: In the present case series, we report six patients with locally advanced or synchronous metastatic sarcomatoid renal cell carcinoma and intermediate or poor International Metastatic RCC Database Consortium (IMDC) risk score, five of whom were successfully subjected to cytoreductive nephrectomy. Results: All six patients received the combination regimen of ipilimumab with nivolumab. Five of these patients underwent upfront cytoreductive nephrectomy followed by systemic treatment without any significant delay, with a durable treatment outcome. Notably, two patients with poor prognostic features achieved a long-term major partial response to therapy. We also performed a review of the literature on optimal treatment strategies for patients with sarcomatoid renal cell carcinoma. Conclusion: Herein, we highlight the feasibility of performing cytoreductive nephrectomy in patients with intermediate/poor prognosis metastatic renal cell carcinoma with sarcomatoid dedifferentiation followed by immunotherapy with ipilimumab and nivolumab. To enhance the chances of immunotherapy success, cytoreductive nephrectomy should also be considered for patients presenting with a disease with adverse prognostic parameters. View Full-Text
Keywords: cytoreductive nephrectomy; renal cell carcinoma; sarcomatoid; immunotherapy; checkpoint inhibitors cytoreductive nephrectomy; renal cell carcinoma; sarcomatoid; immunotherapy; checkpoint inhibitors
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MDPI and ACS Style

Studentova, H.; Rusarova, N.; Ondruskova, A.; Zemankova, A.; Student, V., Jr.; Skanderova, D.; Melichar, B. The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature. Curr. Oncol. 2022, 29, 5475-5488. https://doi.org/10.3390/curroncol29080433

AMA Style

Studentova H, Rusarova N, Ondruskova A, Zemankova A, Student V Jr., Skanderova D, Melichar B. The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature. Current Oncology. 2022; 29(8):5475-5488. https://doi.org/10.3390/curroncol29080433

Chicago/Turabian Style

Studentova, Hana, Nikol Rusarova, Andrea Ondruskova, Anezka Zemankova, Vladimir Student Jr., Daniela Skanderova, and Bohuslav Melichar. 2022. "The Role of Cytoreductive Nephrectomy in Renal Cell Carcinoma with Sarcomatoid Histology: A Case Series and Review of the Literature" Current Oncology 29, no. 8: 5475-5488. https://doi.org/10.3390/curroncol29080433

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