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GU Cancers 2021 | NAXIVA: axitinib for reducing VTT in RCC

Robert Jones, MD, PhD, University of Glasgow & Beatson West of Scotland Cancer Centre, Glasgow, UK, discusses the multicenter Phase II NAXIVA feasibility study (NCT03494816) of axitinib, a tyrosine kinase inhibitor, for reducing venous tumor thrombus (VTT) in patients with clear cell renal cell cancer (RCC) with venous invasion. This study demonstrated that neoadjuvant axitinib was effective in downstaging VTT and reduced the extent of surgery required in a significant number of patients, indicating its potential in reducing morbidity and mortality associated with invasive VTT surgery in RCC. This interview took place during the 2021 Genitourinary Cancers Symposium.

Transcript (edited for clarity)

NAXIVA was another UK National Cancer Research Institute trial. This was done in renal cancer and it was actually led by a urologist. And it’s exploring a novel concept for the use of drugs in renal cancer. Renal cancer, as we know, has a tendency to grow along the renal vein and into the inferior vena cava. And as soon as the tumor is in the inferior vena cava, then it produces substantial increased operative complexity and indeed, operative mortality...

NAXIVA was another UK National Cancer Research Institute trial. This was done in renal cancer and it was actually led by a urologist. And it’s exploring a novel concept for the use of drugs in renal cancer. Renal cancer, as we know, has a tendency to grow along the renal vein and into the inferior vena cava. And as soon as the tumor is in the inferior vena cava, then it produces substantial increased operative complexity and indeed, operative mortality. The further up the cava the tumor grows, the greater the surgical morbidity and mortality.

And so the idea here, is that we might be able to use drugs to shrink down the tumor, to bring it down the inferior vena cava and ultimately, to result in a less morbid surgery and hopefully therefore less peri-operative morbidity and mortality. It was a small single arm Phase II trial and it included patients both with and without metastases but the patients had to be planned for nephrectomy. It was a positive trial and it showed that there was, that there were a significant number of patients where the surgical intent was changed due to reduction in the extent of the inferior vena cava tumor thrombus.

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