[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-456626-105":59,"doc-detail-456626-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","neoadjuvant-avelumab-plus-axitinib-enabling-curative-resection-of-renal-cell-carcinoma-with-direct-liver-invasion-a-case-report","Neoadjuvant Avelumab Plus Axitinib Enabling Curative Resection of Renal Cell Carcinoma With Direct Liver Invasion - A Case Report","","Direct liver invasion by renal cell carcinoma (RCC) is uncommon and frequently prevents margin-negative surgery. This case report describes a 67-year-old woman with gross hematuria and a 70-mm right renal mass invading the liver, confirmed as clear-cell RCC at clinical stage cT4N0M0. Ten cycles of neoadjuvant avelumab plus axitinib reduced tumor size to 35 mm and enabled open radical nephrectomy with partial hepatectomy achieving negative margins. No adjuvant therapy followed, and disease control persisted for 24 months.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/neoadjuvant-avelumab-plus-axitinib-enabling-curative-resection-of-renal-cell-carcinoma-with-direct-liver-invasion-a-case-report/456626/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/neoadjuvant-avelumab-plus-axitinib-enabling-curative-resection-of-renal-cell-carcinoma-with-direct-liver-invasion-a-case-report/456626.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is direct liver invasion by RCC difficult to manage surgically?","Question",{"text":112,"@type":113},"Direct invasion of adjacent organs is rare but can significantly increase technical difficulty and often prevents margin-negative resection.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What neoadjuvant treatment was used in this case and how did it affect tumor size?",{"text":117,"@type":113},"The patient received ten cycles of avelumab (10 mg/kg every two weeks) plus axitinib (10 mg/day). The tumor shrank from 70 mm to 35 mm, supporting eligibility for complete resection.",{"name":119,"@type":110,"acceptedAnswer":120},"What surgery was performed and what were the outcomes?",{"text":121,"@type":113},"She underwent open radical nephrectomy with partial hepatectomy, achieving negative surgical margins. Histology showed hepatic parenchymal invasion with no viable tumor at the inked hepatic margin, and she remained disease-free for 24 months.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},456626,1791086760,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","IJU Case Reports  \n CASE REPORT  OPEN ACCESS   \nNeoadjuvant Avelumab Plus Axitinib Enabling Curative Resection of Renal Cell Carcinoma With Direct Liver Invasion: A Case Report  \nFumihiro Ito  | Koki Kobayashi | Gaku Hayashi | Shunsuke Kamijo | Takashi Fujita Department of Urology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan  \nCorrespondence: Fumihiro Ito ([doradora0381@gmail.com](doradora0381@gmail.com))  \nReceived: 30 August 2025 | Revised: 22 October 2025 | Accepted: 28 November 2025  \nKeywords: avelumab | axitinib | neoadjuvant therapy | renal cell carcinoma  \nABSTRACT  \nIntroduction: Direct liver invasion by renal cell carcinoma (RCC) is rare and often precludes margin-negative resection. Herein, we report a case where neoadjuvant treatment with avelumab plus axitinib downstaged the disease, enabling complete surgical resection.  \nCase Presentation: A 67-year-old woman presented with gross hematuria. Computed tomography revealed a 70-mm right renal mass with direct liver invasion. Core biopsy confirmed clear-cell RCC and clinical stage cT4N0M0 . She received ten cycles of avelumab (10 mg/kg, biweekly) plus axitinib (10 mg/day), resulting in tumor shrinkage to 35 mm. She underwent open radical nephrectomy with partial hepatectomy, achieving negative surgical margins. Histological examination revealed hepatic parenchymal invasion, with no viable tumor at the inked hepatic margin. Adjuvant therapy was not administered. The patient has remained disease-free for 24 months.  \nConclusion: In select cases of organ-invasive non-metastatic RCC, short-term neoadjuvant therapy with avelumab plus axitinib may allow for complete resection and prolonged disease control.  \n1 | Introduction  \nRenal cell carcinoma (RCC) accounts for 2%–3% of adult malignancies and most commonly metastasizes to the lungs, bones, and brain. Direct invasion of adjacent organs is rare and presents significant surgical challenges [1, 2] . Immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have transformed first-line treatment in advanced RCC, producing durable responses [3–5] . However, the neoadjuvant use of these regimens in organ-invasive, non-metastatic disease remains unestablished, withcurrent evidence limited to pilot studies and  \ninstitutional case series [6–10] . Here, we report a case of cT4 RCC with direct hepatic invasion that responded to neoadjuvantavelumab plus axitinib, allowing for R0 nephrectomy with partial hepatectomy.  \n2 | Case Presentation  \nA 67-year-old woman with an ECOG performance status score of 1 presented with gross hematuria. Laboratory findings revealed white blood cell 11 800/μL, hemoglobin 11.9 g/dL,  \n\n| Abbreviations: ALP, alkaline phosphatase; CRP, C-reactive protein; CT, computed tomography; CTCAE, Common Terminology Criteria for Adverse Events; ECOG, Eastern Cooperative Oncology Group; H&E, hematoxylin and eosin; ICI, immune checkpoint inhibitor; IMDC, International Metastatic RCC Database Consortium; IO, immuno-oncology; ISUP, International Society of Urological Pathology; PD-L1, programmed death-ligand 1; RCC, renal cell carcinoma; RECIST, Response Evaluation Criteria in Solid Tumors; TKI, tyrosine kinase inhibitor; VEGFR, vascular endothelial growth factor receptor; WBC, white blood cell; WHO, World Health Organization. |\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.\u003Cbr>© 2026 The Author(s). IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association. |\n\nIJU Case Reports, 2026; 9:e70124 1 of 5  \n[https://doi.org/10.1002/iju5.70124](https://doi.org/10.1002/iju5.70124)  \nKeynote Message  \n(1) Locally advanced renal cell carcinoma with hepatic invasion is rare and technically challenging to treat. (2) Neoadjuvant avelumab plus axit","cbCailOyYqrI63fd","https://ap.wps.com/l/cbCailOyYqrI63fd","pdf",671045,"English","# Introduction\n## Case Presentation\n## Conclusion\n# Keynote Message","[{\"question\":\"Why is direct liver invasion by RCC difficult to manage surgically?\",\"answer\":\"Direct invasion of adjacent organs is rare but can significantly increase technical difficulty and often prevents margin-negative resection.\"},{\"question\":\"What neoadjuvant treatment was used in this case and how did it affect tumor size?\",\"answer\":\"The patient received ten cycles of avelumab (10 mg/kg every two weeks) plus axitinib (10 mg/day). The tumor shrank from 70 mm to 35 mm, supporting eligibility for complete resection.\"},{\"question\":\"What surgery was performed and what were the outcomes?\",\"answer\":\"She underwent open radical nephrectomy with partial hepatectomy, achieving negative surgical margins. Histology showed hepatic parenchymal invasion with no viable tumor at the inked hepatic margin, and she remained disease-free for 24 months.\"}]","Neoadjuvant Avelumab Plus Axitinib Enabling Curative Resection of Renal Cell Carcinoma With Direct Liver Invasion - A Case Report | PDF",1790746545,13]