Neoadjuvant Avelumab Plus Axitinib Enabling Curative Resection of Renal Cell Carcinoma With Direct Liver Invasion: A Case Report.

Introduction: 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. Case 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. Conclusion: 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.