The authors present the first case report of pre-surgical axitinib treatment on primary renal tumor and vena cava thrombus. We report the case of a 78-year-old woman with renal cell carcinoma and inferior vena cava tumor thrombus, successfully downstaged with pre-surgical therapy with axitinib. A significant objective response was observed for tumor size and thrombus. After initiation of axitinib therapy, computed tomography showed a decrease, from 57 to 51 mm, in the maximal renal tumor diameter. The tumor thrombus had shortened to 42 mm and had moved to the inferior hepatic vein (Levels 4-3), thereby obviating the need for thoracotomy. The patient finally accepted surgical treatment. Our case was enabled to perform less surgery for advanced renal cell carcinoma with tumor thrombus using axitinib as a pre-surgical therapy.