1
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Zhang Z, Gao Z, Fang H, Zhao Y, Xing R. Therapeutic importance and diagnostic function of circRNAs in urological cancers: from metastasis to drug resistance. Cancer Metastasis Rev 2024; 43:867-888. [PMID: 38252399 DOI: 10.1007/s10555-023-10152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/31/2023] [Indexed: 01/23/2024]
Abstract
Circular RNAs (circRNAs) are a member of non-coding RNAs with no ability in encoding proteins and their aberrant dysregulation is observed in cancers. Their closed-loop structure has increased their stability, and they are reliable biomarkers for cancer diagnosis. Urological cancers have been responsible for high mortality and morbidity worldwide, and developing new strategies in their treatment, especially based on gene therapy, is of importance since these malignant diseases do not respond to conventional therapies. In the current review, three important aims are followed. At the first step, the role of circRNAs in increasing or decreasing the progression of urological cancers is discussed, and the double-edged sword function of them is also highlighted. At the second step, the interaction of circRNAs with molecular targets responsible for urological cancer progression is discussed, and their impact on molecular processes such as apoptosis, autophagy, EMT, and MMPs is highlighted. Finally, the use of circRNAs as biomarkers in the diagnosis and prognosis of urological cancer patients is discussed to translate current findings in the clinic for better treatment of patients. Furthermore, since circRNAs can be transferred to tumor via exosomes and the interactions in tumor microenvironment provided by exosomes such as between macrophages and cancer cells is of importance in cancer progression, a separate section has been devoted to the role of exosomal circRNAs in urological tumors.
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Affiliation(s)
- Zhibin Zhang
- College of Traditional Chinese Medicine, Chengde Medical College, Chengde, 067000, Hebei, China.
| | - Zhixu Gao
- Chengde Medical College, Chengde, 067000, Hebei, China
| | - Huimin Fang
- Chengde Medical College, Chengde, 067000, Hebei, China
| | - Yutang Zhao
- Chengde Medical College, Chengde, 067000, Hebei, China
| | - Rong Xing
- Chengde Medical College, Chengde, 067000, Hebei, China
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2
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Marciano Y, del Solar V, Nayeem N, Dave D, Son J, Contel M, Ulijn RV. Encapsulation of Gold-Based Anticancer Agents in Protease-Degradable Peptide Nanofilaments Enhances Their Potency. J Am Chem Soc 2023; 145:234-246. [PMID: 36542079 PMCID: PMC10720394 DOI: 10.1021/jacs.2c09820] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated the use of amphiphilic, protease-cleavable peptides as encapsulation moieties for hydrophobic metallodrugs, in order to enhance their bioavailability and consequent activity. Two hydrophobic, gold-containing anticancer agents varying in aromatic ligand distribution (Au(I)-N-heterocyclic carbene compounds 1 and 2) were investigated. These were encapsulated into amphiphilic decapeptides that form soluble filamentous structures with hydrophobic cores, varying supramolecular packing arrangements and surface charge. Peptide sequence strongly dictates the supramolecular packing within the aromatic core, which in turn dictates drug loading. Anionic peptide filaments can effectively load 1, and to a lesser extent 2, while their cationic counterparts could not, collectively demonstrating that loading efficiency is dictated by both aromatic and electrostatic (mis)matching between drug and peptide. Peptide nanofilaments were nontoxic to cancerous and noncancerous cells. By contrast, those loaded with 1 and 2 displayed enhanced cytotoxicity in comparison to 1 and 2 alone, when exposed to Caki-1 and MDA-MB-231 cancerous cell lines, while no cytotoxicity was observed in noncancerous lung fibroblasts, IMR-90. We propose that the enhanced in vitro activity results from the enhanced proteolytic activity in the vicinity of the cancer cells, thereby breaking the filaments into drug-bound peptide fragments that are taken up by these cells, resulting in enhanced cytotoxicity toward cancer cells.
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Affiliation(s)
- Yaron Marciano
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Virginia del Solar
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Nazia Nayeem
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program inBiology, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Dhwanit Dave
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Department of Chemistry, Hunter College, CUNY, 695 Park Avenue, New York, NY 10065, USA
| | - Jiye Son
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
| | - María Contel
- Department of Chemistry, Brooklyn College, CUNY, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program in Biochemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program inBiology, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
| | - Rein V. Ulijn
- Nanoscience Initiative, Advanced Science Research Center at The Graduate Center of the City University of New York (CUNY), 85 Saint Nicholas Terrace, New York, NY 10031, USA
- Ph.D. Program in Chemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Ph.D. Program in Biochemistry, The Graduate Center of CUNY, 365 Fifth Avenue, New York, NY 10016, USA
- Department of Chemistry, Hunter College, CUNY, 695 Park Avenue, New York, NY 10065, USA
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3
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Inflammation in Urological Malignancies: The Silent Killer. Int J Mol Sci 2023; 24:ijms24010866. [PMID: 36614308 PMCID: PMC9821648 DOI: 10.3390/ijms24010866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
Several studies have investigated the role of inflammation in promoting tumorigenesis and cancer progression. Neoplastic as well as surrounding stromal and inflammatory cells engage in well-orchestrated reciprocal interactions to establish an inflammatory tumor microenvironment. The tumor-associated inflammatory tissue is highly plastic, capable of continuously modifying its phenotypic and functional characteristics. Accumulating evidence suggests that chronic inflammation plays a critical role in the development of urological cancers. Here, we review the origins of inflammation in urothelial, prostatic, renal, testicular, and penile cancers, focusing on the mechanisms that drive tumor initiation, growth, progression, and metastasis. We also discuss how tumor-associated inflammatory tissue may be a diagnostic marker of clinically significant tumor progression risk and the target for future anti-cancer therapies.
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Elie BT, Hubbard K, Layek B, Yang WS, Prabha S, Ramos JW, Contel M. Auranofin-Based Analogues Are Effective Against Clear Cell Renal Carcinoma In Vivo and Display No Significant Systemic Toxicity. ACS Pharmacol Transl Sci 2020. [PMID: 32832867 DOI: 10.1021/acsptsci.9b00107/asset/images/large/pt9b00107_0002.jpeg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Effective pharmacological treatments for patients with advanced clear cell renal carcinoma (ccRCC) are limited. Bimetallic titanium-gold containing compounds exhibit significant cytotoxicity against ccRCC in vitro and in vivo and inhibit invasion and angiogenisis in vitro and markers driving these phenomena. However, in vivo preclinical evaluations of such compounds have not examined their pharmacokinetics, pathology, and hematology. Here we use NOD.CB17-Prkdc SCID/J mice bearing xenograft ccRCC Caki-1 tumors to evaluate the in vivo efficacies of two titanium-gold compounds Titanocref and Titanofin (based on auranofin analogue scaffolds) accompanied by pharmacokinetic and pathology studies. A therapeutic trial was performed over 21 days at 5 mg/kg/72h of Titanocref and 10 mg/kg/72h of Titanofin tracking changes in tumor size. We observed a significant reduction of 51% and 60%, respectively (p < 0.01) in tumor size in the Titanocref- and Titanofin-treated mice compared to the starting size, while the vehicle-treated mice exhibited a tumor size increase of 138% (p < 0.01). Importantly, no signs of pathological complication as a result of treatment were found. In addition, Titanocref and Titanofin treatment reduced angiogenesis by 38% and 54%, respectively. Microarray and qRT-PCR analysis of ccRCC Caki-1 cells treated with Titanocref revealed that the compound alters apoptosis, JNK MAP kinase, and ROS pathways within 3 h of treatment. We further show activation of apoptosis by Titanocref and Titanofin in vivo by caspase 3 assay. Titanocref is active against additional kidney cancer cells. Titanocref and Titanofin are therefore promising candidates for further evaluation toward clinical application in the treatment of ccRCC.
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Affiliation(s)
- Benelita T Elie
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States
| | - Karen Hubbard
- Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Department of Biology, City College of New York, The City University of New York, New York, New York 10031, United States
| | - Buddhadev Layek
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Won Seok Yang
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Swayam Prabha
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Joe W Ramos
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Maria Contel
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
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5
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Elie BT, Hubbard K, Layek B, Yang WS, Prabha S, Ramos JW, Contel M. Auranofin-Based Analogues Are Effective Against Clear Cell Renal Carcinoma In Vivo and Display No Significant Systemic Toxicity. ACS Pharmacol Transl Sci 2020; 3:644-654. [PMID: 32832867 DOI: 10.1021/acsptsci.9b00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Indexed: 01/03/2023]
Abstract
Effective pharmacological treatments for patients with advanced clear cell renal carcinoma (ccRCC) are limited. Bimetallic titanium-gold containing compounds exhibit significant cytotoxicity against ccRCC in vitro and in vivo and inhibit invasion and angiogenisis in vitro and markers driving these phenomena. However, in vivo preclinical evaluations of such compounds have not examined their pharmacokinetics, pathology, and hematology. Here we use NOD.CB17-Prkdc SCID/J mice bearing xenograft ccRCC Caki-1 tumors to evaluate the in vivo efficacies of two titanium-gold compounds Titanocref and Titanofin (based on auranofin analogue scaffolds) accompanied by pharmacokinetic and pathology studies. A therapeutic trial was performed over 21 days at 5 mg/kg/72h of Titanocref and 10 mg/kg/72h of Titanofin tracking changes in tumor size. We observed a significant reduction of 51% and 60%, respectively (p < 0.01) in tumor size in the Titanocref- and Titanofin-treated mice compared to the starting size, while the vehicle-treated mice exhibited a tumor size increase of 138% (p < 0.01). Importantly, no signs of pathological complication as a result of treatment were found. In addition, Titanocref and Titanofin treatment reduced angiogenesis by 38% and 54%, respectively. Microarray and qRT-PCR analysis of ccRCC Caki-1 cells treated with Titanocref revealed that the compound alters apoptosis, JNK MAP kinase, and ROS pathways within 3 h of treatment. We further show activation of apoptosis by Titanocref and Titanofin in vivo by caspase 3 assay. Titanocref is active against additional kidney cancer cells. Titanocref and Titanofin are therefore promising candidates for further evaluation toward clinical application in the treatment of ccRCC.
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Affiliation(s)
- Benelita T Elie
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States
| | - Karen Hubbard
- Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Department of Biology, City College of New York, The City University of New York, New York, New York 10031, United States
| | - Buddhadev Layek
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Won Seok Yang
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Swayam Prabha
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota 55455, United States
| | - Joe W Ramos
- University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
| | - Maria Contel
- Department of Chemistry, Brooklyn College, The City University of New York, Brooklyn, New York 11210, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,Biology, Chemistry and Biochemistry PhD Programs, The Graduate Center, The City University of New York, New York, New York 10016, United States.,University of Hawaii Cancer Center, Honolulu, Hawaii 96813, United States
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6
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Xu Z, Li X, Qi F, Hu X, Zheng Y, Cai H, Xu T, Yu B, Zou Q. A new strategy for the treatment of sorafenib-refractory metastatic renal cell carcinoma in China: combination with intermittent chemotherapy. Transl Androl Urol 2019; 8:339-345. [PMID: 31555557 DOI: 10.21037/tau.2019.06.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background This study assesses the clinical safety and efficacy of Gemcitabine and S-1 combination chemotherapy in sorafenib-refractory metastatic renal cell carcinoma (RCC) patients. Methods The baseline characteristics and survival outcomes of 19 patients suffering from metastatic and progressive sorafenib-refractory RCC were retrospectively collected and analyzed from January 2010 to April 2014. Patients were treated by combining Gemcitabine (1,000 mg/m2, day 1 and day 8 of every cycle of 21 days) and S-1 (40 mg/m2, twice a day for 14 days, followed by the rest period of 7 days), with a continual treatment of sorafenib 400 mg twice a day in a cycle of 28 days. Results After combination chemotherapy, the disease control rate was 68.4%. Among them, 6 patients (31.6%) had progressive disease (PD), 5 patients (26.3%) had stable disease (SD) and 8 patients (42.1%) had partial response (PR). The median time to progression (TTP) was 6.3 months (range, 2.0-32.7 months), and the median overall survival (OS) was 19.7 months (range, 5.7-45.0 months). In the survival analysis, comparing PD group, disease control (PR + SD) group showed an obviously longer TTP (median TTP: 9.5 vs. 2.0 months, 95% CI, 7.7-11.3 months, P<0.001) and OS (median OS: 21.0 vs. 8.3 months, 95% CI, 14.5-24.9 months, P<0.001). In univariate and multivariate analysis, TTP and OS were significantly associated with disease control condition. Side-effects were found in all patients at different degree, but only 3 patients suffered grade 3/4 toxicities (15.8%). No death related to treatment was observed. Conclusions The combination chemotherapy could be a promising treatment option for advanced metastatic RCC (mRCC) patients after sorafenib refractory.
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Affiliation(s)
- Zicheng Xu
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Xiao Li
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Feng Qi
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xin Hu
- Department of Urology, First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yuxiao Zheng
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Hongzhou Cai
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Ting Xu
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Bin Yu
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Qing Zou
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
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7
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Elie BT, Hubbard K, Pechenyy Y, Layek B, Prabha S, Contel M. Preclinical evaluation of an unconventional ruthenium-gold-based chemotherapeutic: RANCE-1, in clear cell renal cell carcinoma. Cancer Med 2019; 8:4304-4314. [PMID: 31192543 PMCID: PMC6675714 DOI: 10.1002/cam4.2322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There are few effective treatments for patients with advanced clear cell renal cell carcinoma (CCRCC). Recent findings indicate that ruthenium-gold containing compounds exhibit significant antitumor efficacy against CCRCC in vitro affecting cell viability as well as angiogenesis and markers driving those 2 phenomena. However, no in vivo preclinical evaluation of this class of compounds has been reported. METHODS Following the dose-finding pharmacokinetic determination, NOD.CB17-Prkdc SCID/J mice bearing xenograft CCRCC Caki-1 tumors were treated in an intervention trial for 21 days at 10 mg/kg/72h of RANCE-1. At the end of the trial, tumor samples were analyzed for histopathological and changes in protein expression levels were assessed. RESULTS After 21 days of treatment there was no significant change in tumor size in the RANCE-1-treated mice as compared to the starting size (+3.87%) (P = 0.082) while the vehicle treated mice exhibited a significant tumor size increase (+138%) (P < 0.01). There were no signs of pathological complications as a result of treatment. Significant reduction in the expression of VEGF, PDGF, FGF, EGFR, and HGRF, all key to the proliferation of tumor cells and stromal cells serving protumorigenic purposes was observed. CONCLUSIONS The tumor growth inhibition displayed and favorable pathology profile of RANCE-1 makes it a promising candidate for further evaluation toward clinical use for the treatment of advanced CCRCC.
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Affiliation(s)
- Benelita T. Elie
- Department of ChemistryBrooklyn College, The City University of New YorkBrooklynNew York
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
| | - Karen Hubbard
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Department of BiologyCity College of New York, The City University of New YorkNew YorkNew York
| | - Yuriy Pechenyy
- Department of BiologyCity College of New York, The City University of New YorkNew YorkNew York
| | - Buddhadev Layek
- University of Minnesota College of PharmacyMinneapolisMinnesota
| | - Swayam Prabha
- University of Minnesota College of PharmacyMinneapolisMinnesota
| | - Maria Contel
- Department of ChemistryBrooklyn College, The City University of New YorkBrooklynNew York
- Biology PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Chemistry PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
- Biochemistry PhD Program, The Graduate CenterThe City University of New YorkNew YorkNew York
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8
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Bilen MA, Carlisle JW, Sonpavde G. The prospects for combination therapy with capecitabine in the rapidly evolving treatment landscape of renal cell carcinoma. Expert Opin Investig Drugs 2018; 27:163-170. [PMID: 29323560 DOI: 10.1080/13543784.2018.1427731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although significant advances have been made in the treatment of advanced renal cell carcinoma (RCC), patients still develop resistance to standard therapies and require the administration of subsequent lines of treatment. New therapeutic approaches are thus imperative to improve the prognosis for patients with RCC. AREAS COVERED Based on the current literature, we summarize the treatment of metastatic RCC, including the use of cytotoxic chemotherapy, in this review article. We also review the existing scientific literature regarding the role of capecitabine in the treatment of RCC. EXPERT OPINION Currently, targeted therapies including vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors are widely used in the treatment of metastatic RCC. More recently, the role of immune checkpoint inhibitors has been established in the treatment of advanced RCC. Traditionally, the use of cytotoxic chemotherapy in the treatment of RCC is limited. However, cytotoxic chemotherapy may have benefit in different types of RCC, such as variant histology. Furthermore, new combinations of chemotherapy with immune checkpoint inhibitors may provide new treatment options for our patients.
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Affiliation(s)
- Mehmet Asim Bilen
- a Department of Hematology and Medical Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - Jennifer W Carlisle
- a Department of Hematology and Medical Oncology , Winship Cancer Institute of Emory University , Atlanta , GA , USA
| | - Guru Sonpavde
- b Department of Medicine, Division of Hematology and Oncology , University of Alabama at Birmingham Comprehensive Cancer Center , Birmingham , AL , USA
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9
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Das S, da Silva CJ, Silva MDM, Dantas MDDA, de Fátima Â, Góis Ruiz ALT, da Silva CM, de Carvalho JE, Santos JCC, Figueiredo IM, da Silva-Júnior EF, de Aquino TM, de Araújo-Júnior JX, Brahmachari G, Modolo LV. Highly functionalized piperidines: Free radical scavenging, anticancer activity, DNA interaction and correlation with biological activity. J Adv Res 2017; 9:51-61. [PMID: 30046486 PMCID: PMC6057241 DOI: 10.1016/j.jare.2017.10.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Twenty-five piperidines were studied as potential radical scavengers and antitumor agents. Quantitative interaction of compounds with ctDNA using spectroscopic techniques was also evaluated. Our results demonstrate that the evaluated piperidines possesses different abilities to scavenge the radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) and the anion radical superoxide (•O2−). The piperidine 19 was the most potent radical DPPH scavenger, while the most effective to •O2− scavenger was piperidine 10. In general, U251, MCF7, NCI/ADR-RES, NCI-H460 and HT29 cells were least sensitive to the tested compounds and all compounds were considerably more toxic to the studied cancer cell lines than to the normal cell line HaCaT. The binding mode of the compounds and ctDNA was preferably via intercalation. In addition, these results were confirmed based on theoretical studies. Finally, a linear and exponential correlation between interaction constant (Kb) and GI50 for several human cancer cell was observed.
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Affiliation(s)
- Suvankar Das
- Department of Chemistry, Visva-Bharati (a Central University), Santiniketan 731 235, West Bengal, India
| | - Cristiane J da Silva
- Department of Botany, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marina de M Silva
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | | | - Ângelo de Fátima
- Department of Chemistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Lúcia T Góis Ruiz
- Chemical, Biological and Agricultural Pluridisciplinary Research Center, Universidade Estadual de Campinas, Paulínia, SP, Brazil
| | - Cleiton M da Silva
- Department of Chemistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Ernesto de Carvalho
- Chemical, Biological and Agricultural Pluridisciplinary Research Center, Universidade Estadual de Campinas, Paulínia, SP, Brazil
| | - Josué C C Santos
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Isis M Figueiredo
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Edeildo F da Silva-Júnior
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil.,Laboratory of Medicinal Chemistry, Nursing and Pharmacy School, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Thiago M de Aquino
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil.,Laboratory of Medicinal Chemistry, Nursing and Pharmacy School, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - João X de Araújo-Júnior
- Institute of Chemistry and Biotechnology, Universidade Federal de Alagoas, Maceió, AL, Brazil.,Laboratory of Medicinal Chemistry, Nursing and Pharmacy School, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Goutam Brahmachari
- Department of Chemistry, Visva-Bharati (a Central University), Santiniketan 731 235, West Bengal, India
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10
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Maiti A, Nemati-Shafaee M, Msaouel P, Pagliaro LC, Jonasch E, Tannir NM, Shah AY. Phase 2 Trial of Capecitabine, Gemcitabine, and Bevacizumab in Sarcomatoid Renal-Cell Carcinoma. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30238-0. [PMID: 28870517 PMCID: PMC5809227 DOI: 10.1016/j.clgc.2017.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with sarcomatoid renal-cell carcinomas (sRCC) have poor outcomes and limited treatment options. Preclinical and clinical data suggest susceptibility to cytotoxic agents and vascular endothelial growth factor-targeted therapies. We designed a phase 2 trial to evaluate the efficacy and safety of capecitabine, gemcitabine, and bevacizumab in sRCC. PATIENTS AND METHODS Patients with metastatic or unresectable sRCC were eligible for inclusion. Patients received oral capecitabine 800 mg/m2 twice daily on days 1 to 21 of a 28-day cycle, intravenous gemcitabine 900 mg/m2 on days 1 and 15, and intravenous bevacizumab 10 mg/kg on days 1 and 15. Primary end points were progression-free survival and time to treatment failure (TTF). Secondary end points were safety, objective response rate, and overall survival. RESULTS Thirty-four patients were enrolled onto the trial. One patient was excluded from survival analysis and 4 from response analysis as a result of missing data. Median progression-free survival was 5.5 months (95% confidence interval [CI], 3.4-7.7), median TTF was 4.2 months (95% CI, 2.4-6.0), and median overall survival was 12 months (95% CI, 10.6-13.4). Objective response rate was 20% (5 partial responses, 1 complete response), and disease control rate was 73%. Thirty-one (91%) of the 34 patients discontinued treatment. The most common reason for treatment discontinuation was progressive disease, which occurred in 24 patients (71%). The most common grade 3 toxicity was rash (including hand-foot syndrome) in 24% patients. CONCLUSION The combination of capecitabine, gemcitabine, and bevacizumab is an option for patients with sRCC; however, response rates are low. Novel therapies are needed to improve outcomes in patients with sRCC.
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Affiliation(s)
- Abhishek Maiti
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Pavlos Msaouel
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Abstract
INTRODUCTION With an increasing incidence, over half a million cases of head and neck cancer (HNC) are diagnosed annually worldwide. Various chemotherapeutic agents are utilized to achieve adequate locoregional control. Cisplatin, fluorouracil (FU), and taxanes are often used to treat HNC but these regimens have shown high toxicity and poor patient compliance. Capecitabine is an orally administered prodrug that is preferentially converted to FU in tumor cells in comparison to normal cells. AREA COVERED In this review, the authors evaluate the role of capecitabine in radical and palliative settings either alone or in combination with other chemotherapeutic drugs in the management of HNC. In addition, metabolic conversion, pharmacokinetics, pharmacodynamics, and toxicity profile of capecitabine are discussed. EXPERT OPINION Various phase II trials conducted on capecitabine in the management of recurrent HNC have shown comparable results and tolerable toxic effects especially in pre-treated fragile patients. Capecitabine, used in induction or concurrent settings in the radical management of locoregionally advanced HNC, have also shown promising results. Randomized trials are needed to validate the role of capecitabine in the management of HNC.
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Affiliation(s)
- Hassan Iqbal
- a Department of Otolaryngology - Head and Neck Surgery , The Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Quintin Pan
- a Department of Otolaryngology - Head and Neck Surgery , The Ohio State University Wexner Medical Center and Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
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12
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Flavin K, Vasdev N, Ashead J, Lane T, Hanbury D, Nathan P, Gowrie-Mohan S. Perioperative Considerations in Metastatic Renal Cell Carcinoma. Rev Urol 2016; 18:133-142. [PMID: 27833463 PMCID: PMC5102929 DOI: 10.3909/riu0697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with metastatic renal cell carcinoma are complex, with the potential for significant complications, and require extensive pre-, peri-, and postoperative management. This article discusses, in depth, the necessary considerations in the treatment of these patients.
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Affiliation(s)
| | | | | | - Tim Lane
- NHS North Central London London, UK
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13
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Diamond E, Molina AM, Carbonaro M, Akhtar NH, Giannakakou P, Tagawa ST, Nanus DM. Cytotoxic chemotherapy in the treatment of advanced renal cell carcinoma in the era of targeted therapy. Crit Rev Oncol Hematol 2015; 96:518-26. [PMID: 26321263 DOI: 10.1016/j.critrevonc.2015.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/26/2015] [Accepted: 08/05/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a heterogeneous disease with regards to histology, progression, and response to treatment. Cytotoxic chemotherapy has been extensively studied in metastatic RCC (mRCC). Responses in most studies are modest and the mechanisms of resistance remain poorly understood. Targeted therapies have significantly improved outcomes in mRCC; however, most patients eventually relapse and die of their disease. Early clinical data suggest that combinations of chemotherapy and targeted agents are clinically active and are well tolerated. METHODS We reviewed the available literature for published clinical trials incorporating traditional chemotherapeutic agents in the treatment of mRCC. These papers were identified through a Medline search and were included if they employed at least one chemotherapeutic agent in the treatment of mRCC. The literature was also reviewed for information regarding mechanisms of chemotherapy resistance. RESULTS The data regarding the use of cytotoxic chemotherapy in mRCC consist of small, non-randomized phase I and II studies. The major response proportions with single agent chemotherapies are low but combination regimens either with other cytotoxic agents, cytokines, or targeted agents have demonstrated moderate activity. Disparate trial designs and lack of head to head clinical trials make it difficult to compare the efficacy of chemotherapy with that of immunotherapy or targeted agents. Chemotherapy is particularly useful in patients with collecting duct histology and predominantly sarcomatoid differentiation. Chemotherapy resistance may be mediated by overexpression of p-glycoprotein efflux pumps and the dysregulation of the microtubule-hypoxia inducible factor signaling axis. CONCLUSIONS The role of cytotoxic chemotherapy in the treatment for clear cell RCC remains poorly defined. Cytotoxic chemotherapy is considered a standard of care in patients with mRCC with predominantly sarcomatoid differentiation and collecting duct RCC variants (Motzer et al., 2014). Early trials combining chemotherapy with targeted therapies are generally well tolerated and show clinical activity. A better understanding of the biology of aggressive subsets of RCC and mechanisms of resistance will help elucidate the role of cytotoxic agents in the current treatment paradigm of RCC.
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Affiliation(s)
- E Diamond
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A M Molina
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M Carbonaro
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - N H Akhtar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - P Giannakakou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - S T Tagawa
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - D M Nanus
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Bharthuar A, Pandey H, Sood S. Management of metastatic renal cell carcinoma - mini review. J Kidney Cancer VHL 2015; 2:75-83. [PMID: 28326262 PMCID: PMC5345543 DOI: 10.15586/jkcvhl.2015.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/03/2015] [Indexed: 12/05/2022] Open
Abstract
The management of metastatic renal cell carcinoma (mRCC) has evolved considerably in the last decade. A number of different systemic molecular targeted agents that have been recently approved have improved the survival of patients with mRCC. This mini-review focuses on the implementation of multi-modality therapy in the management of mRCC and the approved indications of the various available novel agents. These novel agents have expanded our armamentarium and improved clinical outcomes of this challenging disease that has considerable biological heterogeneity and clinical variability.
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Affiliation(s)
- Anubha Bharthuar
- Department of Medical Oncology and Hematology; Department of Urology, Patel Cancer and Superspeciality Hospital, Jalandhar City, Punjab, INDIA
| | - Himanshu Pandey
- Department of Medical Oncology and Hematology; Department of Urology, Patel Cancer and Superspeciality Hospital, Jalandhar City, Punjab, INDIA
| | - Swapan Sood
- Department of Medical Oncology and Hematology; Department of Urology, Patel Cancer and Superspeciality Hospital, Jalandhar City, Punjab, INDIA
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15
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Geynisman DM, Stadler WM. Variant Renal Carcinoma Histologies: Therapeutic Considerations. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Combinatorial and Sequential Targeted Therapy in Metastatic Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Vera-Badillo FE, Templeton AJ, Duran I, Ocana A, de Gouveia P, Aneja P, Knox JJ, Tannock IF, Escudier B, Amir E. Systemic therapy for non-clear cell renal cell carcinomas: a systematic review and meta-analysis. Eur Urol 2014; 67:740-9. [PMID: 24882670 DOI: 10.1016/j.eururo.2014.05.010] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/15/2014] [Indexed: 12/18/2022]
Abstract
CONTEXT Clinical data supporting the use of targeted agents for the treatment of metastatic renal cell carcinoma (RCC) are based predominantly on patients with clear cell histology. Little is known about the efficacy of these drugs in non-clear cell variants. OBJECTIVE To evaluate the efficacy of different clear cell RCC (ccRCC)-approved targeted agents among patients with non-ccRCC compared with ccRCC. EVIDENCE ACQUISITION We conducted a systematic review of electronic databases to identify publications evaluating the outcomes of patients with non-ccRCC treated with targeted agents approved for treatment of ccRCC. Patients with sarcomatoid variant RCC were excluded from the main analysis but were evaluated as an independent cohort. End points of interest were response rate, median progression-free survival (PFS), and median overall survival (OS). Where possible, data were pooled in a meta-analysis. For studies of unselected patients with RCC, the outcomes of patients with non-ccRCC histology were compared with ccRCC. In exploratory analyses, outcomes of non-ccRCC with nonapproved agents were assessed. EVIDENCE SYNTHESIS A total of 49 studies comprising 7771 patients were included in the analysis. Of these, 1244 patients (16.0%) had non-ccRCC, 6300 (83.1%) had ccRCC, and 227 (2.9%) had sarcomatoid tumours. The overall response rate for non-ccRCC with targeted agents was 10.5%. In studies directly comparing non-ccRCC and ccRCC, there were significantly lower response rates for non-ccRCC (odds ratio for response: 0.52; 95% confidence interval, 0.40-0.68; p<0.001). For non-ccRCC treated with targeted agents, median PFS and OS were 7.4 and 13.4 mo, respectively; for patients with ccRCC, these were 10.5 mo and 15.7 mo, respectively (p value for difference<0.001 for both parameters). CONCLUSIONS Patients with non-clear cell renal cell carcinoma (non-ccRCC) have significantly lower response rates and poorer median progression-free survival and overall survival than those with ccRCC. The optimal treatment of patients with non-ccRCC remains unclear and warrants further study. PATIENT SUMMARY Systemic treatments for patients with renal cell carcinoma (RCC) tend to be significantly less effective for non-clear cell RCC, with lower response rates and worse progression-free survival and overall survival when compared with clear cell RCC. Optimal therapy remains unclear and warrants further study.
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Affiliation(s)
- Francisco E Vera-Badillo
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Arnoud J Templeton
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Ignacio Duran
- Department of Medical Oncology, Hospital Universitario "Virgen del Rocío", Sevilla, Spain
| | - Alberto Ocana
- Translational Research Unit, Albacete University Hospital, Albacete, Spain
| | - Paulo de Gouveia
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Priya Aneja
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer J Knox
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Ian F Tannock
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada.
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Pagliaro LC, Tannir N, Sircar K, Jonasch E. Systemic therapy for sarcomatoid renal cell carcinoma. Expert Rev Anticancer Ther 2014; 11:913-20. [DOI: 10.1586/era.11.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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de Vivar Chevez AR, Finke J, Bukowski R. The Role of Inflammation in Kidney Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 816:197-234. [DOI: 10.1007/978-3-0348-0837-8_9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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20
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Phase II trial of pemetrexed plus gemcitabine in patients with locally advanced and metastatic nonclear cell renal cell carcinoma. Am J Clin Oncol 2013; 36:450-4. [PMID: 22706175 DOI: 10.1097/coc.0b013e3182546a91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the clinical activity and safety of the combination of pemetrexed and gemcitabine in advanced nonclear cell renal cell carcinoma (nccRCC). METHODS In this phase II study, patients received pemetrexed 500 mg/m intravenous infusion over 10 minutes on day 1 followed immediately by gemcitabine 1500 mg/m intravenously over 30 minutes on day 1, with cycles repeated every 14 days. Planned enrollment was 40 patients. The primary endpoints were objective response rate and progression-free survival (PFS). The secondary endpoints were safety and overall survival. RESULTS Between December 2005 and December 2008, 16 patients with locally advanced or metastatic nccRCC were enrolled. The trial was stopped early due to low efficacy and excessive toxicity. The objective response rate was 0% [95% confidence interval (CI), 0%-18%]. The median number of cycles administered was 4 (range, 1 to 12). Median PFS was 3.2 months (95% CI, 1.9-6+), and the 16-week PFS rate was 46.7% (95% CI, 19.8%-100%). Median overall survival was 23.2 months (95% CI, 12.9-38.1). The most common grade 3 or 4 adverse events were neutropenia (53%), leukopenia (53%), anemia (13%), fatigue (40%), and renal insufficiency (13%). CONCLUSIONS In this phase II trial in nccRCC, the combination of pemetrexed and gemcitabine was toxic and ineffective. Further development of this regimen in nccRCC is not warranted.
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Affiliation(s)
| | - James Larkin
- The Royal Marsden Hospital, Department of Medicine, London, UK
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23
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Staehler M, Haseke N, Roosen A, Stadler T, Bader M, Siebels M, Karl A, Stief CG. Sorafenib after combination therapy with gemcitabine plus doxorubicine in patients with sarcomatoid renal cell carcinoma: a prospective evaluation. Eur J Med Res 2012; 15:287-91. [PMID: 20696639 PMCID: PMC3351952 DOI: 10.1186/2047-783x-15-7-287] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sarcomatoid renal cell cancer (RCC) is a distinct histological variant of RCC that is associated with rapid progression and a poor prognosis. The optimal treatment for patients with sarcomatoid RCC remains to be defined. Gemcitabine plus doxorubicine (GD) has shown some efficacy, however durability of response is limited. We carried out a prospective, open-label study to investigate the efficacy and safety of sorafenib in patients after GD failure in sarcomatoid RCC. METHODS Fifteen patients with pure sarcomatoid RCC and objective progressive disease were treated with GD (gemcitabine 1500 mg/m², doxorubicine 50 mg/m² administered by weekly intravenous infusion) until progression of disease. Subsequently 9 patients were switched to sorafenib (400 mg twice daily). Tumor response was measured by physical examination and computerized tomography scans and evaluated according to Response Evaluation Criteria in Solid Tumors criteria. RESULTS Median time to progression (TTP) under GD was 6.6 months (range 0.8 - 8 months). During GD treatment there were no remissions and 6 patients died from progressive disease. Median TTP for the 9 patients switched to sorafenib was 10.9 months (range 0.6 - 25.5 months). During sorafenib therapy one patient had a partial remission lasting for 3 months and 4 patients experienced stable disease with a duration of 3 to 9 months. Four patients immediately progressed on sorafenib treatment but had a slower dynamic of tumor progression than under GD. Dosing in both treatment phases was generally well tolerated with manageable toxicities and no requirement for dose reduction. CONCLUSIONS Chemotherapy with GD was ineffective in our patients with pure sarcomatoid RCC. Subsequent anti-angiogenic treatment using the multi-tyrosine kinase inhibitor sorafenib resulted in additional progression-free survival in 5 of 9 patients. Further evaluation of targeted anti-angiogenic agents for the treatment of sarcomatoid RCC is warranted.
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Affiliation(s)
- Michael Staehler
- Department of Urology, University of Munich, Klinikum Grosshadern, Marchioninistr. 15, 81377 München, Germany.
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Buti S, Bersanelli M, Donini M, Ardizzoni A. Systemic adjuvant therapies in renal cell carcinoma. Oncol Rev 2012; 6:e18. [PMID: 25992216 PMCID: PMC4419621 DOI: 10.4081/oncol.2012.e18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) is one of the ten most frequent solid tumors worldwide. Recent innovations in the treatment of metastatic disease have led to new therapeutic approaches being investigated in the adjuvant setting. Observation is the only current standard of care after radical nephrectomy, although there is evidence of efficacy of adjuvant use of vaccine among all the strategies used. This article aims to collect published experiences with systemic adjuvant approaches in RCC and to describe the results of past and ongoing phase III clinical trials in this field. We explored all the systemic treatments, including chemotherapy, immunotherapy and targeted drugs while alternative approaches have also been described. Appropriate selection of patients who would benefit from adjuvant therapies remains a crucial dilemma. Although the international guidelines do not actually recommend any adjuvant treatment after radical surgery for RCC, no conclusions have yet been drawn pending the results of the promising ongoing clinical trials with the target therapies. The significant changes that these new drugs have made on advanced disease outcome could represent the key to innovation in terms of preventing recurrence, delaying relapse and prolonging survival after radical surgery for RCC.
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Affiliation(s)
- Sebastiano Buti
- Operative Unit of Medical Oncology, University Hospital of Parma
| | | | | | - Andrea Ardizzoni
- Operative Unit of Medical Oncology, University Hospital of Parma
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26
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Variant Renal Cell Carcinoma Histologies: Therapeutic Considerations. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fisher R, Larkin J, Swanton C. Delivering preventive, predictive and personalised cancer medicine for renal cell carcinoma: the challenge of tumour heterogeneity. EPMA J 2011; 3:1. [PMID: 22738081 PMCID: PMC3375102 DOI: 10.1007/s13167-011-0137-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/02/2011] [Indexed: 12/14/2022]
Abstract
Recent years have seen major advances in the management of metastatic renal cell carcinoma (mRCC). The tyrosine kinase and mammalian target of rapamycin inhibitors have resulted in disease control and improved survival for many patients with mRCC, but they have not led to preventive, predictive or personalised medicine (PPPM). Failure to achieve this rests ultimately with inadequate knowledge of tissue and molecular heterogeneity; discovery of these drugs was based upon identification of pathogenic molecular pathways in RCC, but research into molecular factors which underpin drug response, resistance and selection of therapy for individual patients has lagged well behind clinical trials of drug development. This review will provide an overview of the development of targeted drug therapies for mRCC, will discuss the challenges which currently impede the delivery of PPPM, including identification of biomarkers, drug resistance and molecular heterogeneity, and will propose research methodologies and technologies required to overcome these obstacles.
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Affiliation(s)
- Rosalie Fisher
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - James Larkin
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Charles Swanton
- Cancer Research UK London Research Institute, Translational Cancer Therapeutics Laboratory, 44 Lincoln's Inn Fields, London WC2A 3LY, UK
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A Phase I Trial of Sorafenib Plus Gemcitabine and Capecitabine for Patients With Advanced Renal Cell Carcinoma. Am J Clin Oncol 2011; 34:443-8. [DOI: 10.1097/coc.0b013e3181e9c0d7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A phase II trial of gemcitabine, capecitabine, and bevacizumab in metastatic renal carcinoma. Am J Clin Oncol 2011; 34:150-4. [PMID: 20395787 DOI: 10.1097/coc.0b013e3181d6b2fe] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Renal cancer is resistant to most DNA and DNA repair targeted chemotherapy; although moderate response rates to nucleotide analog based therapy have been reported. Bevacizumab also has activity. We thus performed a phase II trial of gemcitabine, capecitabine, and bevacizumab in patients with metastatic renal cancer. METHODS Following significant hematotoxicity, dosing was modified to gemcitabine 1000 mg/m (Days 1, 8), capecitabine 1000 mg twice daily (Days 1-14), and bevacizumab 15 mg/kg (Day 1) on a 21-day cycle with evaluation every 3 cycles. Primary end point was objective response rate. RESULTS Twenty-nine patients were enrolled between March 2005 and May 2008. Most patients had been previously treated with a vascular endothelial growth factor receptor tyrosine kinase inhibitor. Seven patients (24%) had a partial response. Median overall and progression-free survival were 9.8 months (95% confidence interval: 6.2, 14.9) and 5.3 months (95% confidence interval: 3.9, 9.9), respectively. The regimen was well tolerated with hematologic toxicity, fatigue, and rash being most common. CONCLUSION The trial was terminated early despite not meeting criteria for success or futility because of slow accrual and because the historical response rate became irrelevant with emerging data using sequential vascular endothelial growth factor therapies. Nevertheless, the observed progression-free and overall survival compare favorably to other phase II trials in this heavily pretreated population.
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Fisher R, Pickering L, Larkin J. New targeted therapies for renal cell carcinoma. Expert Opin Investig Drugs 2011; 20:933-45. [PMID: 21506895 DOI: 10.1517/13543784.2011.577065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of treatment in metastatic renal cell carcinoma is palliation. In the last 5 years, multiple targeted agents have been developed which have resulted in prolongation of patients' lives, but complete responses remain rare. New therapies and approaches are required to further improve the prognosis for patients with this disease. AREAS COVERED This review discusses the molecular targets in renal cell carcinoma relevant to the development of new treatments and describes the progress of novel therapies. The evidence is compiled from the PubMed database and proceedings of scientific meetings, searched up to December 2010. EXPERT OPINION A multitude of experimental agents are in clinical development and offer theoretical advantages over those currently in use. It is hoped that these treatments will result in better long-term control of metastatic renal cell carcinoma, with improved side effect profiles, but curative treatment in this disease remains elusive until the mechanisms underlying response and resistance to therapy are elucidated. Progress in the field has been limited by inadequate tissue collection within clinical trials; current and future clinical trial design will incorporate a larger translational component in an attempt to establish predictive biomarkers.
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Richey SL, Ng C, Lim ZD, Jonasch E, Tannir NM. Durable remission of metastatic renal cell carcinoma with gemcitabine and capecitabine after failure of targeted therapy. J Clin Oncol 2011; 29:e203-5. [PMID: 21172884 PMCID: PMC4468428 DOI: 10.1200/jco.2010.31.6091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Chaan Ng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zita D. Lim
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M. Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Naito S, Eto M, Shinohara N, Tomita Y, Fujisawa M, Namiki M, Nishikido M, Usami M, Tsukamoto T, Akaza H. Multicenter Phase II Trial of S-1 in Patients With Cytokine-Refractory Metastatic Renal Cell Carcinoma. J Clin Oncol 2010; 28:5022-9. [DOI: 10.1200/jco.2010.29.1203] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This phase II multicenter trial was conducted to evaluate the activity and safety of S-1 in Japanese patients with metastatic renal cell carcinoma (mRCC). We also examined the relation between response and mRNA expression levels of enzymes involved in the metabolism of fluorouracil (FU). Methods Patients with mRCC who had received nephrectomy in whom cytokine-based immunotherapy was ineffective or contraindicated were studied. S-1 was administered orally at 80-, 100-, or 120-mg daily, assigned according to body surface area, on days 1 to 28 of a 42-day cycle. The primary end point was the objective response rate. The mRNA expression levels of FU-related enzymes were measured by reverse-transcriptase polymerase chain reaction in formalin-fixed, paraffin-embedded specimens of tumors obtained at nephrectomy. Results A total of 45 eligible patients were enrolled. Eleven (24.4%) of 45 patients had partial responses to S-1, and 28 (62.2%) had stable disease. Median progression-free survival was 9.2 months. The severity of most adverse events was mild to moderate. The most common grade 3/4 drug-related adverse events were neutropenia (8.9%) and anorexia (8.9%). The expression level of thymidylate synthase (TS) mRNA was significantly lower in patients who responded to treatment (t-test, P = .048), and progression-free survival was significantly longer in patients whose TS mRNA expression levels were below the median value, as compared with those with higher levels (log-rank test, P = .006). Conclusion S-1 is active against cytokine-refractory mRCC. Quantification of TS mRNA levels in tumors before treatment may facilitate prediction of the response of mRCC to S-1.
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Affiliation(s)
- Seiji Naito
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Masatoshi Eto
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Nobuo Shinohara
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Yoshihiko Tomita
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Masato Fujisawa
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Mikio Namiki
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Masaharu Nishikido
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Michiyuki Usami
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Taiji Tsukamoto
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
| | - Hideyuki Akaza
- From Graduate School of Medical Sciences, Kyushu University, Fukuoka; Hokkaido University Graduate School of Medicine, Sapporo; Yamagata University Faculty of Medicine, Yamagata; Kobe University Graduate School of Medicine, Kobe; Kanazawa University Hospital, Kanazawa; Nagasaki University School of Medicine, Nagasaki; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka; Sapporo Medical University School of Medicine, Sapporo; and Graduate School of Comprehensive Human Science, University of
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The end of chemotherapy in renal cell carcinoma: for much but not for all. Am J Clin Oncol 2010; 33:522-3. [PMID: 20924226 DOI: 10.1097/coc.0b013e3181dea9d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jonasch E, Lal LS, Atkinson BJ, Byfield SD, Miller LA, Pagliaro LC, Feng C, Tannir NM. Treatment of metastatic renal carcinoma patients with the combination of gemcitabine, capecitabine and bevacizumab at a tertiary cancer centre. BJU Int 2010; 107:741-747. [PMID: 21355978 DOI: 10.1111/j.1464-410x.2010.09626.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE • To investigate the effect of combining gemcitabine plus capecitabine (GX) with bevacizumab (A) in patients with metastatic RCC previously treated with cytokines and targeted agents. METHODS • The combination of GX + A was evaluated in patients with metastatic RCC using institutional databases. • Data included demographics, previous therapies, number of metastatic sites, Memorial Sloan-Kettering Cancer Center risk stratification variables, and previous nephrectomy status. • Descriptive statistics and survival analysis were employed for data analysis. RESULTS • Between January 2005 and October 2008, 28 patients were identified. Mean age was 55.7 years. Fifteen (53.57%) patients had been given tyrosine kinase inhibitor (TKI) previously. Nine (32.14%) patients had clear cell histology, 10 (35.71%) patients had sarcomatoid features on histopathology, and 19 patients (67.86%) had a prior nephrectomy. • Initial treatment consisted of G (mean dose 786.07 mg/m²) every 2 weeks, X (mean dose 2.73 g/day), and A (mean dose 10 mg/kg) every 2 weeks. Median progression-free survival (PFS) was 5.9 months and the median overall survival (OS) was 10.4 months. • In patients with previous TKI therapy, median PFS was 6.2 months and median OS was 11.7 months. • In patients with sarcomatoid features, median PFS was 3.9 months and OS was 9.0 months. • Three patients discontinued one or more of the drugs because of adverse reactions. CONCLUSIONS • The combination of GX + A shows potential efficacy and acceptable tolerability in patients with intermediate and poor prognosis metastatic RCC. • Based on these observations, a phase II trial is now underway assessing this combination in patients with sarcomatoid RCC.
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Affiliation(s)
- Eric Jonasch
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lincy S Lal
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Bradley J Atkinson
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Stacey DaCosta Byfield
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lesley Ann Miller
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Lance C Pagliaro
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Chun Feng
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Nizar M Tannir
- Genitourinary Medical OncologyClinical Pharmacy Services, Division of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, TXHealth Economics and Outcomes, i3 Innovus, Eden Prairie, MNUS Outcomes Research, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
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Activity of a multitargeted chemo-switch regimen (sorafenib, gemcitabine, and metronomic capecitabine) in metastatic renal-cell carcinoma: a phase 2 study (SOGUG-02-06). Lancet Oncol 2010; 11:350-7. [DOI: 10.1016/s1470-2045(09)70383-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Van Veldhuizen PJ, Hussey M, Lara PN, Mack PC, Gandour-Edwards R, Clark JI, Lange MK, Crawford DE. A phase ii study of gemcitabine and capecitabine in patients with advanced renal cell cancer: Southwest Oncology Group Study S0312. Am J Clin Oncol 2009; 32:453-9. [PMID: 19487915 PMCID: PMC3394591 DOI: 10.1097/coc.0b013e3181925176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Gemcitabine plus capecitabine has moderate efficacy in patients with advanced renal cell cancer (RCC) but has considerable toxicity. We evaluated the efficacy and toxicity of a modified dose-schedule of this doublet in patients with metastatic RCC. METHODS Chemotherapy-naive patients were treated with gemcitabine at 900 mg/m2 on days 1, 8, and 15 and with capecitabine at 625 mg/m2 twice daily on days 1 through 21, and every 28 days thereafter. The primary end point was response rate (RR). No further evaluation of this regimen would be pursued if the RR was ≤ 5%. In an exploratory analysis, we also evaluated potential markers of prognosis and treatment response, including thymidylate synthase, PTEN, pAKT, pmTOR, XRCC1, and ERCC1. RESULTS Of 43 patients, 1 was ineligible and 2 were not analyzable. There was 1 complete response and 3 partial responses, for an overall RR of 10% (95% CI = 3, 24). Nineteen patients (48%) had stable disease. The 6-month freedom-from-treatment-failure and overall survival rates were 20% (95% CI = 8, 32) and 75% (95% CI = 62, 88), respectively. Median survival time was 23 months (95% CI = 10, 37). One patient each experienced grade 4 neutropenia, fatigue, thrombocytopenia, and hemolysis with renal failure. The most common grade 3 toxicities were neutropenia (12 patients), fatigue (5), and leucopenia (4). Patients with a best response of stable disease or better were more likely to have decreased expression of PTEN and increased expression of pmTOR. CONCLUSIONS Gemcitabine plus capecitabine at this reduced dose-schedule benefits a small percentage of patients with RCC with an acceptable toxicity profile.
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Affiliation(s)
- Peter J Van Veldhuizen
- Department of Internal Medicine, Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Attia S, Morgan-Meadows S, Holen KD, Bailey HH, Eickhoff JC, Schelman WR, Traynor AM, Mulkerin DL, Campbell TC, McFarland TA, Huie MS, Cleary JF, Tevaarwerk AJ, Alberti DB, Wilding G, Liu G. Dose-escalation study of fixed-dose rate gemcitabine combined with capecitabine in advanced solid malignancies. Cancer Chemother Pharmacol 2009; 64:45-51. [PMID: 18841362 PMCID: PMC2676212 DOI: 10.1007/s00280-008-0844-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 09/20/2008] [Indexed: 12/27/2022]
Abstract
PURPOSE To define dose limiting toxicities (DLTs) and the maximum tolerated dose (MTD) of capecitabine with fixed-dose rate (FDR) gemcitabine. METHODS Eligible adults (advanced solid tumor; performance status RESULTS Thirty patients (median age 59 years) were enrolled. The predominant grade >or=3 toxicity was myelosuppression, particularly neutropenia. At dose level 4 (1,000 mg/m(2) gemcitabine), two out of five evaluable patients had a DLT (grade 4 neutropenia >or=7 days). At dose level 3 (800 mg/m(2) gemcitabine), one patient had a DLT (grade 3 neutropenia >or=7 days) among six evaluable patients. Therefore, the MTD and recommended phase II dose was designated as capecitabine 500 mg/m(2) PO BID days 1-14 with 800 mg/m(2) FDR gemcitabine days 1 and 8 infused at 10 mg/m(2) per min on a 21-day cycle. Partial responses occurred in pretreated patients with esophageal, renal cell and bladder carcinomas. CONCLUSIONS This regimen was well tolerated and may deserve evaluation in advanced gastrointestinal and genitourinary carcinomas.
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Affiliation(s)
- Steven Attia
- University of Wisconsin Paul P Carbone Comprehensive Cancer Center Madison, Madison, WI 53792, USA.
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Soga N, Yamada Y, Nishikawa K, Hasegawa Y, Kise H, Arima K, Sugimura Y. Gemcitabine and capecitabine chemotherapy in Japanese patients with immunotherapy-resistant renal cell carcinoma. Int J Urol 2009; 16:576-9. [PMID: 19456985 DOI: 10.1111/j.1442-2042.2009.02308.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate the efficacy and toxicity of combined gemcitabine and capecitabine (Gca) chemotherapy in patients with advanced renal cell cancer after immunotherapy failure. Nine patients were enrolled in this trial. Gemcitabine (1000 mg/m(2)) was injected on days 1 and 8, followed by oral administration of capecitabine (1660 mg/m(2)) on days 1-14. The response rate was 11%, with a partial response in one patient (11%), stable disease in five patients (56%) and disease progression in three patients (33%). Grade 3-4 neutropenia was observed in one patient (11%) and thrombocytopenia in two patients (22%). The quality of life (QOL) questionnaire scales showed no significant changes induced by chemotherapy. The median progression-free survival was 4 months with an overall 1-year survival rate of 78%. Gemcitabine and capecitabine chemotherapy can be safely administered as second-line therapy in renal cell cancer patients, maintaining QOL baseline parameters.
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Affiliation(s)
- Norihito Soga
- Division of Nephro-Urologic Surgery and Andrology, Department of Reparative and Regenerative Medicine, Institute of Medical Life Science, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
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Solimando DA, Waddell JA. Gemcitabine and Capecitabine (GemCap) Regimen for Solid Tumors. Hosp Pharm 2009. [DOI: 10.1310/hpj4404-303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complexity of cancer chemotherapy requires that pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparing, dispensing, and administering antineoplastic therapy and to the agents, commercially available and investigational, used to treat malignant diseases.
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Affiliation(s)
| | - J. Aubrey Waddell
- University of Tennessee College of Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E Lamar Alexander Parkway, Maryville, TN 37804
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Abstract
Considerable progress has been made in the treatment of patients with renal cell carcinoma, with innovative surgical and systemic strategies revolutionising the management of this disease. In localised disease, partial nephrectomy for small tumours and radical nephrectomy for large tumours continue to be the gold-standard treatments, with emphasis on approaches that have reduced invasiveness and preserve renal function. Additionally, cytoreductive nephrectomy is often indicated before the start of systemic treatment in patients with metastatic disease as part of integrated management strategy. The effectiveness of immunotherapy, although previously widely used for treatment of metastatic renal cell carcinoma, is still controversial, and is mainly reserved for patients with good prognostic factors. Development of treatments that have specific targets in relevant biological pathways has been the main advance in treatment. Targeted drugs, including inhibitors of the vascular endothelial growth factor and mammalian target of rapamycin pathways, have shown robust effectiveness and offer new therapeutic options for the patients with metastatic disease.
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Affiliation(s)
- Brian I Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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Abstract
Renal cell cancer (RCC) is the most common form of cancer of the kidney and accounts for approximately 44,000 cases per year in the United States. Historically, only immunotherapy showed activity in metastatic RCC. The improved survival and quality of life for patients with metastatic RCC over the last several years are direct results of advances made in understanding the development of RCC. Three targeted therapies-sunitinib, sorafenib, and temsirolimus-have been approved for use in the United States recently. Current research is aimed at developing new drugs and combining available drugs to improve upon the responses and survival seen with approved single agents.
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Affiliation(s)
- Glenn S Kroog
- Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Romo de Vivar Chavez A, de Vera ME, Liang X, Lotze MT. The biology of interleukin-2 efficacy in the treatment of patients with renal cell carcinoma. Med Oncol 2009; 26 Suppl 1:3-12. [PMID: 19148593 DOI: 10.1007/s12032-008-9162-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 01/22/2023]
Abstract
Renal cell carcinoma (RCC) is the eighth most common malignancy in adults in the United States. More than 50% of individuals present with metastatic disease and conventional chemotherapeutic strategies have been associated with poor response rates. Immunotherapy with Interleukin (IL)-2, however, induces durable remission, achieving >10 year recurrence free survival in 5-10% of patients with advanced RCC. First described as a T cell growth factor, IL-2 has a wide spectrum of effects in the immune system. Some of the possible mechanisms by which IL-2 carries out its anticancer effects include the augmentation of cytotoxic immune cell functions and reversal of T cell anergy, enabling delivery of immune cells and possibly serum components into tumor. IL-2 indirectly limits tumor escape mechanisms such as defective tumor cell expression of Class I or Class II molecules or expansion of regulatory T cells. Indirect effects on the tumor microenvironment are also likely and associated with rather dramatic T cell infiltration during the global delayed type hypersensitivity response that is associated with systemic IL-2 administration. The IL-2 signaling pathway, its effects on immune cells, and its role in various independent mechanisms of tumor surveillance likely play a role but little substantive data defining a clear phenotype or genotype of IL-2 responders distinguishing them from nonresponders has emerged in the last 25 years since IL-2 therapy was initiated. At best, we can only speculate that the disturbed homeostatic host/tumor interaction is reset in a small subset of patients allowing an antitumor response to recover or ensue.
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Affiliation(s)
- Antonio Romo de Vivar Chavez
- Department of Surgery, University of Pittsburgh, G.27A Hillman Cancer Center 5117 Centre Avenue, Pittsburgh, PA 15213, USA
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The Combination of Thalidomide and Capecitabine in Metastatic Renal Cell Carcinoma—Is Not the Answer. Am J Clin Oncol 2008; 31:417-23. [DOI: 10.1097/coc.0b013e318168ef47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Tannir NM, Thall PF, Ng CS, Wang X, Wooten L, Siefker-Radtke A, Mathew P, Pagliaro L, Wood C, Jonasch E. A phase II trial of gemcitabine plus capecitabine for metastatic renal cell cancer previously treated with immunotherapy and targeted agents. J Urol 2008; 180:867-72; discussion 872. [PMID: 18635226 PMCID: PMC4167838 DOI: 10.1016/j.juro.2008.05.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Indexed: 12/16/2022]
Abstract
PURPOSE We assessed the clinical activity and safety of gemcitabine plus capecitabine in patients with metastatic renal cell cancer previously treated with immunotherapy. MATERIALS AND METHODS In this phase II trial patients received 1,000 mg/m(2) gemcitabine intravenously on days 1, 8 and 15, plus 830 mg/m(2) capecitabine orally twice daily on days 1 to 21 of 28-day cycles. The primary end point was progression-free survival time. Secondary end points included overall survival time, objective response rate and toxicity. RESULTS Of 84 patients enrolled 83 were evaluable for response and toxicity. A total of 65 patients had intermediate or poor risk prognosis. Median progression-free survival and overall survival were 4.6 (95% CI 3.7-7.3) and 17.9 months (95% CI 13.2-23.6), respectively. There were 6 partial responses and 1 complete response (objective response rate 8.4% [95% CI 3.5-16.6]). Two patients remain in unmaintained remission close to 3 years from the initiation of gemcitabine plus capecitabine treatment. On multivariate analysis more than 3 disease sites were significantly associated with shorter progression-free survival and patients with thrombocytosis, more than 3 disease sites or anemia had a significantly increased risk of death. Adverse events occurring at least once in more than 5% of patients included grade 3 or greater neutropenia (83%), grade 2 or greater hand-foot syndrome (13%), grade 3 or greater thrombocytopenia (12%), grade 3 or greater thromboembolic events (8%), grade 3 or greater fatigue (8%) and grade 2 or greater mucositis (6%). CONCLUSIONS At the doses and schedule tested gemcitabine plus capecitabine demonstrated modest clinical activity in metastatic renal cell cancer after cytokine failure and produced significant neutropenia. A modified gemcitabine plus capecitabine regimen may be evaluated in patients with metastatic renal cell cancer after failure of approved targeted therapies.
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Affiliation(s)
- Nizar M Tannir
- Genitourinary Medical Oncology Department, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Laudadio L, Biondi E, D'Ostilio N, Cesta A, Di Giandomenico F, Forciniti S, Nuzzo A. Paralytic Ileus Associated with Capecitabine. TUMORI JOURNAL 2008; 94:742-5. [DOI: 10.1177/030089160809400517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Paralytic ileus is a temporary arrest of intestinal peristalsis. We report on two patients with breast cancer who developed paralytic ileus following treatment with capecitabine. The pathophysiology of this disorder and its possible connection to capecitabine are described with the aim of promoting the early recognition of the clinical picture so that unnecessary surgery can be avoided.
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Affiliation(s)
- Lucio Laudadio
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano (Chieti), Italy
| | - Edoardo Biondi
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano (Chieti), Italy
| | - Nicola D'Ostilio
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano (Chieti), Italy
| | - Alisia Cesta
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano (Chieti), Italy
| | | | | | - Antonio Nuzzo
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano (Chieti), Italy
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Marur S, Eliason J, Heilbrun LK, Dickow B, Smith DW, Baranowski K, Alhasan S, Vaishampayan U. Phase II trial of capecitabine and weekly docetaxel in metastatic renal cell carcinoma. Urology 2008; 72:898-902. [PMID: 18692873 DOI: 10.1016/j.urology.2008.05.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 04/23/2008] [Accepted: 05/03/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the toxicity and efficacy of capecitabine and weekly docetaxel in a phase II clinical trial. METHODS Eligibility included metastatic renal cancer with a maximum of 2 prior regimens, performance status of 0-2, and adequate renal, hepatic, and bone marrow function. Docetaxel was administered intravenously at a dose of 36 mg/m(2) weekly on days 1, 8, and 15 of a 28- day cycle and capecitabine was administered orally at a dose of 1800 mg/m(2) from days 5-18. Toxicity was assessed on days 1, 8, and 15 of each cycle, and response was evaluated every 2 cycles. RESULTS Twenty-five patients, 19 white and 6 African American, were enrolled on this phase II trial. The median age was 60 years (range: 39-75 years). Eighteen patients had clear cell histology, 7 had papillary, sarcomatoid, or chromophobe histology. Thirteen had liver/bone metastases and 13 had >or=2 of the Memorial Sloan-Kettering Cancer Center prognostic risk factors. Twelve patients received prior immunotherapy. A total of 93 cycles were administered; median of 3 cycles and range from 0-10 cycles. The therapy was well tolerated. No treatment-related mortality was observed and 2 treatment-related hospitalizations for nausea, diarrhea, and dehydration occurred. Ten patients had stable disease. The median time to progression was 1.7 months and median survival was 11.1 months. CONCLUSIONS The combination of capecitabine and docetaxel was well tolerated in metastatic renal cancer. Clinical activity was predominantly noted in non-clear cell histology in which chemotherapy would be worthy of future investigation.
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Affiliation(s)
- Shanthi Marur
- Division of Oncology, Department of Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
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Manuel Trigo J, Bellmunt J. Estrategias actuales en el tratamiento del carcinoma de células renales: fármacos dirigidos a dianas moleculares. Med Clin (Barc) 2008; 130:380-92. [DOI: 10.1157/13117476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Longo R, D'Andrea MR, Sarmiento R, Salerno F, Gasparini G. Integrated therapy of kidney cancer. Ann Oncol 2007; 18 Suppl 6:vi141-8. [PMID: 17591809 DOI: 10.1093/annonc/mdm244] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Historically, treatment options for metastatic renal cell carcinoma (RCC) have been limited because of inherent tumor resistance to chemotherapy and radiotherapy. The only approved drug for RCC in the past 30 years has been high-dose interleukin-2. Its benefit is observed in a small percentage (20%-25%) of highly selected good performance status RCC patients. The treatment of advanced RCC has recently undergone a major change with the development of potent angiogenesis inhibitors and targeted agents. In fact, advanced RCC is a highly vascular tumor associated with expression of vascular endothelial growth factor (VEGF); thereafter, antiangiogenic strategies have become an attractive approach. Several multitargeted tyrosine kinase inhibitors (sorafenib and sunitinib) have already been approved for the treatment of advanced RCC; bevacizumab, a monoclonal antibody anti-VEGF, has shown promising clinical activity. Temsirolimus, a derivative of rapamycin (CCI-779), has also shown a survival advantage over interferon in advanced, poor-prognosis RCC patients. The aim of this review is to describe these agents in terms of mechanisms of action, efficacy, and toxicity profile and also to analyze future development strategies.
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Affiliation(s)
- R Longo
- Division of Clinical Oncology, San Filippo Neri Hospital, Rome, Italy
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