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Adeniran AJ, Shuch B, Humphrey PA. Sarcomatoid and Rhabdoid Renal Cell Carcinoma: Clinical, Pathologic, and Molecular Genetic Features. Am J Surg Pathol 2024; 48:e65-e88. [PMID: 38736105 DOI: 10.1097/pas.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Renal cell carcinoma (RCC) with sarcomatoid and rhabdoid morphologies has an aggressive biological behavior and a typically poor prognosis. The current 2022 WHO classification of renal tumors does not include them as distinct histologic entities but rather as transformational changes that may arise in a background of various distinct histologic types of RCC. The sarcomatoid component shows malignant spindle cells that may grow as intersecting fascicles, which is reminiscent of pleomorphic undifferentiated sarcoma. The rhabdoid cells are epithelioid cells with eccentrically located vesicular nuclei with prominent nucleoli and large intracytoplasmic eosinophilic inclusions. Studies have shown that RCCs with sarcomatoid and rhabdoid differentiation have distinctive molecular features. Sarcomatoid RCC harbors shared genomic alterations in carcinomatous and rhabdoid components, but also enrichment of specific genomic alterations in the sarcomatoid element, suggesting molecular pathways for development of sarcomatoid growth from a common clonal ancestor. Rhabdoid differentiation also arises through clonal evolution although less is known of specific genomic alterations in rhabdoid cells. Historically, treatment has lacked efficacy, although recently immunotherapy with PD-1/PD-L1/CTLA-4 inhibitors has produced significant clinical responses. Reporting of sarcomatoid and rhabdoid features in renal cell carcinoma is required by the College of American Pathologists and the International Collaboration on Cancer Reporting. This manuscript reviews the clinical, pathologic, and molecular features of sarcomatoid RCC and rhabdoid RCC with emphasis on the morphologic features of these tumors, significance of diagnostic recognition, the molecular mechanisms of tumorigenesis and differentiation along sarcomatoid and rhabdoid lines, and advances in treatment, particularly immunotherapy.
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Affiliation(s)
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT
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Salgia NJ, Zengin ZB, Pal SK, Dizman N. Renal Cell Carcinoma of Variant Histology: New Biologic Understanding Leads to Therapeutic Advances. Am Soc Clin Oncol Educ Book 2024; 44:e438642. [PMID: 38776514 PMCID: PMC11235416 DOI: 10.1200/edbk_438642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Renal cell carcinoma (RCC) is one of the 10 most commonly diagnosed solid tumors. Most RCCs are histologically defined as clear cell, comprising approximately 75% of diagnoses. However, the remaining RCC cases are composed of a heterogeneous combination of diverse histopathologic subtypes, each with unique pathogeneses and clinical features. Although the therapeutic approach to both localized and metastatic RCCs has dramatically changed, first with the advent of antiangiogenic targeted therapies and more recently with the approval of immune checkpoint inhibitor (ICI)-based combinations, these advances have primarily benefited the clear cell RCC patient population. As such, there remains critical gaps in the optimization of treatment regimens for patients with non-clear cell, or variant, RCC histologies. Herein, we detail recent advances in understanding the biology of RCC with variant histology and how such findings have guided novel clinical studies investigating precision oncology approaches for these rare subtypes. Among the most common variant histology RCCs are papillary RCC, comprising approximately 15%-20% of all diagnoses. Although a histopathologically diverse subset of tumors, papillary RCC is canonically associated with amplification of the MET protooncogene; recently completed and ongoing trials have investigated MET-directed therapies for this patient population. Finally, we discuss the unique biology of RCC with sarcomatoid dedifferentiation and the recent clinical findings detailing its paradoxical sensitivity to ICIs.
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Affiliation(s)
- Nicholas J Salgia
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Zeynep B Zengin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Sumanta K Pal
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Nazli Dizman
- Department of Hematology and Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Guerassimoff L, Ferrere M, Van Herck S, Dehissi S, Nicolas V, De Geest BG, Nicolas J. Thermosensitive polymer prodrug nanoparticles prepared by an all-aqueous nanoprecipitation process and application to combination therapy. J Control Release 2024; 369:376-393. [PMID: 38554772 DOI: 10.1016/j.jconrel.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
Despite their great versatility and ease of functionalization, most polymer-based nanocarriers intended for use in drug delivery often face serious limitations that can prevent their clinical translation, such as uncontrolled drug release and off-target toxicity, which mainly originate from the burst release phenomenon. In addition, residual solvents from the formulation process can induce toxicity, alter the physico-chemical and biological properties and can strongly impair further pharmaceutical development. To address these issues, we report polymer prodrug nanoparticles, which are prepared without organic solvents via an all-aqueous formulation process, and provide sustained drug release. This was achieved by the "drug-initiated" synthesis of well-defined copolymer prodrugs exhibiting a lower critical solution temperature (LCST) and based on the anticancer drug gemcitabine (Gem). After screening for different structural parameters, prodrugs based on amphiphilic diblock copolymers were formulated into stable nanoparticles by all-aqueous nanoprecipitation, with rather narrow particle size distribution and average diameters in the 50-80 nm range. They exhibited sustained Gem release in human serum and acetate buffer, rapid cellular uptake and significant cytotoxicity on A549 and Mia PaCa-2 cancer cells. We also demonstrated the versatility of this approach by formulating Gem-based polymer prodrug nanoparticles loaded with doxorubicin (Dox) for combination therapy. The dual-drug nanoparticles exhibited sustained release of Gem in human serum and acidic release of Dox under accelerated pathophysiological conditions. Importantly, they also induced a synergistic effect on triple-negative breast cancer line MDA-MB-231, which is a relevant cell line to this combination.
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Affiliation(s)
- Léa Guerassimoff
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay 91400, France
| | - Marianne Ferrere
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay 91400, France
| | - Simon Van Herck
- Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, Ghent 9000, Belgium
| | - Samy Dehissi
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay 91400, France
| | - Valérie Nicolas
- Institut Paris-Saclay d'Innovation Thérapeutique (IPSIT), UMS IPSIT Université Paris-Saclay US 31 INSERM, UMS 3679 CNRS, Microscopy Facility, Orsay 91400, France
| | - Bruno G De Geest
- Department of Pharmaceutics, Ghent University, Ottergemsesteenweg 460, Ghent 9000, Belgium
| | - Julien Nicolas
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, Orsay 91400, France.
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Paindelli C, Parietti V, Barrios S, Shepherd P, Pan T, Wang WL, Satcher RL, Logothetis CJ, Navone N, Campbell MT, Mikos AG, Dondossola E. Bone mimetic environments support engineering, propagation, and analysis of therapeutic response of patient-derived cells, ex vivo and in vivo. Acta Biomater 2024; 178:83-92. [PMID: 38387748 DOI: 10.1016/j.actbio.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/22/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
Bone metastases are the most common milestone in the lethal progression of prostate cancer and prominent in a substantial portion of renal malignancies. Interactions between cancer and bone host cells have emerged as drivers of both disease progression and therapeutic resistance. To best understand these central host-epithelial cell interactions, biologically relevant preclinical models are required. To achieve this goal, we here established and characterized tissue-engineered bone mimetic environments (BME) capable of supporting the growth of patient-derived xenograft (PDX) cells, ex vivo and in vivo. The BME consisted of a polycaprolactone (PCL) scaffold colonized by human mesenchymal stem cells (hMSCs) differentiated into osteoblasts. PDX-derived cells were isolated from bone metastatic prostate or renal tumors, engineered to express GFP or luciferase and seeded onto the BMEs. BMEs supported the growth and therapy response of PDX-derived cells, ex vivo. Additionally, BMEs survived after in vivo implantation and further sustained the growth of PDX-derived cells, their serial transplant, and their application to study the response to treatment. Taken together, this demonstrates the utility of BMEs in combination with patient-derived cells, both ex vivo and in vivo. STATEMENT OF SIGNIFICANCE: Our tissue-engineered BME supported the growth of patient-derived cells and proved useful to monitor the therapy response, both ex vivo and in vivo. This approach has the potential to enable co-clinical strategies to monitor bone metastatic tumor progression and therapy response, including identification and prioritization of new targets for patient treatment.
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Affiliation(s)
- Claudia Paindelli
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Vanessa Parietti
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Sergio Barrios
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States; Rice University, Department of Bioengineering, Houston, TX, 77030, United States
| | - Peter Shepherd
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Tianhong Pan
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Robert L Satcher
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Nora Navone
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States
| | - Antonios G Mikos
- Rice University, Department of Bioengineering, Houston, TX, 77030, United States
| | - Eleonora Dondossola
- Department of Genitourinary Medical Oncology and David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States.
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Ullah A, Yasinzai AQK, Sakhalkar OV, Lee KT, Khan I, Tareen B, Wali A, Waheed A, Khan J, Andam G, Kakar K, Heneidi S, Karki NR. Demographic Patterns and Clinicopathological Analysis of Sarcomatoid Renal Cell Carcinoma in US Population. Clin Genitourin Cancer 2024; 22:38-46. [PMID: 37550179 DOI: 10.1016/j.clgc.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Sarcomatoid renal cell carcinoma (RCC) is defined by the presence of any amount of sarcomatoid components admixed with other RCC histologic subtypes. Our investigation utilizes a large, diverse set of sarcomatoid RCC patients to summarize clinical, demographic, and pathological factors along with demographic disparities that may affect the prognosis and survival of sarcomatoid RCC patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was employed to compile data from 2000 to 2018 from 2695 patients diagnosed with sarcomatoid RCC. RESULTS The mean age for sarcomatoid RCC diagnosis is 62.8 years. Males (68.2%) and White patients (82.6%) were more likely to be diagnosed with sarcomatoid RCC. Among the 64.4% of tumors with known size, 35.4% were less than 7 cm, 27.6% were 7.1 to 10 cm, and 36.4% were larger than 10 cm. Among the 95.8% of patients with known stage, 15.3% were localized, 28.9% were regionalized, and 55.8% were found in distant sites. Among the 44.2% of cases with known metastases site, lung was found to be the most common metastatic site.. Surgery was the most common treatment (70.9%). While the overall 5-year survival was 18.1%, it was 27.1% among patients who underwent surgery. Independent risk factors for mortality include age > 60 years, distant stage, and tumor size > 10 cm, per our multivariate analysis. CONCLUSION Sarcomatoid RCC most commonly affects White males in their seventh decade. Increased age, distant stage, and size > 10 cm tumor size have associations with unfavorable prognosis. Surgery is associated with better survival outcomes in localized disease and multimodal therapy (surgery with adjuvant chemoradiation was associated with better survival.).
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Affiliation(s)
- Asad Ullah
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX.
| | | | | | | | - Imran Khan
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Bisma Tareen
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Agha Wali
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
| | - Gul Andam
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Kaleemullah Kakar
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Saleh Heneidi
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Nabin R Karki
- Department of Medical Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL
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Carthon BC, Kim SE, McDermott DF, Dutcher JP, Puligandla M, Manola J, Pins M, Carducci MA, Plimack ER, Appleman LJ, MacVicar GR, Kohli M, Kuzel TM, DiPaola RS, Haas NB. Results From a Randomized Phase II Trial of Sunitinib and Gemcitabine or Sunitinib in Advanced Renal Cell Carcinoma with Sarcomatoid Features: ECOG-ACRIN E1808. Clin Genitourin Cancer 2023; 21:546-554. [PMID: 37455214 PMCID: PMC10543556 DOI: 10.1016/j.clgc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Sarcomatoid renal cancer (sRCC) patients have poor outcomes. EA1808 evaluated sunitinib and gemcitabine (SG) and sunitinib alone (S) in sRCC in a randomized cooperative group phase II trial (NCT01164228). PATIENTS AND METHODS Pts were aggregated 1:1 to SG (45 pts) or S (40 pts) using a 2-stage design. sRCC pts with ≤ 1 prior nonvascular endothelial growth factor tyrosine kinase inhibitor were stratified into prognostic groups: good (clear cell, < 20% sarcomatoid, PS 0), intermediate (20%-50% sarcomatoid, PS 0), and poor (nonclear cell or > 50% sarcomatoid or PS 1). The primary endpoint was response rate (RR). For SG, the null RR was 15% and a 30% RR was of interest. For S, a 20% RR was of interest vs. a 5% null rate. Secondary endpoints were progression-free survival, overall survival, and safety. RESULTS Both arms met protocol criteria for stage 2 of accrual. A total of 47 pts were randomized to SG and 40 to S. The SG arm had 9 of 45 evaluable patient responses (RR of 20%; CI = [13%-31%]) not meeting the predetermined threshold for success. The sunitinib arm met its endpoint with 6/37 (RR of 16%; CI = [9%-27%]) evaluable responses. Grade ≥ 3 events were experienced by 36 in the SG arm and 17 in the sunitinib arm CONCLUSIONS: EA1808 was the largest and first randomized cytotoxic trial for sarcomatoid RCC. Sunitinib alone but not the SG met the preset threshold of success. Cytotoxic chemotherapy is only useful in limited clinical scenarios for sRCC.
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Affiliation(s)
- Bradley C Carthon
- Department of Medicine, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Se Eun Kim
- Department of Statistics, Dana-Farber Cancer Institute, Boston, MA
| | - David F McDermott
- Division of Hematology/Oncology; Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Judith Manola
- Department of Statistics, Dana-Farber Cancer Institute, Boston, MA
| | - Michael Pins
- Department of Pathology; Advocate Lutheran General Hospital, Park Ridge, IL
| | - Michael A Carducci
- Division of Hematology /Oncology; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Leonard J Appleman
- Department of Medicine; University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Manish Kohli
- Department of Medicine; University of Utah, Salt Lake City, UT; Department of Medicine; Mayo Clinic, Rochester, MN
| | - Timothy M Kuzel
- Department of Medicine; Northwestern University, Chicago, IL
| | - Robert S DiPaola
- Department of Medicine; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Naomi B Haas
- Department of Medicine; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA.
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Méndez-Vidal MJ, Lázaro Quintela M, Lainez-Milagro N, Perez-Valderrama B, Suárez Rodriguez C, Arranz Arija JÁ, Peláez Fernández I, Gallardo Díaz E, Lambea Sorrosal J, González-del-Alba A. SEOM SOGUG clinical guideline for treatment of kidney cancer (2022). Clin Transl Oncol 2023; 25:2732-2748. [PMID: 37556095 PMCID: PMC10425490 DOI: 10.1007/s12094-023-03276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a "bridge" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.
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Affiliation(s)
- María José Méndez-Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Martin Lázaro Quintela
- Medical Oncology Department, Hospital Alvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | - Nuria Lainez-Milagro
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | | | | | | | | | - Julio Lambea Sorrosal
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Lu H, Ye Q, Zheng C, Fan L, Xia X. Efficacy and safety analysis of TACE + sunitinib vs. sunitinib in the treatment of unresectable advanced renal cell carcinoma: a retrospective study. BMC Cancer 2023; 23:270. [PMID: 36964538 PMCID: PMC10037847 DOI: 10.1186/s12885-023-10754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Since renal cell carcinoma(RCC) is insensitive to conventional chemoradiotherapy, molecularly targeted drugs are commonly used treatments for unresectable advanced RCC. The aim of this study was to explore the efficacy and safety of TACE + sunitinib vs. sunitinib in the treatment of unresectable advanced RCC. METHODS This study included 98 patients with unresectable advanced RCC who were treated in Union Hospital from January 2015 to December 2018, and they met the criteria. They were divided into two groups: TACE + Sunitinib group (N = 47) and Sunitinib group (N = 51). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients. RESULTS (1)TACE + Sunitinib group: 4 patients (8.5%) achieved CR, 27 patients (57.5%) achieved PR, 9 patients (19.1%) achieved SD, and 7 patients (14.9%) achieved PD. Sunitinib group, 0 patients (0%) achieved CR, 20 patients (39.2%) achieved PR, 14 patients (27.5%) achieved SD, and 17 patients (33.3%) achieved PD. (P = 0.017) (2)ORR: TACE + sunitinib group, 66.0%; sunitinib group, 39.2%. (P = 0.009) (3)DCR: TACE + sunitinib group, 85.1%; sunitinib group, 66.7%. (P = 0.038) (4) In the TACE + sunitinib group, mPFS was 15.6 months, mOS was 35.0 months; in the sunitinib group, the mPFS was 10.9 months, mOS was 25.7 months. (P < 0.001) (5) The incidence of abdominal pain, fever, and vomiting was higher in the TACE + sunitinib group than in the sunitinib group (abdominal pain: 55.3% vs. 13.7%; fever: 61.7% vs. 7.8%; vomiting: 40.4% vs. 19.6%; P < 0.05). The technical success rate of TACE in TACE + Sunitinib group is 100%. CONCLUSIONS The TACE + sunitinib group had higher ORR and DCR, longer OS and PFS than the sunitinib alone group. TACE combined with sunitinib can play a complementary role and is a safe and effective treatment for advanced RCC.
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Ye
- Huazhong University of Science and Technology Hospital, Luoyu Road #1037, Wuhan, 430071, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Li Fan
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
| | - Xiangwen Xia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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Shan L, Shao X, Gu L, Wu M, Lin P, Yu Z, Chen Q, Zhu D. Clinicopathologic factors linked to oncologic outcomes for renal cell carcinoma with sarcomatoid dedifferentiation: A PRISMA-compliant systematic review and meta-analysis. Front Surg 2022; 9:922150. [PMCID: PMC9633959 DOI: 10.3389/fsurg.2022.922150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background There are still differences in the prognostic factors of renal cell carcinoma with sarcomatoid dedifferentiation (sRCC). The aim of this study was to evaluate important predictors of survival in patients with sRCC. Patients and methods A comprehensive search of PubMed, Embase, and Cochrane Library was conducted to identify eligible studies. The endpoints embraced overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Hazard ratios (HRs) and related 95% confidence intervals (CIs) were extracted. Results A total of 13 studies were included for analyses. The pooled results showed that high European Cooperative Oncology Group performance score (HR 2.39, 95% CI 1.32–4.30; P = 0.004), high T stage (HR 2.18, 95% CI 1.66–2.86; P < 0.001), positive lymph node (HR 1.54, 95% CI 1.40–1.69; P < 0.001), distant metastasis (HR 2.52, 95% CI 1.99–3.21; P < 0.001), lung metastases (HR 1.45, 95% CI 1.16–1.80; P < 0.001), liver metastases (HR 1.71, 95% CI 1.30–2.25; P < 0.001), tumor necrosis (HR 1.78, 95% CI 1.14–2.80; P = 0.010), and percentage sarcomatoid ≥50% (HR 2.35, 95% CI 1.57–3.52; P < 0.001) were associated with unfavorable OS. Positive lymph node (HR 1.57, 95% CI 1.33–1.85; P < 0.001) and high neutrophil to lymphocyte ratio (HR 1.16, 95% CI 1.04–1.29; P = 0.008) were associated with unfavorable CSS. High T stage (HR 1.93 95% CI 1.44–2.58; P < 0.001) was associated with unfavorable progression-free survival. Conclusions A meta-analysis of available data identified important prognostic factors for CSS, OS, and PFS of sRCC, which should be systematically evaluated for patient counseling, risk stratification, and treatment selection. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=249449.
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Affiliation(s)
- Lisong Shan
- Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Xue Shao
- Department of Neurology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Liangyou Gu
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Minhong Wu
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Pengxiu Lin
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Zhiling Yu
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Qingsheng Chen
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Daqing Zhu
- Department of Urology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China,Correspondence: Daqing Zhu
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Hahn AW, Lebenthal J, Genovese G, Sircar K, Tannir NM, Msaouel P. The significance of sarcomatoid and rhabdoid dedifferentiation in renal cell carcinoma. Cancer Treat Res Commun 2022; 33:100640. [PMID: 36174377 DOI: 10.1016/j.ctarc.2022.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
Dedifferentiation in renal cell carcinoma (RCC), either sarcomatoid or rhabdoid, is an infrequent event that may occur heterogeneously in the setting of any RCC histology and is associated with poor outcomes. Sarcomatoid dedifferentiation is associated with inferior survival with angiogenesis targeted therapy and infrequent responses to cytotoxic chemotherapy. However, immune checkpoint therapy has significantly improved outcomes for patients with sarcomatoid dedifferentiation. Biologically, sarcomatoid dedifferentiation has increased programmed death-ligand 1 (PD-L1) expression and an inflamed tumor microenvironment, in addition to other distinct molecular alterations. Less is known about rhabdoid dedifferentiation from either a clinical, biological, or therapeutic perspective. In this focused review, we will discuss the prognostic implications, outcomes with systemic therapy, and underlying biology in RCC with either sarcomatoid or rhabdoid dedifferentiation present.
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Affiliation(s)
- Andrew W Hahn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Justin Lebenthal
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Kanishka Sircar
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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11
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Al-Juhaishi T, Deng X, Bandyopadhyay D, Paul A. The Role of Cytoreductive Nephrectomy and Targeted Therapy on Outcomes of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: A Population-Based Analysis. Cureus 2022; 14:e25395. [PMID: 35774668 PMCID: PMC9236690 DOI: 10.7759/cureus.25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is a rare but aggressive form of kidney cancer with a poor prognosis. Despite recent advances in therapies for kidney cancers, an effective management strategy for sRCC is uncertain. We evaluated the impact of targeted therapy and cytoreductive nephrectomy (CN) on survival outcomes of patients with metastatic sRCC. We identified patients diagnosed with sRCC between January 1, 1973, and December 31, 2014, within the Surveillance, Epidemiology and End Results (SEER) database. Patients with metastatic sRCC were stratified based on the era of diagnosis (before or after the introduction of targeted systemic therapy in 2006) and the status of CN. Cancer-specific survival (CSS) and overall survival (OS) were analyzed. Data of 993 patients with metastatic sRCC were available for analysis. The median age was 62 years. Most patients were male (69%), Caucasian (71%), and were diagnosed in the targeted therapy era (83%); 53% of patients underwent CN. CSS and OS of the whole cohort were 5.0 months and 4.0 months, respectively. While the introduction of targeted therapy did not improve outcomes, CN improved CSS and OS in both pre-targeted therapy and targeted therapy era. On multivariable analysis, CN was a predictor of an improved CSS (hazard ratio [HR] 0.54, p < 0.0001) and OS (HR 0.51, p < 0.0001). Among other factors, older age at diagnosis, higher T stages, and node positivity were associated with worse outcomes. Our results showed that the introduction of targeted therapy did not improve outcomes in patients with metastatic sRCC. CN improved survival in both pre-targeted and targeted therapy eras.
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12
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Fontes-Sousa M, Calvo E. First-line immune checkpoint inhibitors in advanced or metastatic renal cell carcinoma with sarcomatoid features. Cancer Treat Rev 2022; 105:102374. [DOI: 10.1016/j.ctrv.2022.102374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 01/15/2023]
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13
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Filipiak-Duliban A, Brodaczewska K, Kajdasz A, Kieda C. Spheroid Culture Differentially Affects Cancer Cell Sensitivity to Drugs in Melanoma and RCC Models. Int J Mol Sci 2022; 23:ijms23031166. [PMID: 35163092 PMCID: PMC8835769 DOI: 10.3390/ijms23031166] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
2D culture as a model for drug testing often turns to be clinically futile. Therefore, 3D cultures (3Ds) show potential to better model responses to drugs observed in vivo. In preliminary studies, using melanoma (B16F10) and renal (RenCa) cancer, we confirmed that 3Ds better mimics the tumor microenvironment. Here, we evaluated how the proposed 3D mode of culture affects tumor cell susceptibility to anti-cancer drugs, which have distinct mechanisms of action (everolimus, doxorubicin, cisplatin). Melanoma spheroids showed higher resistance to all used drugs, as compared to 2D. In an RCC model, such modulation was only observed for doxorubicin treatment. As drug distribution was not affected by the 3D shape, we assessed the expression of MDR1 and mTor. Upregulation of MDR1 in RCC spheroids was observed, in contrast to melanoma. In both models, mTor expression was not affected by the 3D cultures. By NGS, 10 genes related with metabolism of xenobiotics by cytochrome p450 were deregulated in renal cancer spheroids; 9 of them were later confirmed in the melanoma model. The differences between 3D models and classical 2D cultures point to the potential to uncover new non-canonical mechanisms to explain drug resistance set by the tumor in its microenvironment.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/metabolism
- Carcinoma, Renal Cell/pathology
- Cell Survival
- Drug Resistance, Neoplasm
- Gene Expression Regulation, Neoplastic/drug effects
- High-Throughput Nucleotide Sequencing
- Humans
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/genetics
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Melanoma, Experimental/drug therapy
- Melanoma, Experimental/genetics
- Melanoma, Experimental/metabolism
- Melanoma, Experimental/pathology
- Spheroids, Cellular/drug effects
- Spheroids, Cellular/metabolism
- Spheroids, Cellular/pathology
- Tumor Cells, Cultured
- Tumor Microenvironment
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Affiliation(s)
- Aleksandra Filipiak-Duliban
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, 04-141 Warsaw, Poland;
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence:
| | - Klaudia Brodaczewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Arkadiusz Kajdasz
- Department of RNA Metabolism, Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznan, Poland;
- Laboratory of Human Molecular Genetics, Faculty of Biology, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University Poznan, 61-614 Poznan, Poland
| | - Claudine Kieda
- Center for Molecular Biophysics UPR 4301 CNRS, CEDEX 2, 45071 Orleans, France;
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14
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Immunotherapy-based combinations in the first-line treatment of metastatic renal cell carcinoma with sarcomatoid features: a systematic review and network meta-analysis. Curr Opin Urol 2022; 32:61-68. [PMID: 34720102 DOI: 10.1097/mou.0000000000000940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To perform indirect comparisons of efficacy and safety of first-line immune checkpoint inhibitor (ICI)-based combination therapies for renal cell carcinoma with sarcomatoid features (sRCC). RECENT FINDINGS Five trials were included in our network meta-analyses comprising 568 patients. The combinations nivolumab plus ipilimumab and nivolumab plus cabozantinib achieved significant improvement of progression-free survival (PFS), overall survival (OS), and objective response rates (ORR). Nivolumab plus ipilimumab was associated with the highest likelihood of achieving a complete response. All the included combinations significantly improved PFS and ORR. The combinations of pembrolizumab plus axitinib did not show a statistically significant association with OS. Nivolumab plus cabozantinib had the highest likelihood of improving PFS and OS. SUMMARY Our network meta-analysis demonstrates that sRCC are responsive to immune-based combinations. The dual ICI with nivolumab plus ipilimumab improved all efficacy outcomes and achieved the highest complete response rates (CRR). Although the association of nivolumab plus cabozantinib with CRR was not statistically significant, this combination demonstrated the highest likelihood of PFS and OS improvements.
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15
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Candelario N, Geiger C, Flaig T. Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is an aggressive form of kidney cancer that is associated with poor prognosis. It can arise from any histologic type of renal cell carcinoma. The majority of cases will present with advanced or metastatic disease requiring systemic therapy. Nephrectomy is the treatment of choice in locally resectable disease. The therapeutic options for sRCC have evolved in the past decade. Cytotoxic chemotherapy and monotherapy with targeted therapy (VEGF and mTOR) have historically shown poor response rates and survival in the treatment of metastatic sRCC. The use of checkpoint inhibitors and their combination with targeted therapy against VEGF has changed the landscape and outcomes for renal cell carcinoma. Given the rarity of sRCC most of the data on treatment is from small cohorts or extrapolation from larger clinical trials. The benefit from the combination of checkpoint inhibitors and targeted therapy to VEGF has shown promise in the sRCC population in post hoc analysis of large clinical trials. Future research focusing on further characterizing the unique biologic and clinical features of sRCC is critical in advancing the knowledge and developing effective therapy to improve clinical outcomes and survival.
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Affiliation(s)
- Nellowe Candelario
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher Geiger
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Flaig
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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16
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Durable Remission with Immunotherapy in a Patient with Sarcomatoid Renal Cell Carcinoma. J Kidney Cancer VHL 2021; 8:38-42. [PMID: 34765405 PMCID: PMC8557255 DOI: 10.15586/jkcvhl.v8i4.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Sarcomatoid differentiation is a rare and aggressive histologic subtype with poor prognosis, seen in several malignancies. In sarcomatoid renal cell carcinoma (RCC), the degree of sarcomatoid differentiation and the stage at presentation determines the prognosis. Despite resection, chemotherapy and targeted therapy response is modest, with relapse usually occurring within a few months. We present a case of a gentleman with sarcomatoid RCC managed with pembrolizumab, who has had no evidence of recurrence for over 4 years since the last dose of immunotherapy. RCCs with sarcomatoid differentiation have a high presence of programmed cell death protein 1 and programmed cell death ligand 1 in T cells and tumor cells, respectively, making immunotherapy an attractive option in this setting. Clinical trials are ongoing to further define the benefit of immunotherapy in sarcomatoid RCC.
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17
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Outcomes of patients with metastatic renal cell carcinoma with sarcomatoid dedifferentiation to immune checkpoint inhibitors. Urol Oncol 2020; 39:134.e9-134.e16. [PMID: 33187886 DOI: 10.1016/j.urolonc.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Metastatic renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with poor survival outcomes. We aimed to analyze the efficacy and safety of immune checkpoint inhibitors (ICI) in patients with sRCC comparing clear-cell (sccRCC) to non-clear cell epithelial histology (snccRCC). METHODS We performed retrospective analysis of sRCC patients who received ICI at MD Anderson Cancer Center (n = 48, 41 with ccRCC and 7 with nccRCC) to determine the overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Additionally, we performed a prespecified multivariable Cox regression comparing survival outcomes between sccRCC and snccRCC. RESULTS The ORR for the entire cohort was 35.4% (95% confidence interval [CI]: 23.4%, 49.6%), including 8 (16.7%) patients (95% CI: 8.7%, 29.6%) who achieved a complete remission. The disease control rate was 52% (95% CI: 38.3%, 65.5%). In patients with sccRCC, the ORR was 39% (95% CI: 25.7%, 54.3%) and disease control rate 58.5% (43.4%, 72.2%). Among 7 snccRCC patients, only one (14.3%) achieved an objective partial response. At a median follow-up of 51.1 months, the median PFS was 4.9 months (95% CI: 2.7, 16.3) and the median OS was 28.4 months (95% CI: 15.8, NA) for the entire cohort. For patients with sccRCC, the median PFS was 8.9 months, with median OS of 30.1 months, compared with median PFS of 2.3 months (HR 0.25 [95% CI: 0.08, 0.78]; P= 0.0145) and median OS of 6.7 months (HR 0.13 [95% CI 0.04, 0.44]; P=0.0009) for patients with snccRCC. CONCLUSION ICIs appear to be effective in sccRCC while the treatment of snccRCC remains challenging.
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18
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Blum KA, Gupta S, Tickoo SK, Chan TA, Russo P, Motzer RJ, Karam JA, Hakimi AA. Sarcomatoid renal cell carcinoma: biology, natural history and management. Nat Rev Urol 2020; 17:659-678. [PMID: 33051619 PMCID: PMC7551522 DOI: 10.1038/s41585-020-00382-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Sarcomatoid dedifferentiation is an uncommon feature that can occur in most histological subtypes of renal cell carcinomas (RCCs) and carries a decidedly poor prognosis. Historically, conventional treatments for sarcomatoid RCCs (sRCCs) have shown little efficacy, and median survival is commonly 6–13 months. Despite being first described in 1968, the mechanisms driving sarcomatoid dedifferentiation remain poorly understood, and information and treatment options available to physicians and patients are limited. When diagnosed at an early stage, surgical intervention remains the treatment of choice. However, preoperative identification through routine imaging or biopsy is unreliable and most patients present with advanced disease and systemic symptoms. For these patients, the role of cytoreductive nephrectomy is disputed. The expansion of immunotherapies approved for RCCs has generated a search for biomarkers that might be indicative of treatment response in sRCCs, although a proven effective systemic agent remains elusive. PDL1 expression is increased in sarcomatoid dedifferentiated renal tumours, which suggests that patients with sRCCs could benefit from PD1 and/or PDL1 immune checkpoint blockade therapy. Treatment outcomes for sarcomatoid tumours have remained relatively consistent compared with other RCCs, but further investigation of the tumour–immune cell microenvironment might yield insights into further therapeutic possibilities. In this Review, Blum et al. summarize the current knowledge on sarcomatoid renal cell carcinoma, a diagnosis characterized by the presence of sarcomatoid dedifferentiation and a poor prognosis. They discuss the origin, presentation, molecular biology and treatment of this disease. Sarcomatoid dedifferentiation is not considered to be a unique histological subtype of renal cell carcinomas (RCCs); rather, it can be present within any subtype of RCCs. Sarcomatoid dedifferentiation appears in ~4% of all RCCs, but is present in ~20% of all metastatic RCCs. According to WHO guidelines, any RCC with sarcomatoid dedifferentiation is a WHO–International Society of Urological Pathology grade 4 lesion. Sarcomatoid dedifferentiation is often heterogeneously present within RCCs, making routine imaging and biopsy unreliable for preoperative detection. Surgical resection for localized disease is the standard of care, with subsequent close monitoring of patients following surgery. In patients with metastatic disease, conventional therapies such as surgery and systemic agents have been ineffective and overall 5-year survival remains at 23.5–33%. Previous genomic analyses have failed to identify definitive mutational drivers of disease. However, sarcomatoid RCCs (sRCCs) have been shown to have higher PD1 and PDL1 expression than other subtypes of RCCs. Newer combinations of immune checkpoint inhibitor immunotherapies could yield improved responses and outcomes. Studies investigating sRCCs are limited by patient numbers owing to the low incidence of sRCCs and their advanced stage at presentation. Multi-institutional efforts to establish a consensus on treatment recommendations based on highly powered data are essential.
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Affiliation(s)
- Kyle A Blum
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sounak Gupta
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose A Karam
- Departments of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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19
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Tannir NM, Signoretti S, Choueiri TK, McDermott DF, Motzer RJ, Flaifel A, Pignon JC, Ficial M, Frontera OA, George S, Powles T, Donskov F, Harrison MR, Barthélémy P, Tykodi SS, Kocsis J, Ravaud A, Rodriguez-Cid JR, Pal SK, Murad AM, Ishii Y, Saggi SS, McHenry MB, Rini BI. Efficacy and Safety of Nivolumab Plus Ipilimumab versus Sunitinib in First-line Treatment of Patients with Advanced Sarcomatoid Renal Cell Carcinoma. Clin Cancer Res 2020; 27:78-86. [PMID: 32873572 DOI: 10.1158/1078-0432.ccr-20-2063] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 08/27/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Patients with advanced renal cell carcinoma with sarcomatoid features (sRCC) have poor prognoses and suboptimal outcomes with targeted therapy. This post hoc analysis of the phase III CheckMate 214 trial analyzed the efficacy of nivolumab plus ipilimumab (NIVO+IPI) versus sunitinib in patients with sRCC. PATIENTS AND METHODS Patients with sRCC were identified via independent central pathology review of archival tumor tissue or histologic classification per local pathology report. Patients were randomized 1:1 to receive nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) every 3 weeks (four doses) then nivolumab 3 mg/kg every 2 weeks, or sunitinib 50 mg orally every day (4 weeks; 6-week cycles). Outcomes in patients with sRCC were not prespecified. Endpoints in patients with sRCC and International Metastatic Renal Cell Carcinoma Database Consortium intermediate/poor-risk disease included overall survival (OS), progression-free survival (PFS) per independent radiology review, and objective response rate (ORR) per RECIST v1.1. Safety outcomes used descriptive statistics. RESULTS Of 1,096 randomized patients in CheckMate 214, 139 patients with sRCC and intermediate/poor-risk disease and six with favorable-risk disease were identified. With 42 months' minimum follow-up in patients with sRCC and intermediate/poor-risk disease, median OS [95% confidence interval (CI)] favored NIVO+IPI [not reached (NR) (25.2-not estimable [NE]); n = 74] versus sunitinib [14.2 months (9.3-22.9); n = 65; HR, 0.45 (95% CI, 0.3-0.7; P = 0.0004)]; PFS benefits with NIVO+IPI were similarly observed [median 26.5 vs. 5.1 months; HR, 0.54 (95% CI, 0.33-0.86; P = 0.0093)]. Confirmed ORR was 60.8% with NIVO+IPI versus 23.1% with sunitinib, with complete response rates of 18.9% versus 3.1%, respectively. No new safety signals emerged. CONCLUSIONS NIVO+IPI showed unprecedented long-term survival, response, and complete response benefits versus sunitinib in previously untreated patients with sRCC and intermediate/poor-risk disease, supporting the use of first-line NIVO+IPI for this population.See related commentary by Hwang et al., p. 5.
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Affiliation(s)
- Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abdallah Flaifel
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean-Christophe Pignon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Miriam Ficial
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Thomas Powles
- Department of Urology, Barts Cancer Institute, Queen Mary University of London, Royal Free NHS Trust, London, United Kingdom
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Philippe Barthélémy
- Medical Oncology Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Scott S Tykodi
- Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Judit Kocsis
- Oncology Department, Debrecen University Clinical Center, Debrecen, Hungary.,Department of Oncoradiology, Bács-kiskun County Teaching Hospital (BKMK) Centre of Oncoradiology, Kecskemét, Hungary
| | - Alain Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | | | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Andre M Murad
- CENANTRON-PERSONAL-Precision Oncology, Belo Horizonte, Minas Gerais, Brazil
| | - Yuko Ishii
- Department of Clinical Trials, Bristol Myers Squibb, Princeton, New Jersey
| | | | - M Brent McHenry
- Department of Biostatistics, Bristol Myers Squibb, Princeton, New Jersey
| | - Brian I Rini
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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20
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Long-term follow-up results of patients with sarcomatoid RCC: A retrospective evaluation of a single center experience. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.789516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Safety and efficacy of CDX-014, an antibody-drug conjugate directed against T cell immunoglobulin mucin-1 in advanced renal cell carcinoma. Invest New Drugs 2020; 38:1807-1814. [PMID: 32472319 DOI: 10.1007/s10637-020-00945-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023]
Abstract
CDX-014 is an antibody-drug conjugate directed against TIM-1, a surface marker highly expressed in renal cell carcinoma (RCC) and ovarian carcinoma. This phase I, first-in-human trial was conducted to evaluate the safety and preliminary activity of CDX-014 in patients with advanced refractory RCC, following a dose-escalation and dose expansion design. CDX-014 was administered intravenously at doses ranging from 0.15 to 2.0 mg/kg every 2 or 3 weeks until progression or unacceptable toxicity. Sixteen patients received at least one dose of CDX-014. The maximum tolerated dose was not identified. Most frequent adverse grade 1 or 2 adverse events included nausea (38%), fatigue, alopecia, elevation of AST and decreased appetite (25% each). Adverse events of grade 3 or more included hyperglycemia (19%), urosepsis (6%), and one multi-organ failure (6%) responsible for one treatment-related death. Two patients discontinued therapy for adverse events including fatigue grade 2 and urosepsis grade 4. CDX-014 showed antitumor activity with one prolonged partial response and a clinical benefit rate (objective response or stable disease >6 months) of 31%. The two patients that exhibited the most marked tumor shrinkage had high TIM-1 expression on tumor tissue. Overall, CDX-014 exhibited a manageable toxicity profile and early signs of activity, supporting further evaluation of antibody-drug conjugates in patients with advanced RCC and potentially other TIM-1 expressing cancers. Trial registration https://clinicaltrials.gov/ct2/show/NCT02837991 NCT02837991; July 20, 2016.
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22
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Hou G, Li X, Zheng Y, Liu P, Yan F, Ju D, Zhang G, Zheng W, Gao M, Hou N, Yuan J, Wang F, Yuan J. Construction and validation of a novel prognostic nomogram for patients with sarcomatoid renal cell carcinoma: a SEER-based study. Int J Clin Oncol 2020; 25:1356-1363. [PMID: 32361824 DOI: 10.1007/s10147-020-01681-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/30/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The only one established prognostic nomogram for patients with sarcomatoid renal cell carcinoma (sRCC) was based on a small sample-sized study without external validation, and a nomogram can be applied to western sRCC patients has not yet been developed. Therefore, our study aimed to construct and validate an effective nomogram to predict overall survival (OS) for these patients. METHODS The independent predictors for OS were identified and the nomogram was constructed on the basis of a retrospective study of a training cohort consisted of 428 non-Hispanic white sRCC patients registered in the Surveillance, Epidemiology and End Results (SEER) database from January 2010 to December 2015. Then, the discriminative performance of the nomogram was assessed by the concordance index (C-index). OS calibrations of the nomogram were also performed by comparing the nomogram-predicted probability to the observed survival rate. Furthermore, our nomogram was externally validated using two independent cohorts consisted of 71 non-Hispanic black patients and 82 Hispanic patients, respectively. RESULTS Age at diagnosis, T stage, N stage, bone metastases, liver metastases, lung metastases and nephrectomy were identified as independent predictors for OS. In the training cohort and two validation cohorts, the C-indexes of the nomogram were 0.737, 0.801 and 0.764, respectively. Besides, excellent agreements between the nomogram prediction and the actual observation were achieved in all cohorts. CONCLUSIONS The current study constructed and validated an effective prognostic nomogram for patients with sRCC, which can be used to perform accurate predictions of the 0.5-, 1-, and 2-year possibilities of OS.
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Affiliation(s)
- Guangdong Hou
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Xi'an Li
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Yu Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pengfei Liu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Fei Yan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Dongen Ju
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Geng Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Wanxiang Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Ming Gao
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710061, China
| | - Niuniu Hou
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jiarui Yuan
- St. George's University School of Medicine, West Indies, Grenada
| | - Fuli Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Nanomedicines blocking adaptive signals in cancer cells overcome tumor TKI resistance. J Control Release 2020; 321:132-144. [DOI: 10.1016/j.jconrel.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/20/2020] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
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Gulati S, Philip E, Salgia S, Pal SK. Evolving treatment paradigm in metastatic non clear cell renal cell carcinoma. Cancer Treat Res Commun 2020; 23:100172. [PMID: 32252014 DOI: 10.1016/j.ctarc.2020.100172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
The treatment landscape for renal cell cancer (RCC) has evolved tremendously over the last two decades. Treatment algorithms have shifted from the highly toxic drugs with marginal benefit to better tolerated and more effective targeted therapy drugs. The latter include tyrosine kinase inhibitors, vascular endothelial growth factor inhibitors, MET inhibitors and, more recently, immunotherapy drugs alone and in various combinations. The majority of treatment algorithms for non-clear cell carcinoma have been based on extrapolating results from clear cell RCC trials and retrospective reviews. However, now that we understand that non-clear cell RCC is morphologically and clinically distinct from its clear cell counterpart, several collaborative clinical trials are underway for non-clear cell RCC. This review will delve into the historical aspects of treating non-clear cell RCC and the evolution of treatment paradigms over the last few decades with a focus on immunotherapy based trials.
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Affiliation(s)
- Shuchi Gulati
- Clinical Medicine, Division of Hematology and Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH 45267-0562, United States
| | - Errol Philip
- University of California San Francisco School of Medicine, San Francisco, CA 94143, United States
| | - Sabrina Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States
| | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States.
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25
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George G, Schmidt L, Tolat P, Riese M, Kilari D. Salvage ipilimumab associated with a significant response in sarcomatoid renal cell carcinoma. J Immunother Cancer 2020; 8:e000584. [PMID: 32114501 PMCID: PMC7057424 DOI: 10.1136/jitc-2020-000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Metastatic sarcomatoid renal cell carcinoma (sRCC) is an aggressive variant of RCC with generally poor prognosis. Treatment with vascular endothelial growth factor inhibitors or chemotherapy generates only short-lived responses. Recent research has suggested a role for combination checkpoint inhibition as first line treatment for metastatic sRCC. This therapy consists of induction with cytotoxic T-lymphocyte-associated protein 4 inhibitor, ipilimumab, administered with programmed cell death protein 1 (PD-1) inhibitor, nivolumab. After completion of four cycles of combination therapy, single-agent maintenance nivolumab is recommended until progression. Patients who progress on maintenance nivolumab are switched to alternate therapy. Herein, we present a case of a patient with RCC who progressed on maintenance nivolumab who, on retreatment with ipilimumab, demonstrated a significant response In addition, we summarize important findings to support the role of salvage ipilimumab in patients with sRCC. CASE PRESENTATION A 46-year-old man presented with flank pain and hematuria, the work up of which noted a left kidney mass for which he underwent nephrectomy and was diagnosed with localized sRCC with 60% sarcomatoid differentiation. Within 3 months of nephrectomy, he presented with recurrent flank pain and was diagnosed with recurrence of disease. He was treated with ipilimumab 1 mg/kg and nivolumab 3 mg/kg for four doses and demonstrated a partial response. He was then transitioned to single agent nivolumab maintenance. After 3 months on maintenance therapy, he was noted to have progression of disease. Given prior response to immune check point combination, it was decided to rechallenge the patient with 1 mg/kg ipilimumab. After two doses of ipilimumab and nivolumab combination therapy, the patient was noted to have a partial response. He maintained a response for an additional 9 months and treatment was eventually discontinued due to grade 3 toxicity and progression. CONCLUSIONS This case report demonstrates the utility of retreatment with ipilimumab as a salvage option for patients progressing on maintenance PD-1 inhibitors in metastatic RCC. Further studies are needed to identify predictors of response and toxicity to this approach, as well as the optimal scheduling of ipilimumab with maintenance nivolumab.
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Affiliation(s)
- Gemlyn George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Laura Schmidt
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Parag Tolat
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mathew Riese
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI 53213, USA
| | - Deepak Kilari
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Lázaro M, Valderrama BP, Suárez C, de-Velasco G, Beato C, Chirivella I, González-del-Alba A, Laínez N, Méndez-Vidal MJ, Arranz JA. SEOM clinical guideline for treatment of kidney cancer (2019). Clin Transl Oncol 2020; 22:256-269. [DOI: 10.1007/s12094-019-02285-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022]
Abstract
AbstractIn this article, we review de state of the art on the management of renal cell carcinoma (RCC) and provide recommendations on diagnosis and treatment. Recent advances in molecular biology have allowed the subclassification of renal tumours into different histologic variants and may help to identify future prognostic and predictive factors. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. No adjuvant therapy has demonstrated a clear benefit in overall survival. Considering the whole population of patients with advanced disease, the combination of axitinib with either pembrolizumab or avelumab increase response rate and progression-free survival, compared to sunitinib, but a longer overall survival has only been demonstrated so far with the pembrolizumab combo. For patients with IMDC intermediate and poor prognosis, nephrectomy should not be considered mandatory. In this subpopulation, the combination of ipilimumab and nivolumab has also demonstrated a superior response rate and overall survival vs. sunitinib. In patients progressing to one or two antiangiogenic tyrosine-kinase inhibitors, both nivolumab and cabozantinib in monotherapy have shown benefit in overall survival compared to everolimus. Although no clear sequence can be recommended, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in patients with metastatic RCC.
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Debien V, Thouvenin J, Lindner V, Barthélémy P, Lang H, Flippot R, Malouf GG. Sarcomatoid Dedifferentiation in Renal Cell Carcinoma: From Novel Molecular Insights to New Clinical Opportunities. Cancers (Basel) 2019; 12:E99. [PMID: 31906050 PMCID: PMC7016737 DOI: 10.3390/cancers12010099] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
Sarcomatoid features in renal cell carcinoma (RCC) have long been associated with dismal prognosis and poor response to therapy, while biological mechanisms underpinning sarcomatoid dedifferentiation remained obscure. Several efforts have been conducted to break down the molecular profile of sarcomatoid RCC and investigate different targeted therapeutic approaches. Mutations enriched for in sarcomatoid RCC involve, notably, TP53, BAP1, cell cycle, and chromatin-remodeling genes. The immunological landscape of these tumors is also gradually being uncovered, showing frequent expression of programmed cell death ligand-1 (PD-L1) and high levels of tumor-infiltrating lymphocytes. These features may be major determinants for the activity of immune checkpoint inhibitors in this population, which has been confirmed by retrospective studies and subgroup analyses of large randomized phase 3 trials. Combinations based on PD-1/PD-L1 inhibition have demonstrated response rates and complete responses in >50% and >10% of patients in the first-line metastatic setting, respectively, with median overall survival exceeding two years. This remarkable improvement in outcomes effectively establishes immune checkpoint inhibitor combinations as a new standard of care in patients with sarcomatoid RCC. New research fields, including epigenetic regulations and tumor-microenvironment interactions, may further sharpen understanding of sarcomatoid RCC and advance therapeutic developments.
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Affiliation(s)
- Véronique Debien
- Department of Oncology, Institut de Cancérologie de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67200 Strasbourg, France; (V.D.); (J.T.)
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400 Illkirch, France;
| | - Jonathan Thouvenin
- Department of Oncology, Institut de Cancérologie de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67200 Strasbourg, France; (V.D.); (J.T.)
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400 Illkirch, France;
| | - Véronique Lindner
- Department of Pathology, Centre Hospitalier Universitaire Régional de Strasbourg, 67200 Strasbourg, France;
| | - Philippe Barthélémy
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400 Illkirch, France;
| | - Hervé Lang
- Department of Urology, Centre Hospitalier Universitaire Régional de Strasbourg, 67000 Strasbourg, France;
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, 94800 Villejuif, France;
| | - Gabriel G. Malouf
- Department of Oncology, Institut de Cancérologie de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 67200 Strasbourg, France; (V.D.); (J.T.)
- Department of Cancer and Functional Genomics, Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM/UNISTRA, 67400 Illkirch, France;
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A multicenter, prospective phase II trial of gemcitabine plus axitinib in patients with renal cell carcinoma with a predominant sarcomatoid component. Invest New Drugs 2019; 37:1239-1246. [PMID: 31231787 DOI: 10.1007/s10637-019-00817-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022]
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Ito K. Recent advances in the systemic treatment of metastatic non‐clear cell renal cell carcinomas. Int J Urol 2019; 26:868-877. [DOI: 10.1111/iju.14027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Keiichi Ito
- Department of Urology National Defense Medical College Tokorozawa Saitama Japan
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68Ga-Galmydar: A PET imaging tracer for noninvasive detection of Doxorubicin-induced cardiotoxicity. PLoS One 2019; 14:e0215579. [PMID: 31120912 PMCID: PMC6532866 DOI: 10.1371/journal.pone.0215579] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Cancer patients undergoing Doxorubicin (DOX) treatment are susceptible to acute and chronic cardiac anomalies, including aberrant arrhythmias, ventricular dysfunction, and heart failure. To stratify patients at high risk for DOX -related heart failure (CHF), diagnostic techniques have been sought. While echocardiography is used for monitoring LVEF and LV volumes due to its wide-availability and cost-efficiency, it may not identify early stages of the initiation of DOX-induced systolic heart failure. To address these limitations, PET tracers could also provide noninvasive assessment of early and reversible metabolic changes of the myocardium. Objective Herein, we report a preliminary investigation of 68Ga-Galmydar potential to monitor Dox-induced cardiomyopathy in vivo, ex vivo, and in cellulo employing both nuclear- and optical imaging. Methods and results To assess 68Ga-Galmydar ability for monitoring DOX-induced cardiomyopathy, microPET imaging was performed 5 d post treatment of rats either with a single dose of DOX (15 mg/kg) or vehicle as a control (saline) and images were co-registered for anatomical reference using CT. Following tail-vein injection of the radiotracer in rats at 60 min, micro-PET/CT static scan (10 min acquisition), 68Ga-Galmydar demonstrated 1.91-fold lower uptake in hearts of DOX-treated (standard uptake value; SUV: 0.92, n = 3) rats compared with their vehicle treated (SUV: 1.76, n = 3) control counterparts. For correlation of PET imaging data, post-imaging quantitative biodistribution studies were also performed, wherein excised organs were counted for γ activity, and normalized to injected dose. The post imaging pharmacokinetic data also demonstrated heart uptake values of 2.0 fold lower for DOX treated rats(%ID/g; DOX: 0.44 ± 0.1, n = 3) compared to their vehicle-treated controls (%ID/g; Control: 0.89 ± 0.03, n = 3, p = 0.04). Employing the fluorescent traits of Galmydar, live cell fluorescence imaging indicated a gradual decrease in uptake and retention of Galmydar within mitochondria of H9c2 cells following DOX-treatment, while indicating dose-dependent and time-dependent uptake profiles. Following depolarization of electronegative transmembrane gradients at the mitochondrial membrane, the uptake of the probe was decreased in H9c2 cells, and the uptake profiles were found to be identical, using both fluorescence and radiotracer bioassays. Finally, the decreased uptake of the metalloprobe in H9c2 cells also correlated with caspase-3 expression resulting from DOX-induced cardiotoxicity and cell death. Conclusions 68Ga-Galmydar could provide a noninvasive assessment of DOX-related and likely reversible metabolic changes at earliest stages. Further studies with other chemotherapeutics (potentially capable of inducing cardiomyopathy) are underway.
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Ged Y, Chen YB, Knezevic A, Casuscelli J, Redzematovic A, DiNatale RG, Carlo MI, Lee CH, Feldman DR, Patil S, Hakimi AA, Russo P, Motzer RJ, Voss MH. Metastatic Chromophobe Renal Cell Carcinoma: Presence or Absence of Sarcomatoid Differentiation Determines Clinical Course and Treatment Outcomes. Clin Genitourin Cancer 2019; 17:e678-e688. [PMID: 31036466 DOI: 10.1016/j.clgc.2019.03.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sarcomatoid features (SF) in renal cell carcinoma (RCC) denote poor prognosis. Data for metastatic chromophobe RCC (ChRCC) with SF are limited. We studied clinical outcomes and genomic features in this setting. PATIENTS AND METHODS We performed a retrospective review of newly diagnosed metastatic ChRCC patients; end points included overall survival (OS), time to treatment failure (TTF), and time to metastatic recurrence (TTR) after nephrectomy for localized disease. A subset of patients underwent next-generation sequencing (NGS). Outcomes were compared using nonparametric tests. RESULTS One hundred nine patients with metastatic ChRCC were identified including 29 with SF. Median TTR after nephrectomy was shorter for patients with versus without SF (2.7 months [95% confidence interval (CI), 0.7-6.9] versus 48.8 months [95% CI, 30.8-80.7], log rank P < .001). Median TTF during first-line therapy was shorter for patients with versus without SF (1.8 months [95% CI, 0.9-2.7] vs. 8.0 months [95% CI, 5.1-13.0]; log rank P < .001). No responses were observed in 6 patients treated with nivolumab including 4 with SF. Median OS was inferior for patients with versus without SF (38 months vs.7.5 months; hazard ratio, 4.7 [95% CI, 2.7-8.2]; P < .001). NGS, performed in 22 patients, showed that 64% and 45% harbored tumor protein P53 and phosphatase and tensin homolog alterations, respectively. Microsatellite instability high status was identified in 3 patients. CONCLUSION Metastatic ChRCC patients with SF had worse outcomes compared with those without SF. Median TTR < 3 months for this subgroup supports close surveillance after nephrectomy for localized tumors. Lack of benefit with various systemic regimens warrants studying underlying biology and investigating novel agents.
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Affiliation(s)
- Yasser Ged
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Renzo G DiNatale
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria I Carlo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chung-Han Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ari Hakimi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
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Vinciguerra D, Jacobs M, Denis S, Mougin J, Guillaneuf Y, Lazzari G, Zhu C, Mura S, Couvreur P, Nicolas J. Heterotelechelic polymer prodrug nanoparticles: Adaptability to different drug combinations and influence of the dual functionalization on the cytotoxicity. J Control Release 2019; 295:223-236. [DOI: 10.1016/j.jconrel.2018.12.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/25/2018] [Accepted: 12/28/2018] [Indexed: 11/27/2022]
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Wang Z, Zeng X, Chen R, Chen Z. Ki-67 index and percentage of sarcomatoid differentiation were two independent prognostic predictors in sarcomatoid renal cell carcinoma. Cancer Manag Res 2018; 10:5339-5347. [PMID: 30464630 PMCID: PMC6225922 DOI: 10.2147/cmar.s176242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To identify whether and which of pathological features of sarcomatoid differentiation (SD) in renal cell carcinoma (RCC) can be used as independent predictors associated with overall survival (OS). Materials and methods After institutional review board approval, patients with a diagnosis of sarcomatoid RCC (sRCC), spindled RCC, or RCC with the presence of spindle cells between 2003 and 2017 were further selected and re-examined. The primary pathological features including histological subtypes, tumor necrosis, Ki-67 index of SD, and the percent of SD (%SD) were included into analysis. Histological subtypes were categorized into clear-cell RCC and nonclear-cell RCC. Ki-67 index of SD was confirmed by immunohistochemical staining. %SD was estimated through reviewing all of the tumor sections microscopically and then giving an approximate %SD within the entire tumor. The clinical relevant prognostic predictor's association with OS was analyzed within Cox proportional hazards regression models. Survival curves were generated using the Kaplan-Meier method, and OS differences were compared using the log-rank test. Results A total of 2,089 consecutive patients of RCC were referred to our department, of whom 62 (3.0%) patients were identified with histological element of SD after re-examining the available slides of suspicious cases. Finally, 53 patients were included into survival analysis after excluding 9 patients without adequate information. Thirty-eight (71.7%) patients died at last follow-up. The median OS for all patients was 11.0 months from the date of surgery. In patients with clinical distant metastasis (cM1), the median OS was only 3 compared with 21 months for patients with no clinical distant metastasis (cM0). Tumor stage, status of clinical distant metastasis, Ki-67 index, and %SD were independent predictors of multivariate analysis in overall 53 patients. However, in the cohort of cM0 patients, we found that only %SD and Ki-67 index were two independent predictors of OS in multivariate analysis. Conclusion Patients with sRCC are associated with very poor prognosis. Ki-67 index of SD and %SD were identified as the two most important independent predictors particularly for nonmetastatic patients. The limitations of our study were also observed, and further studies are needed.
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Affiliation(s)
- Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China,
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China, .,Hubei Institute of Urology, Wuhan, China,
| | - Ruibao Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China,
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China, .,Hubei Institute of Urology, Wuhan, China,
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Albiges L, Flippot R, Rioux-Leclercq N, Choueiri TK. Non-Clear Cell Renal Cell Carcinomas: From Shadow to Light. J Clin Oncol 2018; 36:JCO2018792531. [PMID: 30372389 DOI: 10.1200/jco.2018.79.2531] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Non-clear cell renal cell carcinomas (RCCs) account for up to 25% of kidney cancers and encompass distinct diseases with distinct pathologic features, different molecular alterations, and various patterns of response to systemic therapies. Recent advances in molecular biology and large collaborative efforts helped to better define the oncogenic mechanisms at play in papillary, chromophobe, collecting duct, medullary, translocation, and sarcomatoid RCCs. Papillary RCCs are divided into several subsets of tumors characterized by distinct gene expression profiles, chromatin remodeling genes, cell cycle changes, and alterations of the MET pathway. Chromophobe RCC genomic analysis revealed mostly metabolic pathway alterations with mitochondrial dysfunctions. Translocation RCCs are characterized by MITF fusions and wide genomic reprogramming. Collecting duct carcinomas are distinct entities from upper tract urothelial carcinomas associated with high T-cell infiltration and metabolic alterations. Medullary RCCs present alterations of the INI1 gene and rhabdoid features at pathologic analysis. Finally, sarcomatoid RCCs represent sarcomatoid differentiation for any subsets of RCCs with specific alterations associated with mesenchymal dedifferentiation. From the standpoint of systemic therapy, more than a decade of using VEGF and mTOR inhibitors showed that they generally had limited efficacy in non-clear cell RCCs compared with clear cell RCCs. MET inhibitors are actively being developed for papillary RCC with a specific focus on MET-driven tumors. Other strategies under investigation include CDK4/6 inhibitors in tumors with cell cycle alterations and EZH2 inhibitors in RCCs with INI1 loss. The emergence of immune checkpoint inhibitors and combination strategies enlarges the spectrum of investigational treatments. Better understanding of driver and passenger alterations and better patient stratification along with dedicated clinical networks will be key to improving the management of these rare tumors.
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Affiliation(s)
- Laurence Albiges
- Laurence Albiges and Ronan Flippot, Gustave Roussy, Université Paris-Saclay, Villejuif; Nathalie Rioux-Leclercq, Rennes University Hospital, Rennes, France; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Ronan Flippot
- Laurence Albiges and Ronan Flippot, Gustave Roussy, Université Paris-Saclay, Villejuif; Nathalie Rioux-Leclercq, Rennes University Hospital, Rennes, France; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Nathalie Rioux-Leclercq
- Laurence Albiges and Ronan Flippot, Gustave Roussy, Université Paris-Saclay, Villejuif; Nathalie Rioux-Leclercq, Rennes University Hospital, Rennes, France; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K Choueiri
- Laurence Albiges and Ronan Flippot, Gustave Roussy, Université Paris-Saclay, Villejuif; Nathalie Rioux-Leclercq, Rennes University Hospital, Rennes, France; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
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Lebacle C, Pooli A, Bessede T, Irani J, Pantuck AJ, Drakaki A. Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art. World J Urol 2018; 37:115-123. [PMID: 29858701 DOI: 10.1007/s00345-018-2355-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
Long recognized to confer an extremely poor prognosis, sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a tumor phenotype that is finally beginning to be better understood on the molecular and genetic levels. With an overall incidence that ranges from 1 to 32% depending on associated RCC subtype, the survival of sarcomatoid RCC patients rarely exceeds 2 years. The main reasons for its poor outcome include its aggressive biology, its tendency to present at an advanced or metastatic stage at the time of diagnosis, its high rate of tumor recurrence after nephrectomy, and its limited response to systemic therapies. Molecular pathology studies suggest that sarcomatoid dedifferentiation originates from a focal epithelial-mesenchymal transition (EMT) arising in the carcinomatous component of the tumor. It is hoped that the growing understanding of the molecular biology of sRCC will soon make it possible to adapt treatments based on the identification of actionable tumor alterations. The deliberate inclusion of these patients in the multicenter clinical trials of immune, targeted and combination therapies is a necessary next step in pioneering future treatment strategies.
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Affiliation(s)
- Cedric Lebacle
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France.
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas Bessede
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Jacques Irani
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra Drakaki
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
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Treatments, Outcomes, and Validity of Prognostic Scores in Patients With Sarcomatoid Renal Cell Carcinoma: A 20-Year Single-Institution Experience. Clin Genitourin Cancer 2018; 16:e577-e586. [DOI: 10.1016/j.clgc.2017.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/29/2017] [Accepted: 12/15/2017] [Indexed: 11/23/2022]
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Mouallem NE, Smith SC, Paul AK. Sarcomatoid renal cell carcinoma: Biology and treatment advances. Urol Oncol 2018; 36:265-271. [PMID: 29306556 DOI: 10.1016/j.urolonc.2017.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/22/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
Abstract
Sarcomatoid transformation in renal cell carcinoma, so called sacromatoid RCC (sRCC), is associated with an aggressive behavior and a poor prognosis. Current therapeutic approaches are largely ineffective. Recent studies looking into the genomic and molecular characterization of sRCCs have provided insights into the biology and pathogenesis of this entity. These advances in molecular signatures may help development of effective treatment strategies. We herein present a review of recent developments in the pathology, biology, and treatment modalities in sRCC.
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Affiliation(s)
- Nemer El Mouallem
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Steven C Smith
- Department of Pathology, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Asit K Paul
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA.
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Alkhatib MH, Alshehri WS, Abdu FB. In Vivo Evaluation of the Anticancer Activity of the Gemcitabine and Doxorubicin Combined in a Nanoemulsion. J Pharm Bioallied Sci 2018; 10:35-42. [PMID: 29657506 PMCID: PMC5887650 DOI: 10.4103/jpbs.jpbs_225_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Context Doxorubicin (DOX) and gemcitabine (GEM) are anticancer drugs that were combined in a nanoemulsion (NE) to reduce their adverse side effects. Aim To detect the antitumor activity of the combination formulas of GEM and DOX, loaded either in water (GEM+DOX-Sol) or in NEs (GEM-DOX combination/loaded NE [GEM+DOX/LNE]), in female Swiss albino mice inoculated with Ehrlich ascites carcinoma (EAC). Settings and Design The anticancer assessment of the NE formulas was implemented in 200 mice, which were divided into 10 groups. Materials and Methods It includes the detection of the change in body weight, analysis of the hematological and serum biochemical profiles, and study of the histopathologic alterations of the heart tissues. Statistical Analysis One-factor analysis of variance was used. Results Mice treated with GEM + DOX/LNE, which have an z-average of 155.38±2.33nm and zeta potential of -38.5±1.3 mV, recorded a considerable improvement in the mean survival time (MST), which was 60 days, as compared to the EAC control group, which has an MST of 28 days. It also restored the hematological and serum biochemical parameters toward normal values. Conclusions The combination of GEM and DOX in NE has significantly diminished the cardiotoxicity of DOX and hematotoxicity of GEM while improving their antitumor properties.
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Affiliation(s)
- Mayson H Alkhatib
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wafa S Alshehri
- Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faiza B Abdu
- Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Bergerot PG, Bergerot CD, Dizman N, Zequi S, Fay A, Dara Y, Maia MC, Cotta BN, Gonçalves EP, Formiga MN, Tariki MS, Clavijo DA, Choueiri TK, Lopes G, Pal SK. Assessment of Treatment Patterns for Metastatic Renal Cell Carcinoma in Brazil. J Glob Oncol 2017; 4:1-8. [PMID: 29281478 PMCID: PMC6180782 DOI: 10.1200/jgo.17.00113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Although multiple therapies have emerged for the treatment of metastatic
renal cell carcinoma (mRCC), it is unclear whether application of these
agents is consistent in developed and developing countries. We sought to
determine patterns of care for mRCC in Brazil as a representative developing
country. Material and Methods A commercial database was used to acquire information pertaining to patients
with mRCC receiving treatment at private or public hospitals in Brazil
between March 2013 and October 2016. Basic clinical and demographic criteria
were available, as well as information to ascertain the International
Metastatic Renal Cell Carcinoma Database Consortium risk. Treatment-related
data across multiple lines of therapy were collected. Results Of 4,379 patients assessed, 3,990 (91%) had metastatic disease, and 26%, 48%,
and 26% of patients had good, intermediate, and poor International
Metastatic Renal Cell Carcinoma Database Consortium risk disease,
respectively. Although 3,149 patients (79%) received first-line therapy,
only 641 (20%) and 152 (5%) received second- and third-line therapy,
respectively. In the first-line setting, vascular endothelial growth
factor–directed agents represented the most commonly used therapy,
whereas in the second-line setting, vascular endothelial growth
factor– and mammalian target of rapamycin–directed agents were
used with similar frequency. Marked differences were seen in receipt of
systemic therapy on the basis of treatment in private or public
hospitals. Conclusion Relative to developed countries, marked attrition is noted between each
subsequent line of therapy in Brazil. Patterns of care also vary greatly in
private and public settings, pointing to financial constraints as a
potential cause for discordances in treatment.
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Affiliation(s)
- Paulo G Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Cristiane D Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Nazli Dizman
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Stenio Zequi
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Andre Fay
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Yash Dara
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Manuel Caitano Maia
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Brendan N Cotta
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Edna Prado Gonçalves
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Maria Nirvana Formiga
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Milena Shizue Tariki
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Diego Abreu Clavijo
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Toni K Choueiri
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Gilberto Lopes
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Sumanta K Pal
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
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Pang A, Carbini M, Moreira AL, Maki RG. Carcinosarcomas and Related Cancers: Tumors Caught in the Act of Epithelial-Mesenchymal Transition. J Clin Oncol 2017; 36:210-216. [PMID: 29220296 DOI: 10.1200/jco.2017.74.9523] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In this review, we outline the biology and management of patients with carcinosarcomas and related malignancies, which are often included under the broader concept of sarcomatoid carcinomas. Carcinosarcomas are unusual tumors that are commonly gynecologic in origin, where they are referred to as malignant mixed Müllerian tumors, but may appear in any anatomic site. Although a variety of hypotheses have been presented as to the biphasic nature of these tumors, carcinosarcomas seem to represent the best example in human cancers of the concept of epithelial-mesenchymal transition (EMT), in which the two parts of the tumor are genomically related to one another, as opposed to the mesenchymal component that represents a second neoplasm or (benign) reactive process. In general, patients with carcinosarcomas fare worse than patients with carcinomas of the same anatomic site. Treatment paradigms for carcinosarcomas generally follow those of carcinomas of the same organ site, except where clinical trials provide more specific options. Agents that block or reverse EMT are worth examination in patients with carcinosarcoma and arguably may be even more effective in carcinomas, given evidence of dependence on EMT to generate successful metastases. Information about EMT may also inform other phase transitions in cancer, such as those between prostate or lung carcinoma and more aggressive tumors with neuroendocrine differentiation.
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Affiliation(s)
- Angela Pang
- Angela Pang, National University Health System and National University Cancer Institute, Singapore, Singapore; Mariana Carbini, Mount Sinai Medical Center; Andre L. Moreira, New York University Langone Medical Center, New York; and Robert G. Maki, Northwell Health Monter Cancer Center and Cold Spring Harbor Laboratory, Lake Success, NY
| | - Mariana Carbini
- Angela Pang, National University Health System and National University Cancer Institute, Singapore, Singapore; Mariana Carbini, Mount Sinai Medical Center; Andre L. Moreira, New York University Langone Medical Center, New York; and Robert G. Maki, Northwell Health Monter Cancer Center and Cold Spring Harbor Laboratory, Lake Success, NY
| | - Andre L Moreira
- Angela Pang, National University Health System and National University Cancer Institute, Singapore, Singapore; Mariana Carbini, Mount Sinai Medical Center; Andre L. Moreira, New York University Langone Medical Center, New York; and Robert G. Maki, Northwell Health Monter Cancer Center and Cold Spring Harbor Laboratory, Lake Success, NY
| | - Robert G Maki
- Angela Pang, National University Health System and National University Cancer Institute, Singapore, Singapore; Mariana Carbini, Mount Sinai Medical Center; Andre L. Moreira, New York University Langone Medical Center, New York; and Robert G. Maki, Northwell Health Monter Cancer Center and Cold Spring Harbor Laboratory, Lake Success, NY
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Karalli A, Ghaffarpour R, Axelsson R, Lundell L, Bozoki B, Brismar T, Gustafsson O. Transarterial Chemoembolization of Renal Cell Carcinoma: A Prospective Controlled Trial. J Vasc Interv Radiol 2017; 28:1664-1672. [DOI: 10.1016/j.jvir.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023] Open
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Zhang T, Gong J, Maia MC, Pal SK. Systemic Therapy for Non-Clear Cell Renal Cell Carcinoma. Am Soc Clin Oncol Educ Book 2017; 37:337-342. [PMID: 28561708 DOI: 10.1200/edbk_175572] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Treatment options for metastatic clear cell renal cell carcinoma (ccRCC) have evolved markedly over the past decade, with multiple targeted therapies approved for the disease. In contrast, little improvement has been made in the management of metastatic non-clear cell RCC (nccRCC). Non-clear cell disease is an umbrella term that encompasses multiple biologically distinct entities, including but not limited to papillary, chromophobe, and sarcomatoid RCC. To date, prospective studies have largely explored treatments for ccRCC (e.g., VEGF- and mTOR-directed therapies) in trials that aggregate non-clear cell histologies. However, the studies do not acknowledge the varying biology of each non-clear cell subtype. Emerging studies in nccRCC should examine individual histologies and apply biologically relevant therapies. An example of this is SWOG 1500, a randomized phase II study that will compare a VEGF-inhibitor to one of three MET-directed therapies in patients with metastatic papillary RCC. Until the biologic diversity of nccRCC is appreciated, outcomes are likely to remain dismal.
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Affiliation(s)
- Tian Zhang
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jun Gong
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Manuel Caitano Maia
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
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Barata PC, Rini BI. Treatment of renal cell carcinoma: Current status and future directions. CA Cancer J Clin 2017; 67:507-524. [PMID: 28961310 DOI: 10.3322/caac.21411] [Citation(s) in RCA: 519] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past 12 years, medical treatment for renal cell carcinoma (RCC) has transitioned from a nonspecific immune approach (in the cytokine era), to targeted therapy against vascular endothelial growth factor (VEGF), and now to novel immunotherapy agents. Multiple agents-including molecules against vascular endothelial growth factor, platelet-derived growth factor, and related receptors; inhibitors of other targets, such as the mammalian target of rapamycin and the MET and AXL tyrosine-protein kinase receptors; and an immune-checkpoint inhibitor-have been approved based on significant activity in patients with advanced RCC. Despite these advances, important questions remain regarding biomarkers of efficacy, patient selection, and the optimal combination and sequencing of agents. The purpose of this review is to summarize present management and future directions in the treatment of metastatic RCC. CA Cancer J Clin 2017;67:507-524. © 2017 American Cancer Society.
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Affiliation(s)
- Pedro C Barata
- Experimental Therapeutics Fellow, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine; and Leader, Genitourinary Program, Glickman Urological and Kidney Institute, Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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Raychaudhuri R, Riese MJ, Bylow K, Burfeind J, Mackinnon AC, Tolat PP, Iczkowski KA, Kilari D. Immune Check Point Inhibition in Sarcomatoid Renal Cell Carcinoma: A New Treatment Paradigm. Clin Genitourin Cancer 2017. [DOI: 10.1016/j.clgc.2017.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Liaw BC, Mehrazin R, Baker C, Sfakianos JP, Tsao CK. Management of Atypical Renal Cell Carcinomas. Curr Treat Options Oncol 2017; 18:61. [DOI: 10.1007/s11864-017-0501-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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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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Gao YH, Wu ZX, Xie LQ, Li CX, Mao YQ, Duan YT, Han B, Han SF, Yu Y, Lu HJ, Yang PY, Xu TR, Xia JL, Chen GQ, Wang LS. VHL deficiency augments anthracycline sensitivity of clear cell renal cell carcinomas by down-regulating ALDH2. Nat Commun 2017. [PMID: 28643803 PMCID: PMC5481740 DOI: 10.1038/ncomms15337] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The von Hippel-Lindau (VHL) is deficient in ∼70% of clear-cell renal cell carcinomas (ccRCC), which contributes to the carcinogenesis and drug resistance of ccRCC. Here we show that VHL-deficient ccRCC cells present enhanced cytotoxicity of anthracyclines in a hypoxia-inducible factor-independent manner. By subtractive proteomic analysis coupling with RNAi or overexpression verification, aldehyde dehydrogenase 2 (ALDH2) is found to be transcriptionally regulated by VHL and contributes to enhanced anthracyclines cytotoxicity in ccRCC cells. Furthermore, VHL regulates ALDH2 expression by directly binding the promoter of −130 bp to −160 bp to activate the transcription of hepatocyte nuclear factor 4 alpha (HNF-4α). In addition, a positive correlation is found among the protein expressions of VHL, HNF-4α and ALDH2 in ccRCC samples. These findings will deepen our understanding of VHL function and shed light on precise treatment for ccRCC patients. The VHL tumour suppressor gene is lost in approximately 70% of clear cell renal cell carcinoma (ccRCC). In this study, the authors demonstrate that VHL loss in these tumours augments anthracyclines chemotherapy by down-regulation of ALDH2.
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Affiliation(s)
- Yao-Hui Gao
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Zhao-Xia Wu
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Li-Qi Xie
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Cai-Xia Li
- Shanghai Universities E-Institute for Chemical Biology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China
| | - Yu-Qin Mao
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Yan-Tao Duan
- Shanghai Universities E-Institute for Chemical Biology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China
| | - Bing Han
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - San-Feng Han
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Yun Yu
- Shanghai Universities E-Institute for Chemical Biology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China
| | - Hao-Jie Lu
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Peng-Yuan Yang
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Tian-Rui Xu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Jing-Lin Xia
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China
| | - Guo-Qiang Chen
- Shanghai Universities E-Institute for Chemical Biology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China
| | - Li-Shun Wang
- Institute of Fudan-Minhang Academic Health System, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai 201199, China.,Shanghai Universities E-Institute for Chemical Biology, Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 280 South Chongqing Road, Shanghai 200025, China
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Shinder BM, Rhee K, Farrell D, Farber NJ, Stein MN, Jang TL, Singer EA. Surgical Management of Advanced and Metastatic Renal Cell Carcinoma: A Multidisciplinary Approach. Front Oncol 2017; 7:107. [PMID: 28620578 PMCID: PMC5449498 DOI: 10.3389/fonc.2017.00107] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
The past decade has seen a rapid proliferation in the number and types of systemic therapies available for renal cell carcinoma. However, surgery remains an integral component of the therapeutic armamentarium for advanced and metastatic kidney cancer. Cytoreductive surgery followed by adjuvant cytokine-based immunotherapy (predominantly high-dose interleukin 2) has largely given way to systemic-targeted therapies. Metastasectomy also has a role in carefully selected patients. Additionally, neoadjuvant systemic therapy may increase the feasibility of resecting the primary tumor, which may be beneficial for patients with locally advanced or metastatic disease. Several prospective trials examining the role of adjuvant therapy are underway. Lastly, the first immune checkpoint inhibitor was approved for metastatic renal cell carcinoma (mRCC) in 2015, providing a new treatment mechanism and new opportunities for combining systemic therapy with surgery. This review discusses current and historical literature regarding the surgical management of patients with advanced and mRCC and explores approaches for optimizing patient selection.
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Affiliation(s)
- Brian M Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Kevin Rhee
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Douglas Farrell
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Mark N Stein
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Keskin SK, Msaouel P, Hess KR, Yu KJ, Matin SF, Sircar K, Tamboli P, Jonasch E, Wood CG, Karam JA, Tannir NM. Outcomes of Patients with Renal Cell Carcinoma and Sarcomatoid Dedifferentiation Treated with Nephrectomy and Systemic Therapies: Comparison between the Cytokine and Targeted Therapy Eras. J Urol 2017; 198:530-537. [PMID: 28411072 DOI: 10.1016/j.juro.2017.04.067] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE We studied overall survival and prognostic factors in patients with sarcomatoid renal cell carcinoma treated with nephrectomy and systemic therapy in the cytokine and targeted therapy eras. MATERIALS AND METHODS This is a retrospective study of patients with sarcomatoid renal cell carcinoma who underwent nephrectomy and received systemic therapy at our center in the cytokine era (1987 to 2005) or the targeted therapy era (2006 to 2015). Multivariate regression models were used to determine the association of covariables with survival. RESULTS Of the 199 patients with sarcomatoid renal cell carcinoma 167 (83.9%) died (median overall survival 16.5 months, 95% CI 15.2-20.9). Survival of patients with clear cell histology was significantly longer vs those with nonclear cell histology (p = 0.034). Patients with synchronous metastatic disease had significantly shorter survival than patients with metachronous metastatic disease (median 12.1 vs 23.3 months, p = 0.0064). Biopsy of the primary tumor or a metastatic site could detect the presence of sarcomatoid features in only 7.5% of cases. Although a significant improvement in survival rate was observed in the first year in patients treated in the targeted therapy era (p = 0.011), this effect was attenuated at year 2, disappeared at years 3 to 5 after diagnosis and was not evident in patients with poor risk features. CONCLUSIONS Patients with sarcomatoid renal cell carcinoma still have poor prognosis with no clear long-term benefit of targeted therapy. This underscores the need to develop more effective systemic therapies for these patients.
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Affiliation(s)
- Sarp K Keskin
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Pavlos Msaouel
- Department of Genitourinary Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kenneth R Hess
- Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kai-Jie Yu
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Surena F Matin
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kanishka Sircar
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Pheroze Tamboli
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Eric Jonasch
- Department of Genitourinary Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Christopher G Wood
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jose A Karam
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Nizar M Tannir
- Department of Genitourinary Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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Affiliation(s)
- Toni K Choueiri
- From the Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston (T.K.C.); and the Department of Medicine, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Robert J Motzer
- From the Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston (T.K.C.); and the Department of Medicine, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
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