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Zeng K, Li Q, Wang X, Liu C, Chen B, Song G, Li B, Liu B, Gao X, Zhang L, Miao J. STX4 as a potential biomarker for predicting prognosis and guiding clinical treatment decisions in clear cell renal cell carcinoma. Heliyon 2024; 10:e23918. [PMID: 38226288 PMCID: PMC10788513 DOI: 10.1016/j.heliyon.2023.e23918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) represents a frequent subtype of kidney cancer, with the prognosis remaining poor for individuals with metastatic disease. Given its resistance to both radiation and chemotherapy, targeted therapies and immunotherapies have emerged as critical for effective ccRCC treatment. Within this context, the SNARE protein STX4, which is associated with malignant cancer cell migration, provides a promising focus. The underlying mechanism, however, requires further illumination. Furthermore, the influence of STX4 on the ccRCC tumor microenvironment remains to be determined. In our research, we utilized multiple databases and immunohistochemical staining to confirm differential STX4 expression and its prognostic implications. We evaluated the potential tumor-promoting function of STX4 in ccRCC cell lines through molecular studies. Additionally, we conducted functional enrichment analysis to delve deeper into the underlying mechanisms and performed immune infiltration and drug sensitivity analyses to assess the potential of STX4 as a prognostic biomarker and therapeutic target. Our study reveals that STX4 contributes to cancer progression by enhancing AKT expression and stimulating the activation of VEGF signaling pathways. Additionally, STX4 further fosters CD8+ T-cell infiltration and diminishes the percentage of CAFs and M2-TAMs. Our findings suggest that patients presenting higher STX4 levels may exhibit enhanced responsiveness to immunotherapy and higher sensitivity to the medications axitinib and everolimus. Finally, we propose STX4 expression assessment as a novel approach to predict patient response to respective immunotherapies and targeted treatments, hence potentially improving patient outcomes.
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Affiliation(s)
- Kai Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
- Department of Urology, the First Affiliated Hospital of Shihezi University, Shihezi 832008, Xinjiang, China
| | - Qinyu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xi Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Chaofan Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Beining Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Bo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xintao Gao
- Department of Urology, Sir RunRun Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Linli Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jianping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Stares M, Chauhan V, Moudgil-Joshi J, Kong QG, Malik J, Sundaramurthy A, Elliott T, Mains E, Leung S, Laird A, Symeonides SN. Initial active surveillance for patients with metastatic renal cell carcinoma: 10 years' experience at a regional cancer Centre. Cancer Med 2023; 12:5255-5264. [PMID: 36207803 PMCID: PMC10028026 DOI: 10.1002/cam4.5330] [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: 09/07/2022] [Revised: 09/10/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
A subset of patients with metastatic renal cell carcinoma (mRCC) follow an indolent disease course and may benefit from initial active surveillance (AS). However, selecting patients suitable for this approach is challenging. To investigate this we sought to define outcomes of patients with mRCC suitable for initial AS. All patients with mRCC clinically selected for initial AS at the Edinburgh Cancer Centre between January 2010 and December 2020 were identified. Key inflammatory biomarkers (haemoglobin, white cell count, neutrophil count, platelets, C-reactive protein [CRP], albumin, corrected calcium) and the International Metastatic RCC Database Consortium (IMDC) risk score were measured. The relationship between these and time to systemic anticancer therapy (tSACT) and overall survival (OS) was analysed. Data were available for 160 patients. Estimated median overall survival was 88.0 (interquartile range [IQR] 34.0-127.0) months. Median tSACT was 31.8 (IQR 12.0-76.3) months. On multivariate analysis, only CRP was predictive of tSACT (HR 2.47 [95% CI:1.59-3.85] p < 0.001) and OS (HR 3.89 [95% CI:2.15-6.83] p < 0.001). Patients with CRP > 10 mg/L were more likely to commence SACT within 1 year than those with CRP≤10 mg/L (41% vs. 18%, Relative Risk 2.16 (95% CI:1.18-3.96) (p = 0.012)). IMDC risk score was not predictive of tSACT or OS. Active surveillance is an appropriate initial management option for selected patients with mRCC. CRP, a biomarker of systemic inflammation, may provide additional objective information to assist clinical decision-making in patients with mRCC being considered for initial AS. Although this is a retrospective observational study, the cohort is well defined and includes all patients managed with initial AS in an inclusive real-world setting.
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Affiliation(s)
- Mark Stares
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Vishwani Chauhan
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Jigi Moudgil-Joshi
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Qiu G Kong
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Jahangeer Malik
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | | | - Tony Elliott
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Edward Mains
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Steve Leung
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Alexander Laird
- Department of Urology, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Stefan N Symeonides
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
- Institute of Genetics and Cancer, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
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3
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Li Q, Xiao X, Chen B, Song G, Zeng K, Li B, Miao J, Liu C, Luan Y, Liu B. A predictive signature based on enhancer RNA associates with immune infiltration and aids treatment decision in clear cell renal cell carcinoma. Front Oncol 2022; 12:964838. [PMID: 36313627 PMCID: PMC9597358 DOI: 10.3389/fonc.2022.964838] [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] [Received: 06/22/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is a prevalent urinary malignancy. Despite the recent development of better diagnostic tools and therapy, the five-year survival rate for individuals with advanced and metastatic ccRCC remains dismal. Unfortunately, ccRCC is less susceptible to radiation and chemotherapy. Consequently, targeted therapy and immunotherapy play a crucial role in the treatment of ccRCC. Enhancer RNAs (eRNAs) are noncoding RNAs transcribed by enhancers. Extensive research has shown that eRNAs are implicated in a variety of cancer signaling pathways. However, the biological functions of eRNAs have not been systematically investigated in ccRCC. In this study, we conducted a comprehensive investigation of the role of eRNAs in the onset and management of ccRCC. Patient prognosis-influencing eRNAs and target genes were chosen to construct a predictive signature. On the basis of the median riskscore, ccRCC patients were split into high- and low-risk subgroups. The prediction efficiency was assessed in several cohorts, and multi-omics analysis was carried out to investigate the differences and underlying mechanisms between the high- and low-risk groups. In addition, we investigated its potential to facilitate clinical treatment choices. The riskscore might be used to forecast a patient’s response to immunotherapy and targeted therapy, giving a revolutionary method for selecting treatment regimens with pinpoint accuracy.
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Affiliation(s)
- Qinyu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueyan Xiao
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beining Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaofan Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Bo Liu, ; Yang Luan, ; Chaofan Liu,
| | - Yang Luan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Bo Liu, ; Yang Luan, ; Chaofan Liu,
| | - Bo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Bo Liu, ; Yang Luan, ; Chaofan Liu,
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Zeng K, Song G, Chen B, Gao X, Liu C, Miao J, Ruan Y, Luan Y, Chen X, Liu J, Li Q, Liu B. Comprehensive analysis to identify the RP11-478C19.2/ E2F7 axis as a novel biomarker for treatment decisions in clear cell renal cell carcinoma. Transl Oncol 2022; 25:101525. [PMID: 36054996 PMCID: PMC9445397 DOI: 10.1016/j.tranon.2022.101525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
LncRNA RP11–478C19.2 promotes the progression of ccRCC via the RP11–478C19.2/hsa-miR-181b-5p, hsa-miR-181a-5p, hsa-miR-181c-5p/E2F7 axis. E2F7 could be detected in patients with ccRCC to aid treatment regimen selection, particularly in advanced and metastatic disease. Individuals who overexpress E2F7 may have a greater response to some first-line therapy for ccRCC, including cabozantinib, pazopanib, and sunitinib. Patients with higher expression of E2F7 may have a higher percentage of ICB responses.
Clear cell renal cell carcinoma (ccRCC), accounting for 70–80% of all renal cell carcinomas, is a common malignancy. Survival rates decrease significantly in patients with advanced and metastatic ccRCC. Furthermore, ccRCC is less responsive to radiation and chemotherapy than other cancers. Therefore, targeted therapy and immunotherapy are particularly important for ccRCC management. A growing body of literature recognizes that competitive endogenous RNA (ceRNA) regulatory networks play a crucial role in various cancers. However, the biological functions of the ceRNA network in ccRCC require further investigation. In this study, we built the ceRNA network for ccRCC using the “GDCRNATools” package. After survival analysis, the RP11–478C19.2/hsa-miR-181b-5p, hsa-miR-181a-5p, and hsa-miR-181c-5p/E2F7 axes were obtained for further analysis. Unsupervised clustering was conducted basing on this ceRNA network. The results indicated that the prognosis and immune infiltration levels differed between the two clusters. Furthermore, we conducted correlation analysis, immune infiltration analysis, tumor mutation burden analysis, GSEA analysis, drug sensitivity analysis and pan-cancer analysis of E2F7 to explore its potential role in oncogenesis. Experiments in vitro were performed to confirm the pro-oncogenic impact of E2F7. The results suggest that the RP11–478C19.2/E2F7 axis might be a biomarker for the inclusion of cabozantinib, pazopanib, sunitinib, and immunotherapy in the therapeutic regimen. In summary, we found that the ceRNA-based RP11–478C19.2/E2F7 axis is involved in ccRCC and that it could be a novel biomarker for treatment decisions and a possible therapeutic target to increase the success of targeted therapy and immunotherapy in ccRCC.
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Affiliation(s)
- Kai Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Guoda Song
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bingliang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xintao Gao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chaofan Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jianping Miao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yajun Ruan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Luan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xin Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Qinyu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Bo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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5
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Andrews JR, Lohse CM, Boorjian SA, Leibovich BC, Thompson H, Costello BA, Bhindi B. Outcomes following cytoreductive nephrectomy without immediate postoperative systemic therapy for patients with synchronous metastatic renal cell carcinoma. Urol Oncol 2022; 40:166.e1-166.e8. [PMID: 35168879 DOI: 10.1016/j.urolonc.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND While the recent CARMENA trial evaluated upfront cytoreductive nephrectomy (CN) among patients treated with immediate subsequent systemic therapy for metastatic renal cell carcinoma (mRCC), the role of CN in patients not immediately requiring systemic therapy remains to be determined. OBJECTIVE To describe the oncologic outcomes of patients with de-novo synchronous mRCC who underwent CN +/- metastasis-directed therapy (MDT) and subsequent surveillance without planned immediate post-CN systemic therapy. DESIGN, SETTING, PARTICIPANTS Adults who underwent CN for unilateral, sporadic mRCC between 1996 and 2016 without immediate postoperative systemic therapy were identified using the prospectively-maintained Mayo Clinic Nephrectomy Registry. Co-primary outcomes were survival free of systemic therapy or death and overall-survival. RESULTS Of 156 patients who met inclusion criteria for study, 37 (24%) patients were managed after CN with surveillance alone and 119 (76%) underwent MDT. Seventy-two patients ultimately initiated systemic therapy at a median of 0.7 years (IQR 0.3-1.7). Median follow-up among survivors was 6.2 years (IQR 4.4-9.5), during which time 133 patients died. At 1, 3, and 5 years, survival free of systemic therapy or death rates were 47%, 21% and 14% and overall-survival rates were 69%, 37%, and 28%. CONCLUSION Among carefully selected patients managed with surveillance after CN +/- MDT, approximately half may avoid systemic therapy for 1 year, with a subset achieving long-term survival free of systemic therapy or death. Having a single metastatic site and disease amenable to complete metastasectomy are features of patients who might be well served with upfront CN +/- MDT.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Bimal Bhindi
- Section of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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6
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Bao Y, Wu X, Jin X, Kanematsu A, Nojima M, Kakehi Y, Yamamoto S. Apigenin inhibits renal cell carcinoma cell proliferation through G2/M phase cell cycle arrest. Oncol Rep 2022; 47:60. [PMID: 35088891 DOI: 10.3892/or.2022.8271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Apigenin is a flavonoid widely presented in fruits and vegetables, and is known to possess anti‑inflammatory, antioxidant, and anticancer properties. The present study was designed to investigate the effects of apigenin on renal cell carcinoma (RCC) cells. These effects on cell growth were evaluated using a cell counting kit, while cell cycle distribution was investigated by flow cytometry following propidium iodide DNA staining. The human RCC cell lines, Caki‑1, ACHN, and NC65, were each treated with 1‑100 µM apigenin for 24 h, which resulted in concentration‑dependent cell growth inhibition, with the effects confirmed by trypan blue staining. Furthermore, even when the apigenin treatment period was shortened to 3 h, the same cytostatic effect on RCC cells was noted. Similarly, a concentration‑dependent cell growth inhibitory effect was also observed in primary RCC cells, as apigenin induced G2/M phase cell cycle arrest and reduced the expression levels of cyclin A, B1, D3, and E in RCC cells in both dose‑ and time‑dependent manners. These findings suggest the possibility of the use of apigenin as a novel therapeutic strategy for treatment of RCC due to its anticancer activity and ability to function as a cell cycle modulating agent.
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Affiliation(s)
- Yuhang Bao
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
| | - Xiuxian Wu
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
| | - Xinghua Jin
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
| | - Michio Nojima
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
| | - Yoshiyuki Kakehi
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa 761‑0793, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Hyogo 663‑8501, Japan
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Kim IH, Lee HJ. The Frontline Immunotherapy-Based Treatment of Advanced Clear Cell Renal Cell Carcinoma: Current Evidence and Clinical Perspective. Biomedicines 2022; 10:251. [PMID: 35203461 PMCID: PMC8869224 DOI: 10.3390/biomedicines10020251] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/20/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 400,000 patients are diagnosed with kidney cancer annually worldwide, leading to approximately 170,000 deaths. Renal cell carcinoma (RCC) accounts for more than 90% of kidney cancers. The most common histological subtype is clear cell RCC, which is found in approximately 85% of metastatic RCC cases. The VHL-HIF-VEGF axis is well known; therefore, targeting VEGF has been the mainstay for managing advanced clear cell RCC. Recently, the treatment landscape for advanced clear cell RCC has changed extensively. In particular, immune checkpoint inhibitor-based treatment showed promising results in front-line treatment and became the standard of care. Herein, we review the current evidence on front-line treatment options and discuss the clinical and future perspective.
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Affiliation(s)
- In-Ho Kim
- Department of Internal Medicine, Division of Medical Oncology, Seoul St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul 06591, Korea;
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea
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8
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Harrison MR, Costello BA, Bhavsar NA, Vaishampayan U, Pal SK, Zakharia Y, Jim HSL, Fishman MN, Molina AM, Kyriakopoulos CE, Tsao C, Appleman LJ, Gartrell BA, Hussain A, Stadler WM, Agarwal N, Pachynski RK, Hutson TE, Hammers HJ, Ryan CW, Inman BA, Mardekian J, Borham A, George DJ. Active surveillance of metastatic renal cell carcinoma: Results from a prospective observational study (MaRCC). Cancer 2021; 127:2204-2212. [PMID: 33765337 PMCID: PMC8251950 DOI: 10.1002/cncr.33494] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Systemic therapy (ST) can be deferred in patients who have metastatic renal cell carcinoma (mRCC) and slow-growing metastases. Currently, this subset of patients managed with active surveillance (AS) is not well described in the literature. METHODS This was a prospective observational study of patients with mRCC across 46 US community and academic centers. The objective was to describe baseline characteristics and demographics of patients with mRCC initially managed by AS, reasons for AS, and patient outcomes. Descriptive statistics were used to characterize demographics, baseline characteristics, and patient-related outcomes. Wilcoxon 2-sample rank-sum tests and χ2 tests were used to assess differences between ST and AS cohorts in continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to assess survival. RESULTS Of 504 patients, mRCC was initially managed by AS (n = 143) or ST (n = 305); 56 patients were excluded from the analysis. Disease was present in 69% of patients who received AS, whereas the remaining 31% had no evidence of disease. At data cutoff, 72 of 143 patients (50%) in the AS cohort had not received ST. The median overall survival was not reached (95% CI, 122 months to not estimable) in patients who received AS versus 30 months (95% CI, 25-44 months) in those who received ST. Quality of life at baseline was significantly better in patients who were managed with AS versus ST. CONCLUSIONS AS occurs frequently (32%) in real-world clinical practice and appears to be a safe and appropriate alternative to immediate ST in selected patients.
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Affiliation(s)
| | | | - Nrupen A. Bhavsar
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
| | | | - Sumanta K. Pal
- Medical Oncology and Experimental TherapeuticsCity of Hope Comprehensive Cancer CenterDuarteCalifornia
| | - Yousef Zakharia
- Department of MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowa
| | | | | | - Ana M. Molina
- Division of Hematology and Medical OncologyDepartment of MedicineWeill Cornell MedicineNew YorkNew York
| | | | - Che‐Kai Tsao
- Tisch Cancer Institute, Mount Sinai Medical CenterNew YorkNew York
| | - Leonard J. Appleman
- The University of Pittsburgh Medical Center (UPMC) Cancer PavilionPittsburghPennsylvania
| | - Benjamin A. Gartrell
- Department of Medical OncologyMontefiore Medical CenterBronxNew York,Department of UrologyMontefiore Medical CenterBronxNew York
| | - Arif Hussain
- Department of MedicineUniversity of MarylandBaltimoreMaryland
| | - Walter M. Stadler
- Section of Hematology/OncologyDepartment of MedicineComprehensive Cancer CenterUniversity of ChicagoChicagoIllinois
| | - Neeraj Agarwal
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtah
| | - Russell K. Pachynski
- Siteman Cancer Center, Department of MedicineWashington University School of MedicineSt LouisMissouri
| | | | - Hans J. Hammers
- Division of Hematology‐OncologyUniversity of Texas SouthwesternDallasTexas
| | - Christopher W. Ryan
- Department of Medicine, Division of Hematology and Medical OncologyOregon Health and Science UniversityPortlandOregon
| | - Brant A. Inman
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
| | | | | | - Daniel J. George
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
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Kushnir I, Basappa NS, Ghosh S, Lalani AKA, Hansen AR, Wood L, Kollmannsberger CK, Heng DYC, Bjarnason GA, Soulières D, Dawe DE, Tanguay S, Breau RH, Pouliot F, Kapoor A, Graham J, Reaume MN. Active Surveillance in Metastatic Renal Cell Carcinoma: Results From the Canadian Kidney Cancer Information System. Clin Genitourin Cancer 2021; 19:521-530. [PMID: 34158246 DOI: 10.1016/j.clgc.2021.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Active surveillance (AS) is a commonly used strategy in patients with slow-growing disease. We aimed to assess the outcomes and safety of AS in patients with metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS We used the Canadian Kidney Cancer information system (CKCis) to identify patients with mRCC diagnosed between January 1, 2011, and December 31, 2016. The AS strategy was defined as (1) the start of systemic therapy ≥ 6 months after diagnosis of mRCC, or (2) never receiving systemic therapy for mRCC with an overall survival (OS) of ≥1 year. Patients starting systemic treatment <6 months after diagnosis of mRCC were defined as receiving immediate systemic treatment. OS and time until first-line treatment failure (TTF) were compared between the two cohorts. RESULTS A total of 853 patients met the criteria for AS (cohort A). Of these, 364 started treatment >6 months after their initial diagnosis (cohort A1) and 489 never started systemic therapy (cohort A2); 827 patients received immediate systemic treatment (cohort B). The 5-year OS probability was significantly greater for cohort A than for cohort B (70% vs. 33.6%; P < .0001). After adjusting for International Metastatic RCC Database Consortium risk criteria and age, both OS (hazard ratio [HR] = 0.58; 95% confidence interval [CI], 0.47-0.70; P < .0001) and TTF (HR = 0.72; 95% CI, 0.60-0.85; P = .0002) were greater in cohort A1 compared with B. For cohort A1, the median time on AS was 14.2 months (range, 6-71). CONCLUSIONS Based on the largest analysis of AS in mRCC to date, our data suggest that a subset of patients may be safely observed without immediate initiation of systemic therapy.
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Affiliation(s)
- Igal Kushnir
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada; Institute of Oncology, Sackler Faculty of Medicine, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel.
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | | | | | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David E Dawe
- Section of Hematology and Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Graham
- Section of Hematology and Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
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10
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Krabbe LM, Woldu SL, Sanli O, Margulis V. Metastatic Surgery in Advanced Renal Cell Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Graham J, Heng DYC, Brugarolas J, Vaishampayan U. Personalized Management of Advanced Kidney Cancer. Am Soc Clin Oncol Educ Book 2018; 38:330-341. [PMID: 30231375 DOI: 10.1200/edbk_201215] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The treatment of renal cell carcinoma represents one of the great success stories in translational cancer research, with the development of novel therapies targeting key oncogenic pathways. These include drugs that target the VEGF and mTOR pathways, as well as novel immuno-oncology agents. Despite the therapeutic advancements, there is a paucity of well-validated prognostic and predictive biomarkers in advanced kidney cancer. With a number of highly effective therapies available across multiple lines, it will become increasingly important to develop a more tailored approach to treatment selection. Prognostic clinical models, such the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model, are routinely used for prognostication in clinical practice. The IMDC model has demonstrated a predictive capability in the context of these treatments including immune checkpoint inhibition. A number of promising molecular markers and gene expression signatures are being explored as prognostic and predictive biomarkers, but none are ready to be widely used for treatment selection. In this review, we will explore the current landscape of personalized care in metastatic renal cell carcinoma. This will include a focus on both prognostic and predictive factors as well as clinical applications of biology in kidney cancer.
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Affiliation(s)
- Jeffrey Graham
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Daniel Y C Heng
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - James Brugarolas
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ulka Vaishampayan
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
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12
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Comparative Survival following Initial Cytoreductive Nephrectomy versus Initial Targeted Therapy for Metastatic Renal Cell Carcinoma. J Urol 2018; 200:528-534. [DOI: 10.1016/j.juro.2018.03.077] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
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13
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Atkins MB, Tannir NM. Current and emerging therapies for first-line treatment of metastatic clear cell renal cell carcinoma. Cancer Treat Rev 2018; 70:127-137. [PMID: 30173085 DOI: 10.1016/j.ctrv.2018.07.009] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/05/2023]
Abstract
There has been significant progress in the treatment of patients with advanced clear cell renal cell carcinoma (ccRCC), with improved knowledge of disease biology and the introduction of targeted agents and immunotherapies. In this review, we discuss current and emerging first-line treatment options, including recent approvals of the tyrosine kinase inhibitor (TKI) cabozantinib and the immunotherapy combination of nivolumab (anti-programmed cell death 1 [PD-1])/ipilimumab (anti-cytotoxic T-lymphocyte-associated antigen 4 [CTLA-4]), and initial outcomes with the combination of atezolizumab (anti-PD-ligand 1 [PD-L1])/bevacizumab (anti-vascular endothelial growth factor [VEGF]). Key clinical data are reviewed, as these novel first-line treatments offer significant improvement, particularly for patients classified as intermediate/poor risk for whom previously available therapies have demonstrated limited efficacy. Treatment recommendations based on clinical evidence and expert opinion are discussed. We also review ongoing studies investigating combinations of checkpoint inhibitors with TKIs, including cabozantinib and axitinib, and with other novel immunomodulatory agents, and the potential role of single-agent immunotherapy for select patients. With a growing treatment armamentarium, identification and validation of biomarkers will be crucial for optimizing first-line selection and treatment sequences.
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Affiliation(s)
- Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Nizar M Tannir
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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14
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Abstract
PURPOSE OF REVIEW Although novel targeted therapies for metastatic renal cell carcinoma (RCC) are emerging, metastasectomy still remains the only potentially curable intervention and plays an important role both in disease control, cancer-specific survival (CSS) and overall survival (OS). A systematic review was conducted in 2014 by the European Association of Urology RCC guidelines panel to summarize evidence on the subject at hand. The purpose of this review is to update the current evidence base. RECENT FINDINGS A total of 17-19% of initially nonmetastatic patients with later RCC metastasis are potentially curable. Complete metastasectomy still remains the sole curative option, continues to show improved OS and CSS and is suggested to defer time to palliative targeted therapy. Resectability, long time to recurrence, good performance status and oligometastatic disease have better benefit of metastasectomy. Stereotactic radiotherapy remains an excellent option for local tumor control and symptom control in patients with RCC brain and bone metastases. Minimal-invasive options such as thermal ablation are evolving, albeit the evidence base is small. Novel trials are investigating sequencing of metastasectomy and targeted therapy with results pending. SUMMARY Metastasectomy continues to be supported as beneficial for OS, CSS and progression-free survival in patients with good prognostic factors.
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15
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Bhavsar NA, Harrison MR, Hirsch BR, Creel P, Wolf SP, Samsa GP, Abernethy AP, Simantov R, Borham A, George DJ. Design and Rationale of the Metastatic Renal Cell Carcinoma (MaRCC) Registry: A Prospective Academic and Community-Based Study of Patients With Metastatic Renal Cell Cancer. Cancer Invest 2017; 35:333-344. [DOI: 10.1080/07357907.2017.1289215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Patricia Creel
- Duke University Medical Center, Durham, North Carolina, USA
| | - Steve P. Wolf
- Duke University Medical Center, Durham, North Carolina, USA
| | - Greg P. Samsa
- Duke University Medical Center, Durham, North Carolina, USA
| | - Amy P. Abernethy
- Duke University Medical Center, Durham, North Carolina, USA
- Pfizer Inc., New York, New York, USA
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16
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Metastatic Surgery in Advanced Renal Cell Carcinoma. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_65-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Zanardi E, Grassi P, Cavo A, Verzoni E, Maggi C, De Braud F, Boccardo F, Procopio G. Treatment of elderly patients with metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2016; 16:323-34. [PMID: 26654225 DOI: 10.1586/14737140.2016.1131613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of developing renal cell carcinoma (RCC) increases with age, and given the constant gain in life expectancy of the general population, both localized RCC and metastatic RCC (mRCC) are more frequently observed in the elderly population. The elderly are a heterogeneous group of patients often characterized by the presence of comorbidities, different compliance to treatment and polypharmacy. Here we review the available data with the aim to analyze the safety and efficacy of new targeted therapies (TTs) in elderly mRCC patients. TTs seem to be effective in both older and younger patients, but elderly patients appear to show reduced tolerance to treatments compared to younger patients. Prospective trials are needed to better understand how to manage mRCC in elderly patients.
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Affiliation(s)
- Elisa Zanardi
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Paolo Grassi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Alessia Cavo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Elena Verzoni
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Claudia Maggi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Filippo De Braud
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Francesco Boccardo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Giuseppe Procopio
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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