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Shah NJ, Shinde R, Moore KJ, Sainski-Nguyen A, Le LB, Cao F, Song R, Singhal P, Motzer RJ. Health Care Resource Use for Modern First-Line Treatments in Metastatic Renal Cell Carcinoma. JAMA Netw Open 2024; 7:e2422674. [PMID: 39052293 PMCID: PMC11273232 DOI: 10.1001/jamanetworkopen.2024.22674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/10/2024] [Indexed: 07/27/2024] Open
Abstract
Importance Immuno-oncology agents have changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). Such therapies improve survival but can impose considerable health care resource use (HCRU) and associated costs, necessitating their examination. Objective To compare HCRU, costs, and clinical outcomes among patients receiving first-line pembrolizumab plus axitinib (P+A) or ipilimumab plus nivolumab (I+N). Design, Setting, and Participants This retrospective cohort study used data from an administrative claims database on patients with mRCC receiving first-line P+A or I+N that was initiated between January 2018 and May 2020. Data were analyzed from February 2021 to July 2022. Exposure First-line P+A or I+N. Main Outcome and Measures HCRU and costs during the first 90 days, full first-line treatment, and full follow-up periods were assessed. Using Kaplan-Meier analysis, time on treatment, overall survival, time to first emergency department (ED) visit, and time to first inpatient stay were compared. Results Among 507 patients, there were 126 patients receiving P+A (91 male [72.2%]; mean [SD] age, 67.93 [9.66] y) and 381 patients receiving I+N (271 male [71.1%]; mean [SD] age, 66.52 [9.94] years). The median time on treatment was longer for the P+A compared with I+N group (12.4 months [95% CI, 8.40 months to not estimable] vs 4.1 months [95% CI, 3.07 to 5.30 months]; P < .001). The median time to first ED visit was longer for the P+A than I+N group (7.2 months [95% CI 3.9 to 11.1 months ] vs 3.3 months [95% CI, 2.6 to 3.9 months]; P = .005), as was time to first inpatient stay (9.0 months [95% CI 6.5 months to not estimable] vs 5.6 months [95% CI, 3.9 to 7.9 months]; P = .02). During the first 90 days, a lower proportion of the P+A than N+I group had ED visits (43 patients [34.1%] vs 182 patients [47.8%] and inpatient stays (24 patients [19.1%) vs144 patients [37.8%]; P < .001). During full follow-up, mean total adjusted costs were similar for P+A and I+N groups, but adjusted 12-month estimated total costs were higher for P+A than I+N groups ($325 574 vs $ 263 803; P = .03). Conclusions and Relevance In this study, treatment with P+A was associated with longer time on treatment, time to first ED visit, and inpatient stay, while 12-month estimated costs were higher for the P+A group. This is among the first clinical studies to evaluate economic burden associated with modern treatments for mRCC.
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Affiliation(s)
- Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
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Brown J, Harrow B, Marciniak A, McCarthy C, Houchard A, Cirneanu L, Protheroe A. Cabozantinib and Axitinib After Vascular Endothelial Growth Factor Therapy in Patients with Advanced Renal Cell Carcinoma: A Retrospective Cohort Study from England. Drugs Real World Outcomes 2024; 11:195-207. [PMID: 38265633 PMCID: PMC11176148 DOI: 10.1007/s40801-023-00415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The tyrosine kinase inhibitors cabozantinib and axitinib have been widely used in England to treat advanced renal cell carcinoma following prior vascular endothelial growth factor-targeted therapy, but data on real-world usage remain limited. Our objective was to describe the real-world treatment patterns and outcomes of patients with advanced renal cell carcinoma who received second-line or later-line (≥ 2L) cabozantinib or axitinib after vascular endothelial growth factor-targeted therapy in clinical practice in England. METHODS This retrospective cohort study used clinical practice data (collected 2011-20) from the English Cancer Analysis System database. Patient characteristics, treatment sequence and duration, and overall survival (time from initiation of cabozantinib/axitinib treatment to death) were evaluated. RESULTS Data from 1485 eligible adults with advanced renal cell carcinoma were analyzed: 440 received ≥ 2L cabozantinib (2L for 88.6% of them); 1045 received ≥ 2L axitinib (2L for 89.5%). The most common first-line treatments were sunitinib (2L cabozantinib subcohort, 48%; 2L axitinib subcohort, 46%) and pazopanib (46% and 54%, respectively); nivolumab was the most common third-line treatment (18% and 19%, respectively). Median (interquartile range) 2L therapy duration was 5.52 (2.73-11.74) months for cabozantinib and 4.60 (1.45-12.36) months for axitinib. Following adjustment for potential confounders using inverse probability weighting, overall survival (median [interquartile range]) was longer for ≥ 2L cabozantinib (11.2 [5.7-28.0] months) than for ≥ 2L axitinib (10.4 [4.7-22.0] months; log-rank p = 0.0034). CONCLUSIONS The Cancer Analysis System database is a valuable research resource providing extensive real-world clinical data. Real-world overall survival was longer with ≥ 2L cabozantinib than with axitinib. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04637204; registered November 2020.
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Affiliation(s)
- Janet Brown
- Division of Clinical Medicine, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | | | | | | | | | | | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Tang B, Duan R, Fan Z, Yan X, Li S, Zhou L, Li J, Xu H, Mao L, Lian B, Wang X, Bai X, Wei X, Li C, Cui C, Si L, Chi Z, Guo J, Sheng X. Natural history of bone-only metastasis in renal cell carcinoma. Urol Oncol 2024; 42:119.e17-119.e22. [PMID: 38383241 DOI: 10.1016/j.urolonc.2024.01.030] [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: 09/01/2023] [Revised: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Bone metastasis (BM) is considered a poor prognostic factor of renal cell carcinoma (RCC). Confusion exists regarding how to deal with RCC patients with bone-only metastasis. PATIENTS AND METHODS The clinical data of consecutive RCC patients with bone-only metastasis at Peking University Cancer Hospital between 2006 and 2018 were retrospectively collected and analyzed. RESULTS Fifty-four eligible patients were screened from an RCC database of 1,878 metastatic patients. After a median follow-up of 43.6 m, 61.1% of the patients were presented with progression of prior BM or new BM. The progression-free survival (PFS) and overall survival (OS) was 16.2 m (95%CI: 11.4-21.0) and 65.2 m, respectively. For the 30 patients with oligo-metastasis (≤3 loci) and 24 ones with multiple-metastasis (>3 loci), the median OS was not reached and 42.0m (95%CI: 12.7-71.2) with statistical difference (P < 0.001). In the oligo-metastasis group, the median PFS of the 15 patients treated with local therapy and of the 13 patients treated with systemic therapy was 14.2 m (95%CI: 5.3-23.3) and 18.0 m (95%CI:15.4-20.6), respectively. In the multiple-metastasis group, the median PFS and OS of the 18 patients treated with systemic therapy was 16.6 m (95%CI: 7.5-25.7) and 63.9 m (95%CI: 21.8-106.0), respectively. Univariate analysis and multivariate analysis showed that the number of metastatic sites (oligo/multiple) and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score, RCC pathological subtype were significantly associated with prognosis (P < 0.05). CONCLUSION RCC patients with bone-only metastases have a favorable prognosis. The number of metastatic sites, IMDC, RCC pathological subtype could serve as survival predictors, which might provide clue of treatment modality.
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Affiliation(s)
- Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Duan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zenan Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Juan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huayan Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Caili Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Soft Tissue Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
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Chong Y, Xu S, Liu T, Guo P, Wang X, He D, Zhu G. Curcumin Inhibits Vasculogenic Mimicry via Regulating ETS-1 in Renal Cell Carcinoma. Curr Cancer Drug Targets 2024; 24:1031-1046. [PMID: 38299401 DOI: 10.2174/0115680096277126240102060617] [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: 08/26/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Metastatic renal cell carcinoma (RCC) poses a huge challenge once it has become resistant to targeted therapy. Vasculogenic mimicry (VM) is a novel blood supply system formed by tumor cells that can circumvent molecular targeted therapies. As one of the herbal remedies, curcumin has been demonstrated to play antineoplastic effects in many different types of human cancers; however, its function and mechanism of targeting VM in RCC remains unknown. OBJECTIVE Here, in the work, we explored the role of curcumin and its molecular mechanism in the regulation of VM formation in RCC. METHODS RNA-sequencing analysis, immunoblotting, and immunohistochemistry were used to detect E Twenty Six-1(ETS-1), vascular endothelial Cadherin (VE-Cadherin), and matrix metallopeptidase 9 (MMP9) expressions in RCC cells and tissues. RNA sequencing was used to screen the differential expressed genes. Plasmid transfections were used to transiently knock down or overexpress ETS-1. VM formation was determined by tube formation assay and animal experiments. CD31-PAS double staining was used to label the VM channels in patients and xenograft samples. RESULTS Our results demonstrated that VM was positively correlated with RCC grades and stages using clinical patient samples. Curcumin inhibited VM formation in dose and time-dependent manner in vitro. Using RNA-sequencing analysis, we discovered ETS-1 as a potential transcriptional factor regulating VM formation. Knocking down or overexpression of ETS-1 decreased or increased the VM formation, respectively and regulated the expression of VE-Cadherin and MMP9. Curcumin could inhibit VM formation by suppressing ETS-1, VE-Cadherin, and MMP9 expression both in vitro and in vivo. CONCLUSION Our finding might indicate that curcumin could inhibit VM by regulating ETS-1, VE-Cadherin, and MMP9 expression in RCC cell lines. Curcumin could be considered as a potential anti-cancer compound by inhibiting VM in RCC progression.
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MESH Headings
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/metabolism
- Humans
- Curcumin/pharmacology
- Proto-Oncogene Protein c-ets-1/metabolism
- Proto-Oncogene Protein c-ets-1/genetics
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/pathology
- Kidney Neoplasms/metabolism
- Animals
- Mice
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/metabolism
- Xenograft Model Antitumor Assays
- Mice, Nude
- Male
- Gene Expression Regulation, Neoplastic/drug effects
- Female
- Matrix Metalloproteinase 9/metabolism
- Matrix Metalloproteinase 9/genetics
- Cadherins/metabolism
- Cadherins/genetics
- Cell Line, Tumor
- Mice, Inbred BALB C
- Cell Proliferation/drug effects
- Antigens, CD
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Affiliation(s)
- Yue Chong
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shan Xu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Tianjie Liu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Peng Guo
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xinyang Wang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guodong Zhu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
- Oncology Research Laboratory, Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, 710061, China
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province, Xi'an Jiaotong University, Xi'an, 710061, China
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Lin H, Qu L, Chen G, Zhang C, Lu L, Chen Y. Comprehensive analysis of necroptosis-related lncRNA signature with potential implications in tumor heterogeneity and prediction of prognosis in clear cell renal cell carcinoma. Eur J Med Res 2023; 28:236. [PMID: 37452355 PMCID: PMC10347828 DOI: 10.1186/s40001-023-01194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Necroptosis has been reported to play a critical role in occurrence and progression of cancer. The dysregulation of long non-coding RNAs (lncRNAs) is associated with the progression and metastasis of clear cell renal cell carcinoma (CCRCC). However, research on necroptosis-related lncRNAs in the tumor heterogeneity and prognosis of CCRCC is not completely unclear. This study aimed to analysis the tumor heterogeneity among CCRCC subgroups and construct a CCRCC prognostic signature based on necroptosis-related lncRNAs. METHODS Weighted gene co-expression network analysis (WGCNA) was performed to identify necroptosis-related lncRNAs. A preliminary classification of molecular subgroups was performed by non-negative matrix factorization (NMF) consensus clustering analysis. Comprehensive analyses, including fraction genome altered (FGA), tumor mutational burden (TMB), DNA methylation alterations, copy number variations (CNVs), and single nucleotide polymorphisms (SNPs), were performed to explore the potential factors for tumor heterogeneity among the three subgroups. Subsequently, we constructed a predictive signature by multivariate Cox regression. Nomogram, calibration curves, decision curve analysis (DCA), and time-dependent receiver-operating characteristics (ROC) were used to validate and evaluate the signature. Finally, immune correlation analyses, including immune-related signaling pathways, immune cell infiltration status and immune checkpoint gene expression level, were also performed. RESULTS Seven necroptosis-related lncRNAs were screened out by WGCNA, and three subgroups were classified by NMF consensus clustering analysis. There were significant differences in survival prognosis, clinicopathological characteristics, enrichments of immune-related signaling pathway, degree of immune cell infiltration, and expression of immune checkpoint genes in the various subgroups. Most importantly, we found that 26 differentially expressed genes (DEGs) among the 3 subgroups were not affected by DNA methylation alterations, CNVs and SNPs. On the contrary, these DEGs were associated with the seven necroptosis-related lncRNAs. Subsequently, the identified RP11-133F8.2 and RP11-283G6.4 by multivariate Cox regression analysis were involved in the risk model, which could serve as an independent prognostic factor for CCRCC. Finally, qRT-PCR confirmed the differential expression of the two lncRNAs. CONCLUSIONS These findings contributed to understanding the function of necroptosis-related lncRNAs in CCRCC and provided new insights of prognostic evaluation and optimal therapeutic strategy for CCRCC.
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Affiliation(s)
- Hang Lin
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, Changsha, China
| | - Lingzhi Qu
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, Changsha, China
| | - Guanqiu Chen
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Liqing Lu
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, Changsha, China
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yongheng Chen
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics, State Local Joint Engineering Laboratory for Anticancer Drugs, Xiangya Hospital, Central South University, Changsha, China
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Impact of modified Glasgow prognostic score on predicting prognosis and modification of risk model for patients with metastatic renal cell carcinoma treated with first line tyrosine kinase inhibitor. Urol Oncol 2022; 40:455.e11-455.e18. [DOI: 10.1016/j.urolonc.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/22/2022]
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Long-Term Response to Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma. Biomedicines 2022; 10:biomedicines10102444. [PMID: 36289706 PMCID: PMC9599295 DOI: 10.3390/biomedicines10102444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Tyrosine kinase inhibitors (TKIs) prolong progression-free survival (PFS) in patients with metastatic renal cell carcinoma (mRCC), some of which may achieve long-term responses. Herein, we report clinical and pathological characteristics of patients who achieved long-term responses during first-line TKI treatment. Methods: Patients receiving TKI as first-line therapy from January 2010 to December 2017 in seven Italian Oncology Centers were reviewed. Sixty-six patients were considered as long-term responders, as they remained progression-free for 36 months or more during TKI treatment. A logistic regression model was performed to evaluate the effect of each clinical-pathological variable on the probability of responding long-term. Results: A total of 335 patients with a median age of 66 years were included in the analysis. The median PFS and overall survival among the long-term responders was 70 and 106 months, respectively. At a landmark PFS analysis performed 36 months after the start of treatment, the median PFS was 34 months. Multivariate analysis from all patients identified previous nephrectomy, Eastern Cooperative Oncology Group Performance Status (ECOG PS) < 1, and lack of liver metastasis as favorable prognostic factors for long-term response. Female gender and lack of liver metastasis positively correlated with long-term responses in favorable-risk-score population, as well as ECOG PS < 1 in intermediate-poor risk score population. Patients Summary: Previous surgery, clinical condition, and lack of liver metastasis may predict long-term responses to tyrosine kinase inhibitors. Conclusions: TKIs can lead to a long-term response in a subset of patients with metastatic RCC. Previous nephrectomy, optimal performance status (ECOG PS = 0), and lack of liver metastasis may predict long-term responses.
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Nikic P, Babovic N, Dzamic Z, Salma S, Stojanovic V, Matkovic S, Pejcic Z, Juskic K, Soldatovic I. Real World Overall Survival of Patients With Metastatic Renal Cell Carcinoma Treated With Only Available Sunitinib and Pazopanib in First-Line Setting. Front Oncol 2022; 12:892156. [PMID: 35756652 PMCID: PMC9213683 DOI: 10.3389/fonc.2022.892156] [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: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background The emerging new standard of care for metastatic clear cell renal carcinoma (mRCC) becomes a challenge when access to new drugs is limited. In Serbia, sunitinib and pazopanib are the only available first-line therapies. The second-line treatment for mRCC has never been and is still not available. We aimed to assess overall survival (OS) in patients with mRCC who received first-line sunitinib or pazopanib when access to second-line treatment was not available. Methods This retrospective observational study analyzed data from a nationally representative cohort of 759 patients who started on first-line sunitinib or pazopanib between 1 January 2012 and 30 June 2019, in 4 centers in Serbia. The data cut-off date was 31 December 2019. Key eligibility criteria were clear cell RCC histology, measurable metastatic disease, performance status 0 or 1, and the Memorial Sloan Kettering Cancer Center favorable or intermediate prognosis. The primary outcome was OS from the start of first-line treatment to death or data cut-off date. Results The study population included 759 patients with mRCC who started with first-line sunitinib (n = 673; [88.7%]) or pazopanib (n = 86; [11.3%]). Overall, the mean age was 61.0 ± 9.7 years at treatment baseline, and 547 (72%) were men. mRCC was primarily diagnosed in 230 (30%) patients, and most of them underwent cytoreductive nephrectomy prior to systemic therapy (n = 181 [79%]). Additional treatment of metastases prior to and/or during treatment was used in 169 patients (22.3%). Grade 3 and 4 adverse events occurred in 168 (22.1%) and 47 patients (6.2%), respectively, and treatment was permanently stopped because of toxicity in 41 (6.9%). The OS was calculated from the start of first-line treatment, and the median follow-up was 14 months (range, 0–97). The median OS in the entire cohort was 17 months (95% CI, 14.6–19.4). Conclusions With only available sunitinib and pazopanib in first-line treatment, modest improvements are seen in the overall survival of patients with mRCC in real world clinical practice. In circumstances of limited availability of cancer medicines, our results can contribute to accelerating patient access to novel cancer therapies that have been shown to prolong survival in mRCC.
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Affiliation(s)
- Predrag Nikic
- Clinic of Urology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Nada Babovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Zoran Dzamic
- Clinic of Urology, University Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Svetlana Salma
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | | | - Suzana Matkovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Zoran Pejcic
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Kristina Juskic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia.,Institute of Medical Statistics and Informatics, Belgrade, Serbia
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Prediction of early progression of metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitor. Curr Urol 2022; 15:187-192. [PMID: 35069080 PMCID: PMC8772668 DOI: 10.1097/cu9.0000000000000042] [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: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: There are various alternative first-line therapeutic options besides tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC). To inform therapeutic decision-making for such patients, this study aimed to identify predictive factors for resistance to TKI. Materials and methods: A total of 239 cases of mRCC patients who received first-line TKI therapy were retrospectively studied. Patients with a radiologic diagnosis of progressive disease within 3 months after initiating therapy were classified as primary refractory cases; the others were classified as non-primary refractory cases. The association between primary refractory cases and age, gender, pathology findings, serum c-reactive protein (CRP) level, metastatic organ status, and 6 parameters defined by the International Metastatic Renal Cell Carcinoma Database Consortium were analyzed. Results: Of 239 cases, 32 (13.3%) received a radiologic diagnosis of progressive disease within 3 months after initiating therapy. The rates of sarcomatoid differentiation, hypercalcemia, a serum CRP level of 0.3 mg/dL or higher, presence of liver metastasis, anemia, and time from diagnosis to treatment interval of less than a year were significantly higher in the primary refractory group. Multivariate analysis showed that sarcomatoid differentiation, hypercalcemia, a serum CRP level of 0.3 mg/dL or higher, and liver metastasis were independently associated with primary refractory disease. A risk-stratified model based upon the number of patients with these factors indicated rates of primary refractory disease of 4.0%, 10.1%, and 45.0% for patients with 0, 1, and 2 or more factors, respectively. Conclusions: Sarcomatoid differentiation, hypercalcemia, an elevated serum CRP level, and presence of liver metastasis were associated with primary refractory disease in mRCC patients receiving first-line TKI therapy. These results provide clinicians with useful information when selecting a first-line therapeutic option for mRCC patients.
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10
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Courcier J, De La Taille A, Lassau N, Ingels A. Comorbidity and frailty assessment in renal cell carcinoma patients. World J Urol 2021; 39:2831-2841. [PMID: 33616708 DOI: 10.1007/s00345-021-03632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. METHODS Narrative, non-systematic review based on PubMed and EMBASE search with the terms "renal neoplasm", "elderly, frail", "comorbidities", "active surveillance", "metastatic". The selection was restricted to articles written in English. RESULTS Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson's scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients' risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. CONCLUSIONS Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
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Affiliation(s)
- Jean Courcier
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Alexandre De La Taille
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
- Department of Imaging, Institut Gustave Roussy, Villejuif, France
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France.
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11
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Hutson TE, Liu FX, Dieyi C, Kim R, Krulewicz S, Kasturi V, Bhanegaonkar A. Effects of early vs delayed progression on clinical and economic outcomes in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors as first-line therapy: results from the IMPACT RCC claims data analysis. J Manag Care Spec Pharm 2021; 27:1171-1181. [PMID: 34165322 PMCID: PMC10394198 DOI: 10.18553/jmcp.2021.20569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: A key therapeutic goal of metastatic renal cell carcinoma (mRCC) treatment is delayed disease progression. The degree to which early therapeutic success affects downstream outcomes is not well established. OBJECTIVE: To assess the clinical and economic impact of early vs delayed disease progression in patients with mRCC treated with first-line (1L) tyrosine kinase inhibitors (TKIs) followed by second-line (2L) therapy in the US Veterans Health Administration (VHA) database. METHODS: Adult patients newly diagnosed with mRCC who were treated with a TKI as 1L therapy and who progressed to 2L therapy from October 1, 2013, through March 31, 2018, were identified from the US VHA database. Patients were stratified by median time from initiation of 1L therapy to initiation of 2L therapy into early (median time or sooner)and delayed (longer than the median) progression cohorts. Clinical outcomes (time to 2L therapy discontinuation, time to third-line [3L] treatment initiation, and overall survival) were assessed descriptively, and health care resource utilization and costs were compared between patients in the early and those in the delayed progression cohorts. Survival analyses (Kaplan-Meier curves) were used to estimate descriptively the median time to discontinuation, time to next line of treatment, and time to death for each cohort. Multivariate analysis was performed to adjust for the influence of differences in cohort characteristics, and Cox proportional hazards models were used to descriptively assess the impact of predictive factors on clinical outcomes. RESULTS: 289 patients were included in the analysis: 145 in the early progression cohort and 144 in the delayed progression cohort. Baseline characteristics were similar between the early and delayed progression cohorts. Median time from 1L therapy initiation to 2L therapy discontinuation was 7.9 months in the early progression cohort and 18.0 months in the delayed progression cohort, whereas time from 1L therapy initiation to 3L therapy initiation was 9.4 and 21.8 months, respectively; overall survival was 19.7 and 36.4 months, respectively. Descriptive analysis revealed generally lower risks for 2L therapy discontinuation (HR = 0.40, 95% CI = 0.31-0.52), 3L therapy initiation (HR = 0.42, 95% CI = 0.32-0.55), and death (HR = 0.46, 95% CI = 0.33-0.64) for those with delayed progression. After adjustment for possible confounding factors, comparative analysis during the follow-up period showed that delayed progression was associated with a shorter median all-cause hospital length of stay (0.4 days vs 0.8 days for early progression; P = 0.0004), fewer pharmacy visits (3.57 vs 4.08 visits; P = 0.0266), and lower total health care costs ($10,342 vs $13,388; P = 0.0347) per patient per month. CONCLUSIONS: In patients with mRCC, early progression after 1L therapy initiation is associated with generally worse clinical outcomes and statistically significantly greater health care resource utilization and costs than delayed progression. This finding highlights the importance of initiating therapy with an optimal 1L treatment regimen that has been proven to delay disease progression. DISCLOSURES This study was sponsored by EMD Serono Inc., an affiliate of Merck KGaA, and Pfizer Inc. EMD Serono Inc. and Pfizer Inc. were involved in the study design; the collection, analysis, and interpretation of the data; the writing of the report; and the decision to submit the report for publication. Liu and Bhanegaonkar are employed by EMD Serono Inc., an affiliate of Merck KGaA. Kasturi was employed by EMD Serono Inc., an affiliate of Merck KGaA, at the time of this study. Kim and Krulewicz are employed by Pfizer Inc. Dieyi is an employee of STATinMED Research, which received consulting fees from EMD Serono Inc. and Pfizer Inc. Hutson has received grants from Pfizer Inc., Astellas Pharma Inc., Janssen Pharmaceuticals, Exelixis, Inc., and Eisai Co., Ltd., outside of this work. Data from this analysis were presented at the Virtual International Society for Pharmacoeconomics and Outcomes Research 2020 conference, May 18-20, 2020; the virtual American Society of Clinical Oncology Annual Meeting, May 29-31, 2020; and AMCP Nexus 2020 Virtual, October 20-23, 2020.
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Affiliation(s)
| | - Frank X Liu
- EMD Serono Inc., Rockland, MA, USA; an affiliate of Merck KGaA, Darmstadt, Germany
| | | | | | | | - Vijay Kasturi
- EMD Serono Inc., Rockland, MA, USA; an affiliate of Merck KGaA, Darmstadt, Germany
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12
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Roberto M, Botticelli A, Panebianco M, Aschelter AM, Gelibter A, Ciccarese C, Minelli M, Nuti M, Santini D, Laghi A, Tomao S, Marchetti P. Metastatic Renal Cell Carcinoma Management: From Molecular Mechanism to Clinical Practice. Front Oncol 2021; 11:657639. [PMID: 33968762 PMCID: PMC8100507 DOI: 10.3389/fonc.2021.657639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
The therapeutic sc"enario of metastatic renal cell cancer (mRCC) has noticeably increased, ranging from the most studied molecular target therapies to those most recently introduced, up to immune checkpoint inhibitors (ICIs). The most recent clinical trials with an ICI-based combination of molecular targeted agents and ICI show how, by restoring an efficient immune response against cancer cells and by establishing an immunological memory, it is possible to obtain not only a better radiological response but also a longer progression-free and overall survival. However, the role of tyrosine kinase inhibitors (TKIs) remains of fundamental importance, especially in patients who, for clinical characteristics, tumor burden and comorbidity, could have greater benefit from the use of TKIs in monotherapy rather than in combination with other therapies. However, to use these novel options in the best possible way, knowledge is required not only of the data from the large clinical trials but also of the biological mechanisms, molecular pathways, immunological mechanisms, and methodological issues related to both new response criteria and endpoints. In this complex scenario, we review the latest results of the latest clinical trials and provide guidance for overcoming the barriers to decision-making to offer a practical approach to the management of mRCC in daily clinical practice. Moreover, based on recent literature, we discuss the most innovative combination strategies that would allow us to achieve the best clinical therapeutic results.
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Affiliation(s)
- Michela Roberto
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Medical Oncology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Martina Panebianco
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant’Andrea, Rome, Italy
| | - Anna Maria Aschelter
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant’Andrea, Rome, Italy
| | - Alain Gelibter
- Medical Oncology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Chiara Ciccarese
- Department of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Minelli
- Department of Medical Oncology, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Marianna Nuti
- Department of Experimental Medicine, University of Rome Sapienza Rome, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Andrea Laghi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Medical Oncology Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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13
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Pinheiro PS, Medina HN, Callahan KE, Koru-Sengul T, Sharma J, Kobetz EN, Penedo FJ. Kidney cancer mortality disparities among Hispanics in the US. Cancer Epidemiol 2021; 72:101938. [PMID: 33862414 DOI: 10.1016/j.canep.2021.101938] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Kidney cancer incidence is increasing among Hispanics but rate differences by distinct group, such as Cuban, Puerto Rican, and Mexican have not been studied. To fill this knowledge gap, we use mortality data, reflecting fatal kidney cancers, to examine patterns by race-ethnicity, including detailed Hispanic groups, and correlate the mortality rates with each group's prevalence of known kidney cancer risk factors: smoking, obesity, hypertension, diabetes, and chronic kidney disease. METHODS We used individual-level death data for California, Florida, and New York (2008-2018), and population prevalence data from the National Health Interview Surveys (2008-2018). Age-adjusted mortality rates (AAMRs) and regression-derived mortality rate ratios (MRRs) were computed. Pearson correlation analyses assessed the extent to which group-specific risk factor prevalence explained variability in observed AAMRs. RESULTS US-born Mexican Americans and American Indians had the highest rates and MRRs compared to Whites: 1.44 (95 %CI: 1.35-1.53) and 1.51 (1.38-1.64) for Mexican American men and women, respectively, and 1.54 (95 %CI: 1.25-1.89) and 1.53 (95 %CI: 1.15-2.04) for American Indians. In contrast, non-Mexican Hispanics had lower rates than Whites. Among males, positive correlations between AAMRs and smoking, obesity, and chronic kidney disease prevalence by race-ethnicity were found. CONCLUSION Mexican Americans and American Indians are high-risk for fatal kidney cancer. Disparities are only partially attributable to higher smoking and obesity prevalence, and more so among men than women. A shared risk factor profile, as well as possible genetic similarities, may explain their disproportionately higher kidney cancer mortality, but further research is warranted.
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Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, USA; Public Health Sciences, University of Miami School of Medicine, USA.
| | - Heidy N Medina
- Public Health Sciences, University of Miami School of Medicine, USA.
| | | | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, USA; Public Health Sciences, University of Miami School of Medicine, USA.
| | - Janaki Sharma
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, USA.
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, USA; Public Health Sciences, University of Miami School of Medicine, USA.
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, USA; Department of Psychology, University of Miami, USA.
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14
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Park SK, Park L, Silverman C, Heo JH, Park C. Association of congestive heart failure with hospital outcomes among renal cancer patients in the United States: analysis of nationwide inpatient sample. Expert Rev Pharmacoecon Outcomes Res 2021; 21:395-402. [PMID: 33645366 DOI: 10.1080/14737167.2021.1897576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Patients with renal cancer are at increased risk of comorbid congestive heart failure (CHF) due to several shared risk factors and the cardiotoxicity of some medications used for renal cancer treatment. We aimed to examine the relationship between CHF and hospital outcomes among renal cancer patients in the U.S.Methods: In this cross-sectional study, we identified hospitalizations of renal cancer patients using the 2015-2017 National Inpatient Sample. We assessed the relationship between CHF and hospital outcomes in this patient population, including in-hospital mortality, length-of-stay (LoS), and hospital costs.Results: Among the 20,321 hospitalizations of renal cancer patients identified, 6.1% involved patients with comorbid CHF (n = 1,231). The odds of in-hospital mortality did not differ based on CHF presence (odds ratio = 1.21; p = 0.354). Hospitalizations of renal cancer patients with CHF were associated with a greater LoS (incidence rate ratio = 1.44; p < 0.001) and higher hospital costs (cost ratio = 1.27; p < 0.001) than those without CHF.Conclusions: CHF in renal cancer patients is associated with increased LoS and higher hospital costs. These findings suggest that optimal management of comorbid CHF may improve hospital outcomes in patients with renal cancer and provides evidence to support the emerging field of cardio-oncology.
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Affiliation(s)
- Sun-Kyeong Park
- School of Pharmacy, The Catholic University of Korea, Bucheon, Korea
| | - Lindsay Park
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Ciara Silverman
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Ji-Haeng Heo
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Chanhyun Park
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
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15
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Katanoda K, Hori M, Saito E, Shibata A, Ito Y, Minami T, Ikeda S, Suzuki T, Matsuda T. Updated Trends in Cancer in Japan: Incidence in 1985-2015 and Mortality in 1958-2018-A Sign of Decrease in Cancer Incidence. J Epidemiol 2021; 31:426-450. [PMID: 33551387 PMCID: PMC8187612 DOI: 10.2188/jea.je20200416] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Unlike many North American and European countries, Japan has observed a continuous increase in cancer incidence over the last few decades. We examined the most recent trends in population-based cancer incidence and mortality in Japan. Methods National cancer mortality data between 1958 and 2018 were obtained from published vital statistics. Cancer incidence data between 1985 and 2015 were obtained from high-quality population-based cancer registries maintained by three prefectures (Yamagata, Fukui, and Nagasaki). Trends in age-standardized rates (ASR) were examined using Joinpoint regression analysis. Results For males, all-cancer incidence increased between 1985 and 1996 (annual percent change [APC] +1.1%; 95% confidence interval [CI], 0.7–1.5%), increased again in 2000–2010 (+1.3%; 95% CI, 0.9–1.8%), and then decreased until 2015 (−1.4%; 95% CI, −2.5 to −0.3%). For females, all-cancer incidence increased until 2010 (+0.8%; 95% CI, 0.6–0.9% in 1985–2004 and +2.4%; 95% CI, 1.3–3.4% in 2004–2010), and stabilized thereafter until 2015. The post-2000 increase was mainly attributable to prostate in males and breast in females, which slowed or levelled during the first decade of the 2000s. After a sustained increase, all-cancer mortality for males decreased in 1996–2013 (−1.6%; 95% CI, −1.6 to −1.5%) and accelerated thereafter until 2018 (−2.5%; 95% CI, −2.9 to −2.0%). All-cancer mortality for females decreased intermittently throughout the observation period, with the most recent APC of −1.0% (95% CI, −1.1 to −0.9%) in 2003–2018. The recent decreases in mortality in both sexes, and in incidence in males, were mainly attributable to stomach, liver, and male lung cancers. Conclusion The ASR of all-cancer incidence began decreasing significantly in males and levelled off in females in 2010.
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Affiliation(s)
- Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center
| | - Megumi Hori
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center
| | - Eiko Saito
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center
| | - Akiko Shibata
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University
| | - Tetsuji Minami
- Department of Cancer Epidemiology, Division of Social Medicine, Graduate School of Medicine, The University of Tokyo.,Division of Prevention, Center for Public Health Sciences, National Cancer Center
| | - Sayaka Ikeda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center.,Department of Society and Environmental Medicine, Osaka University
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital
| | - Tomohiro Matsuda
- Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center
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16
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Milman T, Magan T, Pradeep T, Tuluc M, Bilyk J. Ocular adnexal metastases from renal cell carcinoma: An update and comprehensive literature review. Saudi J Ophthalmol 2021; 35:209-216. [PMID: 35601855 PMCID: PMC9116086 DOI: 10.4103/sjopt.sjopt_96_21] [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: 04/30/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: The purpose of this study was to review the clinical presentation, systemic work-up, and outcomes of all previously reported ocular adnexal (OA) metastases from renal cell carcinoma (RCC). METHODS: This was a literature review. PubMed and Google Scholar databases were searched for all well-documented cases of OA metastases from RCC. RESULTS: Final analysis identified 44 patients with either biopsy-confirmed (41/44, 93%) or treatment response-documented (3/44, 6%) OA metastases from RCC. Thirty-four (77%) patients were male. The median age was 60 years (mean: 60, range: 22–87 years). The most common presenting signs were proptosis (19/44, 43%) and OA mass (14/44, 32%). Metastases most frequently involved the orbital bones (10/44, 23%) and adjacent extraconal fat, extending from the sinonasal tract in 7/10 (70%) of these cases. OA metastases were initial manifestation of RCC in 18/44 (41%) patients. At the time of primary tumor diagnosis, 22 of 30 (73%) patients had American Joint Committee on Cancer Stage IV disease with metastases to 2 or more sites in 13 (57%) patients. Seventeen of 42 (40%) patients underwent local therapy only, which most commonly included excision/exenteration with margin control (10/17, 59%). Twenty-five of 42 (60%) patients had systemic therapy, which included biologic agents and chemotherapy. The absolute 5-year survival rate was 66% with significantly improved survival in patients reported after 2006 (92% vs. 42%, P = 0.04) and in those with isolated OA metastases (100% vs. 27%, P = 0.02) at 30 months. CONCLUSION: Although RCC metastases to OA occur in a setting of advanced disease, the recent advances in diagnostic modalities and targeted therapies resulted in improved survival.
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Tsimafeyeu I, Shatkovskaya O, Krasny S, Nurgaliev N, Varlamov I, Petkau V, Safina S, Zukov R, Mazhbich M, Statsenko G, Varlamov S, Novikova O, Zaitsev I, Moiseyev P, Rolevich A, Evmenenko A, Popova I, Kaidarova D, Vladimirova L. Overall survival in patients with metastatic renal cell carcinoma in Russia, Kazakhstan, and Belarus: a report from the RENSUR3 registry. Cancer Rep (Hoboken) 2020; 4:e1331. [PMID: 33369240 PMCID: PMC8222559 DOI: 10.1002/cnr2.1331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Real‐world data describing outcomes of treatment among metastatic renal cell carcinoma (mRCC) patients are limited and heterogeneous. Aim RENSUR3 registry study assessed real‐world data on the use of therapies in mRCC and overall survival (OS) in Russia, Kazakhstan, and Belarus. Methods Patients were included in the retrospective multicenter registry study. To be eligible, patients were required to have mRCC diagnosed from January 2015 to January 2016. Anonymized data were collected through an online registry. The outcomes of interest were patient characteristics, treatment patterns, and OS. Results 1094 mRCC patients were identified. Mean age was 62.3 (SD, 11.2) years. Four hundred and forty‐four (41%) patients were 65 years and older. Primary tumor has not been removed in 503 (46%) patients. Subtype of RCC based on WHO classification (clear‐cell or other) has been reported in 402 (37%) patients. In total, 595 (54.4%) patients received systemic therapy for metastatic disease. 58% of elderly patients (≥65) were not treated compared to 37% of younger patients. Cytokines and targeted therapy were used in 298 (50.1%) and 297 (49.9%) of 595 treated patients, respectively. Median OS was 11.9 months (95% CI 10.9‐12.9). The 1‐ and 3‐year OS rates were 49.6% and 19.3%. Conclusions Half of patients received no systemic therapy or had only cytokines for mRCC in Russia, Kazakhstan, and Belarus, which doubtless negatively affected OS in this population. Novel therapies should be considered as life prolonging and a priority.
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Affiliation(s)
- Ilya Tsimafeyeu
- Kidney Cancer Research Bureau, Moscow, Russia.,Institute of Oncology, Hadassah Medical Moscow, Moscow, Russia
| | - Oxana Shatkovskaya
- Department of Strategic Development and International Relations, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Sergei Krasny
- N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
| | - Nurzhan Nurgaliev
- Department of Urology, Kazakh Institute of Oncology and Radiology, Almaty, Kazakhstan
| | - Ilya Varlamov
- Department of Urology, Altai Regional Cancer Center, Barnaul, Russia
| | - Vladislav Petkau
- Out-Patient Department, Sverdlovsk Regional Oncological Dispensary, Ekaterinburg, Russia
| | - Sufia Safina
- Chemotherapy Department, Republican Clinical Oncology Dispensary, Kazan, Russia
| | - Ruslan Zukov
- V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - Mikhail Mazhbich
- Department of Urology, Omsk Regional Cancer Center, Omsk, Russia
| | | | - Sergey Varlamov
- Department of Urology, Altai Regional Cancer Center, Barnaul, Russia
| | - Olga Novikova
- Chemotherapy Department, Khabarovsk Regional Cancer Center, Khabarovsk, Russia
| | - Igor Zaitsev
- Department of Urology, Astrakhan Regional Cancer Center, Astrakhan, Russia
| | - Pavel Moiseyev
- Organization of Anticancer Control, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
| | - Alexander Rolevich
- Laboratory of Oncourological Pathologies, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
| | - Alesya Evmenenko
- Department of the Organization of Anticancer Control, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
| | - Irina Popova
- Department of Medical Oncology, National Medical Research Centre for Oncology, Rostov-on-Done, Russia
| | | | - Liubov Vladimirova
- Department of Medical Oncology, National Medical Research Centre for Oncology, Rostov-on-Done, Russia
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18
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Khan Y, Slattery TD, Pickering LM. Individualizing Systemic Therapies in First Line Treatment and beyond for Advanced Renal Cell Carcinoma. Cancers (Basel) 2020; 12:E3750. [PMID: 33322163 PMCID: PMC7764621 DOI: 10.3390/cancers12123750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
Therapeutic options for treating advanced renal cell cancer (RCC) are rapidly evolving. Vascular endothelial growth factor (VEGF)-directed therapy, predominantly VEGF receptor (VEGFr) tyrosine kinase inhibitors (TKIs) had been the most effective first line treatment since 2005 irrespective of International Metastatic RCC Database Consortium (IMDC) risk stratification. However, immune checkpoint inhibitors (ICI) have recently changed the treatment paradigm for advanced RCC particularly as the first-line systemic treatment modality. The combination of Ipilimumab and Nivolumab provides better disease control and long-term outcomes compared with the anti-VEGFr TKI Sunitinib for IMDC intermediate- to poor-risk patients and we now have the option of using ICI with TKI upfront for all IMDC risk groups. This poses a challenge for physicians, both to select the most suitable first line regimen and the most suitable subsequent therapy given the lack of data about sequencing in this setting. This treatment landscape is expected to become more complex with the emerging treatment options. Moreover, these therapeutic options cannot be generalized as significant variability exists between individual's disease biologies and their physiologies for handling treatment adverse effects. Notable efforts are being made to identify promising predictive biomarkers ranging from neo-antigen load to gene expression profiling. These biomarkers need prospective validation to justify their utility in clinical practice and in treatment decision making. This review article discusses various clinicopathological characteristics that should be carefully evaluated to help select appropriate treatment and discusses the current status of biomarker-based selection.
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Affiliation(s)
| | | | - Lisa M. Pickering
- The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (Y.K.); (T.D.S.)
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Barata P, Hatton W, Desai A, Koshkin V, Jaeger E, Manogue C, Cotogno P, Light M, Lewis B, Layton J, Sartor O, Basu A, Kilari D, Emamekhoo H, Bilen MA. Outcomes With First-Line PD-1/PD-L1 Inhibitor Monotherapy for Metastatic Renal Cell Carcinoma (mRCC): A Multi-Institutional Cohort. Front Oncol 2020; 10:581189. [PMID: 33194712 PMCID: PMC7642690 DOI: 10.3389/fonc.2020.581189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: The treatment landscape of metastatic renal cell carcinoma has advanced significantly with the approval of combination regimens containing an immune checkpoint inhibitor (ICI) for patients with treatment-naïve disease. Little information is available regarding the activity of single-agent ICIs for patients with previously untreated mRCC not enrolled in clinical trials. Methods: This retrospective, multicenter cohort included consecutive treatment-naïve mRCC patients from six institutions in the United States who received ≥1 dose of an ICI outside a clinical trial, between June 2017 and October 2019. Descriptive statistics were used to analyze outcomes including objective best response rate (ORR), progression-free survival (PFS), and tolerability. Results: The final analysis included 27 patients, 70% men, median age 64 years (range 42-92), 67% Caucasian, and 33% with ECOG 2 or 3 at baseline. Most patients had intermediate risk (85%, IMDC) with clear cell (56%), papillary (26%), unclassified (11%), chromophobe (4%), and translocation (4%) RCC. All patients had evidence of metastatic disease involving the lungs (59%), lymph node (41%), CNS (19%), liver (11%), adrenal gland (11%), and bone (11%). The median time on ICI was 3.1 (0.1-26.8) months, and the median PFS was 6.3 (95% CI, 0-18.6) months. Among the 21 patients with an evaluable response, the best ORR was 33%, including two complete responses and five partial responses. The ORR was 29% (n = 1 complete response, n = 5 partial response) in clear cell and 5% (n = 1 complete response) in non-clear cell RCC. Adverse events (AEs) of any cause were reported in 37% and included fatigue (11%), dermatitis (11%), diarrhea (7%), and shortness of breath (7%). Significant AEs (30%) included shortness of breath (7%), acute kidney injury (4%), dermatitis (4%), Clostridium difficile infection (4%), cerebrovascular accident (4%), and fatigue (7%). Three patients discontinued therapy due to grade 4 AEs. Conclusions: In this multi-institutional case series, single-agent ICI demonstrated objective responses and was well tolerated in a heterogeneous treatment-naïve mRCC cohort. ICI monotherapy is not the standard of care for patients with mRCC, and further investigation is necessary to explore predictive biomarkers for optimal treatment selection in this setting.
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Affiliation(s)
- Pedro Barata
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Whitley Hatton
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Arpita Desai
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Vadim Koshkin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ellen Jaeger
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Charlotte Manogue
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Patrick Cotogno
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Malcolm Light
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Brian Lewis
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Jodi Layton
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Oliver Sartor
- Deming Department of Medicine, Tulane University Medical School, New Orleans, LA, United States
| | - Arnab Basu
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deepak Kilari
- Department of Medicine, Medical College of Wisconsin Cancer Center, Milwaukee, WI, United States
| | - Hamid Emamekhoo
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, WI, United States
| | - Mehmet A. Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
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20
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Bergerot P, Lamb P, Wang E, Pal SK. Cabozantinib in Combination with Immunotherapy for Advanced Renal Cell Carcinoma and Urothelial Carcinoma: Rationale and Clinical Evidence. Mol Cancer Ther 2020; 18:2185-2193. [PMID: 31792125 DOI: 10.1158/1535-7163.mct-18-1399] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/29/2019] [Accepted: 08/29/2019] [Indexed: 11/16/2022]
Abstract
The treatment landscape for metastatic renal cell carcinoma (mRCC) and urothelial carcinoma (mUC) has evolved rapidly in recent years with the approval of several checkpoint inhibitors. Despite these advances, survival rates for metastatic disease remain poor, and additional strategies will be needed to improve the efficacy of checkpoint inhibitors. Combining anti-VEGF/VEGFR agents with checkpoint inhibitors has emerged as a potential strategy to advance the immunotherapy paradigm, because VEGF inhibitors have immunomodulatory potential. Cabozantinib is a tyrosine kinase inhibitor (TKI) whose targets include MET, AXL, and VEGFR2. Cabozantinib has a unique immunomodulatory profile and has demonstrated clinical efficacy as a monotherapy in mRCC and mUC, making it a potentially suitable partner for checkpoint inhibitor therapy. In this review, we summarize the current status of immunotherapy for mRCC and mUC and discuss the development of immunotherapy-TKI combinations, with a focus on cabozantinib. We discuss the rationale for such combinations based on our growing understanding of the tumor microenvironment, and we review in detail the preclinical and clinical studies supporting their use.
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Affiliation(s)
- Paulo Bergerot
- City of Hope National Medical Center, Duarte, California
| | | | | | - Sumanta K Pal
- City of Hope National Medical Center, Duarte, California.
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21
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Teishima J, Murata D, Inoue S, Hayashi T, Mita K, Hasegawa Y, Kato M, Kajiwara M, Shigeta M, Maruyama S, Moriyama H, Fujiwara S. Improved prognosis for elderly patients with metastatic renal cell carcinoma in the era of targeted therapy. Mol Clin Oncol 2020; 12:557-564. [PMID: 32337038 DOI: 10.3892/mco.2020.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
The present study investigated the outcomes of targeted therapy for elderly patients with metastatic renal cell carcinoma (mRCC). A total of 277 patients with mRCC who were treated with tyrosine kinase inhibitor as a first-line therapy from January 2008 to May 2018 were retrospectively investigated by reviewing clinicopathological data. Patients 75 years or older were classified into the older-aged group (n=55) while all others were classified into the younger-aged group (n=222). The preoperative clinicopathological characteristics and the overall survival (OS) rate for these two groups were subsequently compared. The median age in the older- and younger-aged groups was 78 and 63 years (P<0.0001), respectively. A total of 7, 42 and 6 cases in the older-aged group and 46, 118 and 58 cases in the younger-aged group were classified into favorable, intermediate, and poor risk groups, respectively. The rate of patients with cardiovascular diseases (29.1%) and malignant diseases other than RCC (20.0%) was significantly higher in the older-aged group compared with the younger-aged group (6.8%; P<0.0001 and 7.2%; P=0.0042, respectively). There was a significant improvement in the OS rate for patients beginning targeted therapy after 2011 compared with those starting therapy prior to 2010. The 50% OS rate in patients starting targeted therapy before 2010 and after 2011 was, respectively, 17.1 and 38.6 months for the older-aged group (P=0.0066), while there was no significant difference for the younger-aged group (P=0.1441; 50% OS; 35.9 vs. 30.5 months). The results of the present study indicated that the prognosis for older patients has improved since the introduction of targeted therapy.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Daiki Murata
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Koji Mita
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Yasuhisa Hasegawa
- Department of Urology, Fukuyama Medical Center, Fukuyama, Hiroshima 720-8520, Japan
| | - Masao Kato
- Department of Urology, Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - Masanobu Shigeta
- Department of Urology, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima 737-0023, Japan
| | - Satoshi Maruyama
- Department of Urology, Miyoshi Central Hospital, Miyoshi, Tokushima 728-8502, Japan
| | - Hiroyuki Moriyama
- Department of Urology, Onomichi General Hospital, Onomichi, Hiroshima 722-8508, Japan
| | - Seiji Fujiwara
- Department of Urology, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Hiroshima 739-0041, Japan
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Dong Y, Wang Z, Lu X, Wu Z, Zhang Z, Yu Y, Peng F, Liu B, Wang L. Clinical outcomes of 168 Chinese patients after local surgery for bone metastases arising from advanced renal cell carcinoma. Cancer 2020; 126 Suppl 9:2079-2085. [PMID: 32293722 DOI: 10.1002/cncr.32800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The effectiveness of local surgery for bone metastases (BM) arising from renal cell carcinoma (RCC) remains uncertain. Herein, the authors performed what to the best of their knowledge is the first investigation of the outcomes of Chinese patients with RCC and BM. METHODS Data were collected for 168 patients with RCC and BM who were treated at Changzheng Hospital in Shanghai, China, between March 2009 and December 2018. All patients underwent local surgery for BM arising from RCC. Overall survival (OS) was defined as the interval between the date of local surgery and death or last follow-up and was estimated using the Kaplan-Meier method. Univariate and multivariable Cox proportional hazards analyses were used to identify significant prognostic factors. RESULTS The median OS in the study cohort was 43 months (range, 0-113 months). The 1-year, 3-year, and 5-year survival rates after surgery were 77.4%, 55.9%, and 31.8%, respectively. Univariate analyses demonstrated significant survival differences associated with sex (P = .003), the number of preoperative metastatic sites (BM alone or BM with concomitant metastasis; P < .001), and the number of BM (single or multiple; P = .008). OS also did not appear to differ regardless of whether the patients received postsurgical targeted therapy. Multivariable Cox regression demonstrated that the following characteristics were independent predictors of OS: the number of preoperative metastatic sites, International Metastatic Renal Cell Carcinoma Database Consortium risk score, and Memorial Sloan Kettering Cancer Center score. CONCLUSIONS Careful patient selection for local surgery is of paramount importance. The prognoses of patients in the Memorial Sloan Kettering Cancer Center-based and International Metastatic Renal Cell Carcinoma Database Consortium-based poor-risk groups were much worse than those of the intermediate-risk groups. In current clinical practice, "stratified treatment" can be performed according to these criteria.
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Affiliation(s)
- Yi Dong
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zheng Wang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xin Lu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhenjie Wu
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zongqin Zhang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yongwei Yu
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fei Peng
- Department of Nursing, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China
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Moran M, Nickens D, Adcock K, Bennetts M, Desscan A, Charnley N, Fife K. Sunitinib for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis of Real-World and Clinical Trials Data. Target Oncol 2020; 14:405-416. [PMID: 31301015 PMCID: PMC6684538 DOI: 10.1007/s11523-019-00653-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Randomized controlled trials (RCTs) have stringent inclusion criteria and may not fully represent patients seen in everyday clinical practice. Real-world data (RWD) can provide supportive evidence for the effectiveness of medical interventions in more heterogeneous populations than RCTs. Sunitinib is a widely used first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Objective This is the first comprehensive meta-analysis to evaluate the efficacy of sunitinib using the novel approach of combining RCTs and RWD. Methods RCTs and RWD studies published between 2000 and 2017 were identified from PubMed, Ovid, MEDLINE, and EMBASE. Eligible studies contained a cohort of ≥ 50 adult patients with mRCC receiving first-line sunitinib treatment. The meta-analysis combined RWD and RCT treatment groups, adjusting for data type (RCT or RWD). Recorded outcomes were median progression-free survival (mPFS), median overall survival (mOS), and objective response rate (ORR). Publication bias was assessed via review of funnel plots for each outcome measure. A random effects model to account for study heterogeneity was applied to each endpoint. Sensitivity analyses evaluated the robustness of the overall estimates. Results Of the 3611 studies identified through medical database searches, 22 (15 RWD studies, 7 RCTs) met eligibility criteria and were analyzed. mPFS (18 studies), mOS (19 studies), and ORR (15 studies) were reported for aggregate measures based on 4815, 5321, and 4183 patients, respectively. Reported mPFS (RWD, 7.5–11.0 months; RCTs, 5.6–15.1 months) and ORR data (RWD, 14.0–34.6%; RCTs, 18.8–46.9%) were consistent with the overall confidence estimates (95% confidence interval [CI]) of 9.3 (8.6–10.2) months and 27.9% (24.2–32.0), respectively. Reported mOS showed greater variation in RWD (6.8–33.2 months) compared with RCTs (21.8–31.5 months), with an overall confidence estimate (95% CI) of 23.0 (19.2–27.6) months. Inspection of funnel plots and sensitivity analyses indicated that there was no publication bias for any efficacy endpoint. Sensitivity analyses showed no evidence of lack of robustness for mPFS, mOS, or ORR. Interpretation of these results is limited by differences in trial design, cohort characteristics, and missing data. Conclusions This novel, comprehensive meta-analysis validates sunitinib as an effective first-line treatment for patients with mRCC in both RCTs and everyday clinical practice. The methodology provides a framework for future analyses combining data from RCTs and RWD. Electronic supplementary material The online version of this article (10.1007/s11523-019-00653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Kate Fife
- Cambridge University Hospital, Cambridge, UK
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Staehler M, Spek AK, Rodler S, Schott M, Casuscelli J, Mittelmeier L, Schlemmer M. Real-World Results from One Year of Therapy with Tivozanib. KIDNEY CANCER 2019. [DOI: 10.3233/kca-190073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Staehler
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Annabel K. Spek
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Severin Rodler
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Melanie Schott
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Jozefina Casuscelli
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Lena Mittelmeier
- Department of Urology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
| | - Marcus Schlemmer
- Department of Medical Oncology, University of Munich, Grosshadern Clinics, Marchioninistr, Munich, Germany
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Aspinall SL, Zhao X, Geraci MC, Good CB, Cunningham FE, Heron BB, Becker D, Lee S, Prasad V. Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration. Cancer Med 2019; 8:6651-6661. [PMID: 31536684 PMCID: PMC6825975 DOI: 10.1002/cam4.2531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study is to describe the use of targeted therapies for the treatment of advanced renal cell carcinoma (RCC) and overall survival (OS) among patients in clinical practice in the Veterans Health Administration (VHA). METHODS A retrospective cohort of 286 patients from 24 VHA Medical Centers diagnosed with advanced clear cell RCC between Fiscal Year (FY) 2010 and FY2014 was followed through September 30, 2016. Among patients who received targeted therapy, we described the medications taken, duration of therapy, and overall survival. We also assessed the effect of the first therapy received on overall survival using Cox Proportional Hazards models. RESULTS There were 66 patients who did not receive therapy for their advanced RCC. Of the 220 treated patients, the mean (sd) number of medications received was 1.9 (1.1). The medications most commonly used first were sunitinib (61.8%), pazopanib (17.3%), and temsirolimus (10.9%). The median duration of first-line therapy was 86 days (interquartile range [IQR] 42, 210). Median total duration of therapy was 159 days (IQR 58, 397). 62.3% of patients had ≥ 1 dose of therapy held or reduced, mainly due to an adverse drug event (ADE). Median survival from the start of treatment to death was 1.08 years (IQR 0.80, 1.31). Finally, receipt of temsirolimus vs sunitinib (HR 1.95 [95%CI 1.09,3.47]) as the first targeted therapy was independently associated with an increased hazard of death. CONCLUSION Our analysis of targeted therapies for advanced RCC in VHA suggests duration of treatment is shorter in a real-world setting than in clinical trials, and dose reductions and ADEs are more common.
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Affiliation(s)
- Sherrie L. Aspinall
- VA Pharmacy Benefits Management ServicesHinesIL
- VA Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPA
- School of PharmacyUniversity of PittsburghPittsburghPA
| | - Xinhua Zhao
- VA Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPA
| | | | - Chester B. Good
- VA Pharmacy Benefits Management ServicesHinesIL
- VA Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPA
- School of PharmacyUniversity of PittsburghPittsburghPA
- School of MedicineUniversity of PittsburghPittsburghPA
- Center for Value‐Based Pharmacy InitiativesUPMC Health PlanPittsburghPA
| | | | | | - Daniel Becker
- New York University School of MedicineNew YorkNY
- VA NY Harbor Healthcare SystemNew YorkNY
| | - Steve Lee
- New York University School of MedicineNew YorkNY
- VA NY Harbor Healthcare SystemNew YorkNY
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Teishima J, Murata D, Hasegawa Y, Moriyama H, Mita K, Matsubara A. C-reactive protein can be used to predict the therapeutic effects of nivolumab in patients with metastatic renal cell carcinoma. Int J Urol 2019; 26:1076-1077. [PMID: 31368187 DOI: 10.1111/iju.14084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daiki Murata
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Hiroyuki Moriyama
- Department of Urology, JA Onomichi General Hospital, Onomichi, Japan
| | - Koji Mita
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Miyake M, Owari T, Fujimoto K. Lack of evidence regarding bone metastases of genitourinary cancers: interventions by surgery, radiotherapy, and bone-targeted systemic therapy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S92. [PMID: 31576300 DOI: 10.21037/atm.2019.04.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Pal S, Gong J, Mhatre SK, Lin SW, Surinach A, Ogale S, Vohra R, Wallen H, George D. Real-world treatment patterns and adverse events in metastatic renal cell carcinoma from a large US claims database. BMC Cancer 2019; 19:548. [PMID: 31174493 PMCID: PMC6555983 DOI: 10.1186/s12885-019-5716-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/14/2019] [Indexed: 02/02/2023] Open
Abstract
Background Vascular endothelial growth factor (VEGF), tyrosine kinase (TK) and mechanistic target of rapamycin kinase (mTOR) inhibitors are common first-line (1 L) treatments for metastatic renal cell carcinoma (mRCC). Despite treatment availability, the 5-year survival rate in patients diagnosed at the metastatic stage is only ≈ 10%. To gain contemporary insights into RCC treatment trends that may inform clinical, scientific and payer considerations, treatment patterns and adverse events (AEs) associated with 1 L therapy were examined in a retrospective, longitudinal, population-based, observational study of patients with mRCC. Methods US administrative claims data (Truven Health MarketScan Commercial Databases) were used to assess trends in 1 L treatment initiation in mRCC (2006–2015) and characterize patterns of individual 1 L treatments, baseline characteristics, comorbidities and treatment-related AEs from 2011 through 2015. Outcomes were evaluated by drug class and route of administration. Results Ten-year trend analysis (n = 4270) showed that TK/VEGF-directed therapy rapidly became more common than mTOR-directed therapy, and oral treatments were favored over intravenous (IV) treatments. Overall, 1992 eligible patients initiated 1 L treatment for mRCC from 2011 through 2015: 1752 (88%) received TK/VEGF-directed agents and 233 (12%) received mTOR-directed agents; 1674 (84%) received oral treatments, and 318 (16%) received IV treatments. The most common 1 L treatment was sunitinib (n = 849), followed by pazopanib (n = 631), temsirolimus (n = 157) and bevacizumab (n = 154). Patient characteristics and comorbidities, including age, diabetes and congestive heart failure, were independent predictors of 1 L mRCC treatment choice. The three most common potentially 1 L treatment–related AEs were nausea/vomiting (128.2 per 100 patient-years [PY]), hypertension (69 per 100 PY) and renal insufficiency (44.6 per 100 PY). A wide variety of agents were used as second-line (2 L) therapy. Substantial latency of onset was observed for several potentially treatment-related toxicities in patients treated with TK/VEGF- or mTOR-directed agents. Conclusions In the US, 1 L TK/VEGF inhibitor uptake in recent years appears largely in line with national approvals and guidelines, with varied 2 L agent use. Although retrospective evaluation of claims data cannot assess underlying causality, insights from these real-world RCC treatment and AE patterns will be useful in informing medical and payer decisions. Electronic supplementary material The online version of this article (10.1186/s12885-019-5716-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumanta Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Jun Gong
- Department of Hematology/Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Shivani K Mhatre
- Real World Data Science (Oncology), Genentech, Inc, 1 DNA Way, MS 352B, South San Francisco, CA, 94080, USA
| | - Shih-Wen Lin
- Real World Data Science (Oncology), Genentech, Inc, 1 DNA Way, MS 352B, South San Francisco, CA, 94080, USA
| | - Andy Surinach
- Genesis Research, 5 Marine View Plaza, Hoboken, NJ, 07030, USA
| | - Sarika Ogale
- US Medical Affairs, Genentech, Inc, 1 DNA Way, MS 352B, South San Francisco, CA, 94080, USA
| | - Rini Vohra
- School of Pharmacy, West Virginia University, P.O. Box 9500, Morgantown, WV, 26506, USA
| | - Herschel Wallen
- Oncology and Hematology Care Clinic, Providence Cancer Center, 4805 NE Glisan Street, Suite 6N40, Portland, OR, 97213, USA
| | - Daniel George
- Department of Medicine, Medical Oncology, Duke University School of Medicine, Box 103861, Durham, NC, 27710, USA
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Li P, Jahnke J, Pettit AR, Wong YN, Doshi JA. Comparative Survival Associated With Use of Targeted vs Nontargeted Therapy in Medicare Patients With Metastatic Renal Cell Carcinoma. JAMA Netw Open 2019; 2:e195806. [PMID: 31199450 PMCID: PMC6575152 DOI: 10.1001/jamanetworkopen.2019.5806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Targeted therapies for advanced renal cell carcinoma (RCC) have shown increased tolerability and survival advantages over older treatments in clinical trials, but understanding of real-world survival improvements is still emerging. OBJECTIVE To compare overall and RCC-specific survival associated with use of targeted vs nontargeted therapy for metastatic RCC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data from 2000 to 2013 to examine patients with stage IV (distant) clear cell RCC at the time of diagnosis who received any targeted or nontargeted therapy. A 2-stage residual inclusion model was fitted to estimate the survival advantages of targeted treatments using an instrumental variable approach to account for both measured and unmeasured group differences. Data analyses were conducted from July 24, 2017, to April 4, 2019. EXPOSURES Targeted therapy (study group) or nontargeted therapy (control group). MAIN OUTCOMES AND MEASURES Overall survival and RCC-specific survival, defined as the interval between the date of first drug treatment and date of death or end of the observation period. RESULTS The final sample included 1015 patients (mean [SD] age, 71.2 [8.1] years; 392 [39%] women); 374 (37%) received nontargeted therapy and 641 (63%) received targeted therapy. The targeted therapy group had a greater percentage of disabled patients (ie, those <65 years old who were eligible for Medicare because of disability) and older patients (ie, those ≥75 years old) and higher comorbidity index and disability scores compared with the nontargeted therapy group. Unadjusted Kaplan-Meier survival curves showed higher overall survival for targeted vs nontargeted therapy (log-rank test, χ21 = 5.79; P = .02); median survival was not statistically significantly different (8.7 months [95% CI, 7.3-10.2 months] vs 7.2 months [95% CI, 5.8-8.8 months]; P = .14). According to the instrumental variable analysis, the median overall survival advantage was 3.0 months (95% CI, 0.7-5.3 months), and overall survival improvements associated with targeted therapy vs nontargeted therapy were statistically significant: 8% at 1 year (44% [95% CI, 39%-50%] vs 36% [95% CI, 30%-42%]; P = .01), 7% at 2 years (25% [95% CI, 20%-30%] vs 18% [95% CI, 13%-23%]; P = .009), and 5% at 3 years (15% [95% CI, 11%-19%] vs 10% [95% CI, 6%-13%]; P = .01). Receipt of targeted therapy was associated with a lower hazard of death compared with nontargeted therapy (overall survival hazard ratio, 0.78 [95% CI, 0.65-0.94]; RCC-specific survival hazard ratio, 0.77 [95% CI, 0.62-0.96]). CONCLUSIONS AND RELEVANCE Targeted therapies were associated with modest survival advantages despite a treatment group with more medical complexity, likely reflecting appropriateness for an expanded population of patients. As advances in cancer treatment continue, rigorous methods that account for unobserved confounders will be needed to evaluate their real-world impact on outcomes.
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Affiliation(s)
- Pengxiang Li
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jordan Jahnke
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy R. Pettit
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Yu-Ning Wong
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Now with Janssen Scientific Affairs, Titusville, New Jersey
| | - Jalpa A. Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
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Deng H, Huang Y, Hong Z, Yuan X, Cao Z, Wei Y, Zhang W. Pazopanib has equivalent anti-tumor effectiveness and lower Total costs than Sunitinib for treating metastatic or advanced renal cell carcinoma: a meta-analysis. BMC Cancer 2019; 19:489. [PMID: 31122210 PMCID: PMC6533682 DOI: 10.1186/s12885-019-5704-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/10/2019] [Indexed: 11/11/2022] Open
Abstract
Background Sunitinib and pazopanib are extensively used as first-line treatment of metastatic renal cell carcinoma (mRCC). We performed this meta-analysis to assess the anti-tumor effectiveness, toxicity, and total costs of the two drugs among patients with mRCC/advanced RCC (aRCC). Materials and Methods: PubMed, ScienceDirect, Scopus, Web of Science, Ovid MEDLINE, the Cochrane Library, Embase, and Google Scholar were searched to obtain eligible articles. The endpoints included progression-free survival (PFS), overall survival (OS), adverse effects (AEs), and per-patient-per-month (PPPM) costs. Results We included 14 medium- to high-quality studies. Both drugs were valid for mRCC/aRCC, with equivalent PFS (hazard ratio (HR) =1.06, 95% confidence interval [CI]: 0.98–1.15, P = 0.13), OS (HR = 0.92, 95% CI: 0.79–1.07, P = 0.29), objective response rate (ORR, risk ratio (RR) =1.03, 95% CI: 0.93–1.13, p = 0.58), and disease control rate (DCR, RR = 1.03, 95% CI: 0.94–1.22, P = 0.54). Sunitinib had more dosage reductions and higher PPPM (weighted mean difference = − 1.50 thousand US dollars, 95% CI: − 2.27 to − 0.72, P = 0.0002). Furthermore, more incidences of severe fatigue, thrombocytopenia, and neutropenia were recorded for sunitinib, but pazopanib had more liver toxicity. In subgroup analysis, studies from the US reported longer OS (HR = 0.86, 95% CI: 0.77–0.95, P = 0.004) and higher ORR (RR = 1.24, 95% CI: 1.03–1.51, P = 0.03). Conclusions Pazopanib provides equivalent anti-tumor effectiveness and lower PPPM as compared with sunitinib for mRCC/aRCC. Great care should be given to pazopanib-treated patients with abnormal liver function. Nevertheless, more large-scale, high-quality studies are required. Electronic supplementary material The online version of this article (10.1186/s12885-019-5704-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huan Deng
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Minde Rd, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yu Huang
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.,Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhengdong Hong
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xuhui Yuan
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.,Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zhi Cao
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.,Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Minde Rd, Nanchang, 330006, Jiangxi Province, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Minde Rd, Nanchang, 330006, Jiangxi Province, China.
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Metastatic Tumor Burden and Loci as Predictors of First Line Sunitinib Treatment Efficacy in Patients with Renal Cell Carcinoma. Sci Rep 2019; 9:7754. [PMID: 31123336 PMCID: PMC6533291 DOI: 10.1038/s41598-019-44226-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/13/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate the prognostic impact of baseline tumor burden and loci on the efficacy of first line renal cancer treatment with sunitinib. Baseline and on-treatment CT scans were evaluated. Both the Kaplan-Meier and Weibull modelling survival estimators have been used to describe sunitinib treatment response. Logistic regression was used to confirm associations between tumor site, burden and survival. Additionally, analysis of the metastases co-occurrence was conducted using the Bayesian inference on treated and external validation cohorts. 100 patients with metastatic clear cell renal cell carcinoma were treated with sunitinib in this study. Presence of metastases in the abdominal region (HR = 3.93), and the number of brain metastases correlate with shorter PFS, while the presence of thoracic metastases (HR = 0.47) with longer PFS. Localization of metastases in the abdominal region significantly impacts risk of metastases development in other locations including bone and brain metastases. Biology of metastases, in particular their localization, requires further molecular and clinical investigation.
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Tuppin P, Paita M, Gastaldi-Menager C, Le Bihan-Benjamin C, Jean Bousquet P, Fagot Campagna A. Patient characteristics and treatments one year after diagnosis of renal cancer in 2015 according to the presence or absence of metastasis and a history of another tumour: A national observational study. Bull Cancer 2019; 106:538-549. [PMID: 31072597 DOI: 10.1016/j.bulcan.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study describes the characteristics, management and outcome of patients one year after a diagnosis of renal cancer, according to the presence of a history of another tumour and metastases at diagnosis or during the first year. METHODS Based on information from the national health data system (SNDS), 10,989 general scheme beneficiaries (>15 years) with a first hospital stay in 2015 for renal cancer were divided into groups according to the presence of a history of another tumour or metastases. RESULTS In this cohort of 10,989 people (75 years and older: 30%, men: 65%), 12% had a history of another tumour diagnosed during the two years before and 22% presented one or more metastases at the time of the index hospitalisation or during the following year. Overall, nephrectomy was performed in 56% of cases (partial nephrectomy in 29% of cases), in 63% and 36% of cases without metastases and in 68% and 40% of cases without metastases and with no history of another tumour. Overall, 2% of patients received at least one monoclonal antibody and 15% received a protein kinase inhibitor. These drugs were used in 6% and 53% of cases, respectively, in the presence of metastases and in 7% and 31% of cases, respectively, in the presence of metastases and a history of another tumour. CONCLUSION This study highlights the high rate of a history of another tumour and adaptation of treatment according to a history of cancer and the presence of metastases.
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Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
| | - Michel Paita
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Menager
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | | | - Philippe Jean Bousquet
- Institut national du cancer, 52, avenue André-Morizet, 92100 Boulogne-Billancourt, France
| | - Anne Fagot Campagna
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
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The value of cytoreductive nephrectomy on the survival of metastatic renal carcinoma patients based on the number of site-specific metastases. PLoS One 2019; 14:e0215861. [PMID: 31013336 PMCID: PMC6478335 DOI: 10.1371/journal.pone.0215861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There has been significant uncertainty in the selection of candidates for cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC). This report investigates the influence of site-specific metastases (bone, brain, liver, and lung) on the survival benefit of CN. METHODS Within the Surveillance, Epidemiology and End Results database (2010-2014), 1113 mRCC patients treated with CN (n = 618) or no surgery (NS, n = 495) met the selection criteria. 168 pairs of patients using propensity scores were matched to balance the selection bias of undergoing CN. Multivariable competing risks regression analysis was used to calculate cancer-specific mortality (CSM) and overall survival (OS). Cases were subdivided to investigate the advantages of each procedure. RESULTS Before or after matching, CN led to better OS and lower CSM in Kaplan-Meier analysis. In matched cohort, decreased CSM after CN compared to without CN were consistently found in most subgroups stratified by age, T stage, and patients with ≤2 site-specific metastases. However, patients with ≥ 3 site-specific metastases, or patients with ≥cT3 stage combined with ≥ 2 site-specific metastases were not benefit from the cytoreductive nephrectomy. CONCLUSIONS The potential benefit of CN disappeared in patients with ≥ 3 site-specific metastases, or patients with ≥cT3 combined with ≥ 2 site-specific metastases.
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Teishima J, Inoue S, Hayashi T, Matsubara A. Current status of prognostic factors in patients with metastatic renal cell carcinoma. Int J Urol 2019; 26:608-617. [PMID: 30959579 DOI: 10.1111/iju.13956] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/03/2019] [Indexed: 12/12/2022]
Abstract
In recent years, the induction of novel agents, including molecular-targeted agents and immune checkpoint inhibitors, have dramatically changed therapeutic options and their outcomes for metastatic renal cell carcinoma. Several prognostic models based on the data of patients with metastatic renal cell carcinoma treated with targeted agents or cytokine therapy have been useful in real clinical practice. Serum or peripheral blood markers related to inflammatory response have been reported to be associated with their prognosis or therapeutic efficacy. In addition to them, investigation for novel predictive factors that represent the efficacy of agents, the risk of adverse events and the prognosis are required for the advance of therapeutic strategies. The present review discusses the conventional prognostic models and clinical factors, and recent advances of the identification of some of the most promising molecules as novel biomarkers for metastatic renal cell carcinoma.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kim MS, Chung HS, Hwang EC, Jung SI, Kwon DD, Hwang JE, Bae WK, Park JY, Jeong CW, Kwak C, Song C, Seo SI, Byun SS, Hong SH, Chung J. Efficacy of First-Line Targeted Therapy in Real-World Korean Patients with Metastatic Renal Cell Carcinoma: Focus on Sunitinib and Pazopanib. J Korean Med Sci 2018; 33:e325. [PMID: 30546281 PMCID: PMC6291404 DOI: 10.3346/jkms.2018.33.e325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To evaluate survival outcomes and prognostic factors for overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) who received sunitinib (SU) and pazopanib (PZ) as first-line therapy in real-world Korean clinical practice. METHODS Data of 554 patients with mRCC who received SU or PZ at eight institutions between 2012 and 2016 were retrospectively reviewed. Based on the targeted therapy, the patients were divided into SU (n = 293) or PZ (n = 261) groups, and the clinicopathological variables and survival rates of the two groups were compared. A multivariable Cox proportional hazard model was used to determine the prognostic factors for OS. RESULTS The median follow-up was 16.4 months (interquartile range, 8.3-31.3). Patients in the PZ group were older, and no significant difference was observed in the performance status (PS) between the two groups. In the SU group, the dose reduction rate was higher and the incidence of grade 3 toxicity was more frequent. The objective response rates were comparable between the two groups (SU, 32.1% vs. PZ, 36.4%). OS did not differ significantly between the two groups (SU, 36.5 months vs. PZ, 40.2 months; log-rank, P = 0.955). Body mass index, Eastern Cooperative Oncology Group PS > 2, synchronous metastasis, poor Heng risk criteria, and liver and bone metastases were associated with a shorter OS. CONCLUSION Our real-world data of Korean patients with mRCC suggested that SU and PZ had similar efficacies as first-line therapy for mRCC. However, PZ was better tolerated than SU in Korean patients.
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Affiliation(s)
- Myung Soo Kim
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jun Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Ansan, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
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Nazha S, Tanguay S, Kapoor A, Jewett M, Kollmannsberger C, Wood L, Bjarnason G, Heng D, Soulières D, Reaume N, Basappa N, Lévesque E, Dragomir A. Use of targeted therapy in patients with metastatic renal cell carcinoma: clinical and economic impact in a Canadian real-life setting. ACTA ACUST UNITED AC 2018; 25:e576-e584. [PMID: 30607126 DOI: 10.3747/co.25.4103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Outside of randomized controlled clinical trials, the understanding of the effectiveness and costs associated with targeted therapies for metastatic renal cell carcinoma (mrcc) is limited in Canada. The purpose of the present study was to use real-world prospective data to assess the effectiveness and cost of targeted therapies for patients with mrcc. Methods The Canadian Kidney Cancer Information System, a pan-Canadian database, was used to identify prospectively collected data relating to patients with mrcc. First- and subsequent-line time to treatment termination (ttt) was determined from therapy initiation time (sunitinib or pazopanib) to discontinuation of therapy. Kaplan-Meier survival curves were used to estimate the unadjusted and adjusted overall survival (os) by treatment. Unit treatment cost was used to estimate the cost by line of treatment and the total cost of therapy for the management of patients with mrcc. Results The study included 475 patients receiving sunitinib or pazopanib in the first-line setting. Patients were treated mostly with sunitinib (81%); 19% of patients were treated with pazopanib. The median ttt in the first line was 7.7 months for patients receiving sunitinib and 4.6 months for those receiving pazopanib (p < 0.001). The adjusted os was 32 months with sunitinib and 21 months with pazopanib (hazard ratio: 1.61; p < 0.01). The total median cost of first- and second-line treatments was $56,476 (interquartile range: $23,738-$130,447) for patients in the sunitinib group and $46,251 (interquartile range: $28,167-$91,394) for those in the pazopanib group. Conclusions For the two therapies, os differed significantly, with a higher median os being observed in the sunitinib group. The cost of treatment was higher in the sunitinib group, which is to be expected with longer survival.
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Affiliation(s)
- S Nazha
- McGill University Health Centre, Montreal, QC
| | - S Tanguay
- McGill University Health Centre, Montreal, QC
| | - A Kapoor
- McMaster University, Hamilton, ON
| | - M Jewett
- Princess Margaret Cancer Centre, Toronto, ON
| | | | - L Wood
- Dalhousie University and qeii Health Sciences Centre, Halifax, NS
| | - G Bjarnason
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
| | - D Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB
| | - D Soulières
- Centre hospitalier de l'Université de Montréal, University of Montreal, Montreal, QC
| | - N Reaume
- University of Ottawa, Ottawa, ON
| | - N Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - E Lévesque
- Centre hospitalier universitaire de Québec, University of Laval, Quebec City, QC
| | - A Dragomir
- McGill University Health Centre, Montreal, QC
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Changes in Treatment Reality and Survival of Patients With Advanced Clear Cell Renal Cell Carcinoma – Analyses From the German Clinical RCC-Registry. Clin Genitourin Cancer 2018; 16:e1101-e1115. [DOI: 10.1016/j.clgc.2018.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
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Nagao K, Shinohara N, Smit F, de Weijert M, Jannink S, Owada Y, Mulders P, Oosterwijk E, Matsuyama H. Fatty acid binding protein 7 may be a marker and therapeutic targets in clear cell renal cell carcinoma. BMC Cancer 2018; 18:1114. [PMID: 30442117 PMCID: PMC6238291 DOI: 10.1186/s12885-018-5060-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/07/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To identify potential therapeutic target in clear cell renal cell carcinoma (ccRCC), we performed a transcriptome analysis. Our analysis showed that fatty acid binding protein 7 (FABP7) has the highest mean differential overexpression in ccRCC compared to normal kidney. We aimed to investigate the significance of FABP7 in ccRCC. METHODS Immunohistochemical staining for 40 advanced ccRCC cases was performed to investigate correlation between clinicopathological parameters and FABP7. They were composed of 40-83 years old cases with 33 male, 22 cases with pT ≥ 3, 19 cases with M1, and 16 cases with grade 3. The effect of gene knockdown was analysed by a cell viability assay and invasion assay in FABP7-overexpressing cell lines (SKRC7 and SKRC10). RESULTS Our immunohistochemical analysis showed that higher FABP7 expression significantly correlated with distant metastasis and poor cancer-specific survival (CSS; both p < 0.05). Functional suppression of FABP7 significantly inhibited SKRC10 cell growth (p < 0.05) and resulted in a significant reduction of the invasive potential (p < 0.01), but did not cause growth inhibition of SKRC7 cells. We found that The Cancer Genome Atlas Research Network (TCGA) database shows FABP6 and 7 as equally overexpressed in the FABP family. Functional suppression of fatty acid binding protein 6 (FABP6) resulted in significant growth inhibition of SKRC7 cells (p < 0.005). CONCLUSIONS Functional suppression of FABP7 significantly reduced cell viability and invasive potential in a ccRCC cell line. FABP7 may play a role in progression in some metastatic ccRCCs. The suppressed function may be compensated by another FABP family member.
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Affiliation(s)
- Kazuhiro Nagao
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan. .,Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands.
| | - Nachi Shinohara
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Frank Smit
- Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands
| | - Mirjam de Weijert
- Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands
| | - Sander Jannink
- Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands
| | - Yuji Owada
- Department of Organ Anatomy, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Peter Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Nijmegen 267 Experimental Urology, Geert Grooteplein, 26-28, P.O. Box 9101, NL-6525, GA, Nijmegen, The Netherlands
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Tsironis G, Koutsoukos K, Athanasakis K, Tsiara A, Tzannis K, Gerolympou M, Visvikis A, Oikonomopoulos G, Kollia A, Giannopoulou E, Dimitra M, Kostouros E, Papatsoris A, Dellis A, Stravodimos K, Varkarakis I, Samantas E, Aravantinos G, Kentepozidis N, Christodoulou C, Bozionelou V, Dimopoulos MA, Bamias A. Patterns of practice and pharmacoeconomic analysis of the management of patients with metastatic renal cell carcinoma (mRCC) in Greece--the CRISIS study. A retrospective analysis by the Hellenic Genitourinary Cancer Group (HGUCG). Expert Rev Pharmacoecon Outcomes Res 2018; 19:491-501. [PMID: 30417707 DOI: 10.1080/14737167.2019.1546121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background:Metastatic RCC (mRCC) treatment has been revolutionized with 11 approved targeted agents. We report patterns of practice, outcomes and pharmacoeconomic analyses after the introduction of targeted therapy. Patients and methods: CRISIS was a retrospective multicenter study of mRCCpatients who received targeted therapy . Results were related to the start of 1st-line therapy, with a cut off at 1 January 2011 in order to depict the impact of increased availability of effective options. Results: 164 patients, were included. 70.1% and 44.5% received 2nd and 3rd-line therapy, respectively. More patients were treated in 2nd-line after 1 January 2011. After a median follow-up of 55.1 months, median progression-free (PFS) and overall survival (OS) were 10.7 (95% confidence intervals [CI]: 8.3-13.7), 7.3 (95% CI: 5.1-8.6), 5.8 (95% CI: 3.8-7.8) and 34 (95% CI: 28.5-39.8), 22.4 (95% CI: 16-32.1), 18.3 (95% CI: 12.4-26.4) months for first, second and third line, respectively. Efficacy of sunitinib and pazopanib in 1st-line were similar. The mean total cost/patient was 35,012.2 Euros (standard deviation [SD]: 28,971.5). Conclusions: Our study confirms previous real-world data suggesting that continuing advances in the treatment of mRCC produce favorable outcomes in everyday practice. Pharmacoeconomic analyses are important for cost-effective utilization of emerging novel therapies.
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Affiliation(s)
- Georgiops Tsironis
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Konstantinos Koutsoukos
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | | | - Anna Tsiara
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece
| | - Kimon Tzannis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Margarita Gerolympou
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | - Anastasios Visvikis
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | | | | | | | | | - Efthymios Kostouros
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece
| | - Athanasios Papatsoris
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,f 2nd Department of Urology, Sismanoglio General Hospital , University of Athens , Athens , Greece
| | - Athanasios Dellis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,g 2nd Department of Surgery, Aretaieion Academic Hospital , University of Athens , Athens , Greece
| | - Konstantinos Stravodimos
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,h 1st University Urology Clinic, Laiko Hospital , University of Athens , Athens , Greece
| | - Ioannis Varkarakis
- b Hellenic Genito-Urinary Cancer Group , Athens , Greece.,f 2nd Department of Urology, Sismanoglio General Hospital , University of Athens , Athens , Greece
| | - Epaminontas Samantas
- d 3rd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | - Gerasimos Aravantinos
- i 2nd Oncology Clinic , General Oncology Hospital of Kifisias "Ag. Anargyroi" , Athens , Greece
| | | | | | - Vasiliki Bozionelou
- k Department of Medical Oncology , University Hospital of Heraklion , Heraklion , Greece
| | - Meletios Athanasios Dimopoulos
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
| | - Aristotle Bamias
- a Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital , University of Athens , Athens , Greece.,b Hellenic Genito-Urinary Cancer Group , Athens , Greece
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Saad AM, Gad MM, Al-Husseini MJ, Ruhban IA, Sonbol MB, Ho TH. Trends in Renal-Cell Carcinoma Incidence and Mortality in the United States in the Last 2 Decades: A SEER-Based Study. Clin Genitourin Cancer 2018; 17:46-57.e5. [PMID: 30391138 DOI: 10.1016/j.clgc.2018.10.002] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/17/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal-cell carcinoma (RCC) is one of the common malignancies in the United States. RCC incidence and mortality have been changing for many reasons. We performed a thorough investigation of incidence and mortality trends of RCC in the United States using the cell Surveillance, Epidemiology, and End Results (SEER) database. PATIENTS AND METHODS The 13 SEER registries were accessed for RCC cases diagnosed between 1992 and 2015. Incidence and mortality were calculated by demographic and tumor characteristics. We calculated annual percentage changes of these rates. Rates were expressed as 100,000 person-years. RESULTS A total of 104,584 RCC cases were reviewed, with 47,561 deaths. The overall incidence was 11.281 per 100,000 person-years. Incidence increased by 2.421% per year (95% confidence interval, 2.096, 2.747; P < .001) but later became stable since 2008. However, the incidence of clear-cell subtype continued to increase (1.449%; 95% confidence interval, 0.216, 2.697; P = .024). RCC overall mortality rates have been declining since 2001. However, mortality associated with distant RCC only started to decrease in 2012, with an annual percentage change of 18.270% (95% confidence interval, -28.775, -6.215; P = .006). CONCLUSION Despite an overall increase in the incidence of RCC, there has been a recent plateau in RCC incidence rates with a significant decrease in mortality.
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Affiliation(s)
- Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M Gad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Inas A Ruhban
- Pathology department, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Thai H Ho
- Mayo Clinic Cancer Center, Phoenix, AZ.
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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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Overview of Current and Future Adjuvant Therapy for High-Risk Localized Renal Cell Carcinoma. Curr Treat Options Oncol 2018; 19:2. [DOI: 10.1007/s11864-018-0522-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Vogelzang NJ, Pal SK, Ghate SR, Swallow E, Li N, Peeples M, Zichlin ML, Meiselbach MK, Perez JR, Agarwal N. Clinical and Economic Outcomes in Elderly Advanced Renal Cell Carcinoma Patients Starting Pazopanib or Sunitinib Treatment: A Retrospective Medicare Claims Analysis. Adv Ther 2017; 34:2452-2465. [PMID: 29076108 PMCID: PMC5702370 DOI: 10.1007/s12325-017-0628-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Indexed: 11/21/2022]
Abstract
Introduction Studies indicate similar survival and toxicity between pazopanib and sunitinib, but few have examined real-world outcomes among elderly patients with advanced renal cell carcinoma (RCC). The purpose of this retrospective claims analysis was to assess real-world overall survival (OS), healthcare resource utilization (HRU), and healthcare costs (both all-cause and associated with RCC diagnosis) among elderly advanced RCC patients starting pazopanib or sunitinib treatment. Methods Advanced RCC patients aged 65 years or older who started first-line treatment with pazopanib or sunitinib (index drug; the initiation date was the index date) were identified from the 100% Medicare database plus Part D linkage (January 1, 2006 to December 31, 2014). Patients were stratified by index drug and matched 1:1 with use of propensity scores based on baseline characteristics. OS was assessed from the index date to death and compared by Kaplan–Meier analyses and univariable Cox models; patients were censored at the end of eligibility/data. Monthly HRU and costs from an intent-to-treat perspective were compared by Wilcoxon signed-rank tests. Results Baseline characteristics were balanced after matching (both N = 522). Treatment with pazopanib was associated with significantly longer median OS compared with treatment with sunitinib (18.2 months vs 14.6 months, respectively; log-rank p = 0.015). Pazopanib was associated with significantly lower monthly all-cause costs compared with sunitinib ($8845 vs $10,416, respectively), as well as lower inpatient costs associated with RCC diagnosis ($1542 vs $2522), fewer monthly inpatient admissions (0.179 vs 0.262), and shorter length of inpatient stay (1.375 days vs 1.883 days; all p ≤ 0.004). Conclusions Among elderly Medicare patients with advanced RCC, first-line pazopanib tretament was associated with significantly longer OS, as well as lower healthcare costs and HRU, compared with first-line sunitinib treatment. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0628-2) contains supplementary material, which is available to authorized users.
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Kinouchi T, Uemura M, Wang C, Ishizuya Y, Yamamoto Y, Hayashi T, Matsuzaki K, Nakata W, Yoshida T, Jingushi K, Kawashima A, Ujike T, Nagahara A, Fujita K, Imamura R, Ueda Y, Kitae K, Tsujikawa K, Nonomura N. Expression level of CXCL7 in peripheral blood cells is a potential biomarker for the diagnosis of renal cell carcinoma. Cancer Sci 2017; 108:2495-2502. [PMID: 28985012 PMCID: PMC5715254 DOI: 10.1111/cas.13414] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/25/2022] Open
Abstract
There are no blood biomarkers for the diagnosis of renal cell carcinoma (RCC) in routine clinical use. We focused on the gene expression profile of peripheral blood cells obtained from RCC patients to discover novel biomarkers for RCC diagnosis. Using microarray analysis and quantitative verification, CXCL7 was shown to be significantly upregulated in the peripheral blood cells of RCC patients. Importantly, aberrant CXCL7 expression was confirmed even in peripheral blood cells obtained from early stage (pT1a) RCC patients, and the expression level of CXCL7 in peripheral blood cells was a potential independent biomarker for the diagnosis of RCC by receiver operating characteristic curve analysis (sensitivity, 70.0%; specificity, 64.0%; area under the curve = 0.722; multiple logistic regression analysis: odds ratio, 1.07; 95% confidence interval, 1.03-1.11; P = 0.0004). Moreover, CXCL7 expression in peripheral blood cells significantly decreased after resection of the primary tumor. CXCL7 is more highly expressed in PBMCs than in neutrophils from both healthy controls and RCC patients. Interestingly, CXCL7 expression in PBMCs from healthy volunteers was significantly elevated following coculture with RCC cells compared to those cocultured with normal cells as a control. These results suggest that aberrant CXCL7 expression in peripheral blood cells is induced by RCC cells and may serve as a novel biomarker in the diagnosis of RCC.
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Affiliation(s)
- Toshiro Kinouchi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Therapeutic Urologic Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Cong Wang
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yu Ishizuya
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiyuki Yamamoto
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuji Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyosuke Matsuzaki
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Nakata
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahiro Yoshida
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Jingushi
- Department of Therapeutic Urologic Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Nagahara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Ueda
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Kaori Kitae
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Kazutake Tsujikawa
- Laboratory of Molecular and Cellular Physiology, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Survival of metastatic renal cell carcinoma patients continues to improve over time, even in targeted therapy era. Int Urol Nephrol 2017; 49:2143-2149. [DOI: 10.1007/s11255-017-1703-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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Rossetti S, D'Aniello C, Iovane G, Scagliarini S, Laterza MM, De Vita F, Savastano C, Cartenì G, Porricelli MA, Berretta M, Pisconti S, Facchini G, Cavaliere C. Sequential Treatment with Pazopanib and Everolimus in Metastatic Renal Cell Carcinoma. Front Pharmacol 2017; 8:484. [PMID: 28775690 PMCID: PMC5517440 DOI: 10.3389/fphar.2017.00484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/05/2017] [Indexed: 11/13/2022] Open
Abstract
In metastatic renal cell carcinoma, complete response to first-line antiangiogenic agents is rare and resistance to therapy often develops. Protocols for sequential treatment with angiogenesis and mTOR inhibitors are under evaluation to improve outcomes. In this observational, real-world study, patients received a first-line therapy with pazopanib until discontinuation for disease progression or toxicity, then a second-line with everolimus. Primary endpoints were overall survival (OS) for sequence, progression free survival (PFS) for each agent, and safety. Thirty-one patients were included in the analysis: 73.3% of patients underwent nephrectomy before treatment, 25.8% had at least three comorbidities. At the beginning of therapy, the median age was 68 years, with more than 60% of patients older than 65 years. The median OS for sequence was 26.5 months (95% CI 17.4-nc); median PFS was 10.6 months (95% CI 6.3–12.1) with pazopanib and 5.3 months (95% CI 3.8–6.7) with everolimus. The median persistence in pazopanib therapy was 8.1 months (Interquartile Range IQR 5.3–12.7), with 31% of patients who required dose reduction, while persistence in everolimus was 4.4 months (IQR 3.4–6.5). Sequence was well tolerated with a different profile of adverse events for each agent. These data confirmed that pazopanib was effective, even in reduced dosing, and well tolerated and suggested that everolimus may represent an opportunity to continue a therapy when patients cannot further tolerate angiogenesis inhibitors or develop a resistance.
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Affiliation(s)
- Sabrina Rossetti
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS)Naples, Italy
| | - Carmine D'Aniello
- Division of Medical Oncology, Ospedali dei Colli-Monaldi-Contugno-CTO, Azienda Ospedaliera Specialistica Dei Colli (AORN)Naples, Italy
| | - Gelsomina Iovane
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS)Naples, Italy
| | - Sarah Scagliarini
- Unità Operativa Sperimentazioni Cliniche Oncologia, Azienda Ospedaliera di Rilievo Nazionale 'Antonio Cardarelli,'Naples, Italy
| | - Maria M Laterza
- Division of Medical Oncology, Department of Internal and Experimental Medicine, "F. Magrassi" Second University of NaplesNaples, Italy
| | - Fernando De Vita
- Division of Medical Oncology, Department of Internal and Experimental Medicine, "F. Magrassi" Second University of NaplesNaples, Italy
| | - Clementina Savastano
- Unità Operativa Oncologia, Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d'AragonaSalerno, Italy
| | - Giacomo Cartenì
- Unità Operativa Sperimentazioni Cliniche Oncologia, Azienda Ospedaliera di Rilievo Nazionale 'Antonio Cardarelli,'Naples, Italy
| | - Maria A Porricelli
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS)Naples, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), National Cancer InstituteAviano, Italy
| | - Salvatore Pisconti
- Department of Onco-Hematology Medical Oncology, S.G. Moscati Hospital of TarantoTaranto, Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS)Naples, Italy
| | - Carla Cavaliere
- Operating Unit Complex (U.O.C.) of Medical OncologyNola, Italy
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