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Barthélémy P, Albigès L, Escudier B, Narciso B, Bigot P, Chehimi M, Emambux S, Calcagno F, Mouillet G, Eymard JC, Schlürmann F, Bailly S, Garbay D, Berdah JF, Palmaro MB, Goupil MG, Spaeth D, Néré S, Quentric C, Vano YA, Thiery-Vuillemin A. Nivolumab in patients with advanced renal cell carcinoma in France: interim results of the observational, real-world WITNESS study. ESMO Open 2024; 9:103602. [PMID: 38897136 PMCID: PMC11237687 DOI: 10.1016/j.esmoop.2024.103602] [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: 01/31/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Nivolumab is the first immune checkpoint inhibitor approved in Europe for the treatment of advanced renal cell carcinoma (aRCC) in patients resistant to prior antiangiogenic therapy. WITNESS is an ongoing, prospective, observational study designed to evaluate the effectiveness and safety of nivolumab in patients with aRCC treated in real life (or routine practice) in France (ClinicalTrials.gov identifier: NCT03455452). PATIENTS AND METHODS This study includes adult patients with a confirmed diagnosis of aRCC who have initiated nivolumab after 1-2 prior lines of antiangiogenic therapy. Endpoints include overall survival (OS), progression-free survival (PFS), duration of treatment (DOT), duration of response (DOR), overall response rate (ORR), subgroup analyses, and treatment-related adverse events (TRAEs). Results after a median follow-up of 12.3 months are presented here. RESULTS A total of 325 patients with aRCC were included, of whom 38.2% had a Karnofsky score <80, 77.8% received nivolumab as second-line therapy, and 69.5% had undergone a previous nephrectomy. In the overall population, median OS was 20.5 [95% confidence interval (CI) 17.6-25.0] months and median PFS was 5.2 (95% CI 4.5-5.9) months. ORR was 34.5%, median DOT was 3.8 months, and median DOR was 16.5 months. Nivolumab was effective in different subgroups including patients with bone or glandular metastases and those receiving baseline corticosteroids. Moreover, effectiveness was observed irrespective of prior nephrectomy and line of treatment. No new safety signals were identified; TRAEs of any grade were reported in 32.0% of patients, grade ≥3 and serious TRAEs in 11.1% each, and TRAEs leading to discontinuation in 8.9%. CONCLUSIONS Preliminary results of the ongoing WITNESS study confirm the real-world effectiveness and safety of nivolumab monotherapy in previously treated patients with aRCC. Treatment benefits were similar to those observed in the pivotal phase III CheckMate 025 randomized clinical trial, despite a broader, real-life study population.
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Affiliation(s)
- P Barthélémy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg.
| | - L Albigès
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Paris
| | - B Escudier
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Paris
| | - B Narciso
- Department of Medical Oncology, Centre Hospitalier Universitaire de Tours, Tours
| | - P Bigot
- Department of Urology, Centre Hospitalier Universitaire d'Angers, Angers
| | - M Chehimi
- Department of Medical Oncology and Hematology, Centre Hospitalier de Saint-Quentin, Saint-Quentin
| | - S Emambux
- Department of Medical Oncology, Centre Hospitalier Universitaire de Poitiers, Poitiers
| | - F Calcagno
- Department of Medical Oncology, Centre Hospitalier Universitaire de Besançon, Besançon
| | - G Mouillet
- Department of Medical Oncology, Centre Hospitalier Universitaire de Besançon, Besançon
| | - J-C Eymard
- Department of Medical Oncology, Institut Jean Godinot, Reims CEDEX
| | - F Schlürmann
- Department of Medical Oncology, Centre Hospitalier Intercommunal Quimper, Quimper
| | - S Bailly
- Department of Thoracic Oncology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - D Garbay
- Department of Medical Oncology, Clinique Tivoli-Ducos, Bordeaux
| | - J-F Berdah
- Department of Medical Oncology and Radiotherapy, Hôpital privé Toulon Hyères-Sainte Marguerite, Hyères
| | - M B Palmaro
- Department of Medical Oncology, Hôpital Nord, Marseille
| | - M G Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint-André, Bordeaux
| | - D Spaeth
- Department of Medical Oncology, Polyclinique de Gentilly, Nancy
| | - S Néré
- Department of Medical Affairs, Bristol Myers Squibb, Paris
| | - C Quentric
- Department of Medical Affairs, Bristol Myers Squibb, Paris
| | - Y-A Vano
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, APHP Centre-Université de Paris, Paris, France
| | - A Thiery-Vuillemin
- Department of Medical Oncology, Centre Hospitalier Universitaire de Besançon, Besançon
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Franke K, Foller S, Rosero Moreno ME, Ali N, Leistritz L, Leucht K, Grimm MO. Reasonability of Frequent Laboratory Analyses during Therapy with Nivolumab and Nivolumab+Ipilimumab in Patients with Advanced or Metastatic Renal Cell Carcinoma during the Phase 2 Clinical Trial TITAN-RCC. Cancers (Basel) 2024; 16:2287. [PMID: 38927991 PMCID: PMC11201947 DOI: 10.3390/cancers16122287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
In clinical trials, laboratory values are assessed with high frequency. This can be stressful for patients, resource intensive, and difficult to implement, for example in office-based settings. In the prospective, multicentre phase 2 TITAN-RCC trial (NCT02917772), we investigated how many relevant changes in laboratory values would have been missed if laboratory values had been assessed less frequently. Patients with metastatic renal cell carcinoma (n = 207) received a response-based approach with nivolumab and nivolumab+ipilimumab boosts for non-response. We simulated that laboratory values were obtained before every second dose instead of every dose of the study drug(s). We assessed elevated leukocyte counts, alanine aminotransferase, aspartate aminotransferase, bilirubin, creatinine, amylase, lipase, and thyroid-stimulating hormone. Dose delay and discontinuation criteria were defined according to the study protocol. With the reduced frequency of laboratory analyses, dose delay criteria were rarely missed: in a maximum of <0.1% (3/4382) of assessments (1% [2/207] of patients) during nivolumab monotherapy and in a maximum of 0.2% (1/465) of assessments (1% [1/132] of patients) during nivolumab+ipilimumab boosts. An exception was lipase-related dose delay which would have been missed in 0.6% (25/4204) of assessments (7% [15/207] of patients) during nivolumab monotherapy and in 0.8% (4/480) of assessments (3% [4/134] of patients) during nivolumab+ipilimumab boosts, but would have required the presence of symptoms. Discontinuation criteria would have only been missed for amylase (<0.1% [1/3965] of assessments [0.5% (1/207) of patients] during nivolumab monotherapy, none during nivolumab+ipilimumab boosts) and lipase (0.1% [5/4204] of assessments [2% (4/207) of patients] during nivolumab monotherapy; 0.2% [1/480] of assessments [0.7% (1/134) of patients] during nivolumab+ipilimumab boosts). However, only symptomatic patients would have had to discontinue treatment due to amylase or lipase laboratory values. In conclusion, a reduced frequency of laboratory testing appears to be acceptable in asymptomatic patients with metastatic renal cell carcinoma treated with nivolumab or nivolumab+ipilimumab.
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Affiliation(s)
- Klara Franke
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
| | - Susan Foller
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
| | - Michele Estephania Rosero Moreno
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
| | - Nalyan Ali
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
| | - Lutz Leistritz
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
- Institute of Medical Statistics, Informatics and Data Science, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany
| | - Katharina Leucht
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, Friedrich-Schiller University, 07747 Jena, Germany; (K.F.); (S.F.); (M.E.R.M.); (N.A.); (K.L.)
- Comprehensive Cancer Center Central Germany (CCCG), 07743 Jena, Germany;
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3
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Chen JJ, Lee TH, Kuo G, Yen CL, Lee CC, Chang CH, Tu KH, Chen YC, Fang JT, Hung CC, Yang CW, Chou WC, Chi CC, Tu YK, Yu Yang H. All-cause and immune checkpoint inhibitor-associated acute kidney injury in immune checkpoint inhibitor users: a meta-analysis of occurrence rate, risk factors and mortality. Clin Kidney J 2024; 17:sfad292. [PMID: 38186874 PMCID: PMC10768773 DOI: 10.1093/ckj/sfad292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have been associated with acute kidney injury (AKI). However, the occurrence rate of ICI-related AKI has not been systematically examined. Additionally, exposure to proton pump inhibitors (PPIs) and non-steroidal anti-inflammatory drugs (NSAIDs) were considered as risk factors for AKI, but with inconclusive results in ICI-related AKI. Our aim was to analyse the occurrence rate of all-cause AKI and ICI-related AKI and the occurrence rates of severe AKI and dialysis-requiring AKI, and to determine whether exposure to PPIs and NSAIDs poses a risk for all-cause and ICI-related AKI. Methods This study population was adult ICI recipients. A systematic review was conducted by searching MEDLINE, Embase and PubMed through October 2023. We included prospective trials and observational studies that reported any of the following outcomes: the occurrence rate of all-cause or ICI-related AKI, the relationship between PPI or NSAID exposure and AKI development or the mortality rate in the AKI or non-AKI group. Proportional meta-analysis and pairwise meta-analysis were performed. The evidence certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results A total of 120 studies comprising 46 417 patients were included. The occurrence rates of all-cause AKI were 7.4% (14.6% from retrospective studies and 1.2% from prospective clinical trials). The occurrence rate of ICI-related AKI was 3.2%. The use of PPIs was associated with an odds ratio (OR) of 1.77 [95% confidence interval (CI) 1.43-2.18] for all-cause AKI and an OR of 2.42 (95% CI 1.96-2.97) for ICI-related AKI. The use of NSAIDs was associated with an OR of 1.77 (95% CI 1.10-2.83) for all-cause AKI and an OR of 2.57 (95% CI 1.68-3.93) for ICI-related AKI. Conclusions Our analysis revealed that approximately 1 in 13 adult ICI recipients may experience all-cause AKI, while 1 in 33 adult ICI recipients may experience ICI-related AKI. Exposure to PPIs and NSAIDs was associated with an increased OR risk for AKI in the current meta-analysis.
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Affiliation(s)
- Jia-Jin Chen
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tao-Han Lee
- Nephrology Department, Chansn Hospital, Taoyuan City, Taiwan
| | - George Kuo
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ji-Tseng Fang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital in Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chi Chi
- School of Medicine, College of Medicine, Chang Gung University; Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Huang- Yu Yang
- Kidney Research Center, Nephrology Department, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Clavijo ND, Lara PA, Silva JAM, Triana IC, Vargas HA, Pino LE, Segovia JM, Cantor EA. Successful long-term management of metastatic clear cell renal cell carcinoma with nivolumab: a case report and literature review. Ecancermedicalscience 2023; 17:1643. [PMID: 38414972 PMCID: PMC10898913 DOI: 10.3332/ecancer.2023.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 02/29/2024] Open
Abstract
In Colombia, renal cancer is a rare condition, with clear cell renal cell carcinoma (ccRCC) being the most prevalent neoplasm. In recent years, immune checkpoint inhibitors (ICI) have been proposed for the management of metastatic disease, as they have shown improved rates of response and long-term survival. Furthermore, they exhibit a favourable tolerance profile, and adverse events causing significant morbidity are infrequent. We report the case of a 61-year-old male patient initially diagnosed with early-stage ccRCC who underwent right nephrectomy in 2009. Six years later, disease recurrence with metastatic compromise was documented, which led to the resection of the L1 vertebral body followed by radiotherapy and maintenance treatment with sunitinib. Due to disease progression, treatment with sunitinib was discontinued. Subsequently, everolimus was initiated as second-line immunotherapy, which was later discontinued due to the appearance of new metastatic lesions. In 2017, the patient was referred to our institution, where a third-line pharmacological treatment with nivolumab was initiated. In 2022, complete remission by positron emission tomography-computed tomography (PET-CT) was evidenced, which has been sustained to date. This case demonstrates the efficacy and safety of ICI in patients with metastatic ccRCC. The case presented is relevant in that it describes the achievement of complete remission in a patient who did not respond to the first two lines of immunotherapy. Given the limited literature regarding the discontinuation of therapy after achieving sustained remission, further research is warranted to explore this topic.
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Affiliation(s)
- Nicolás Duque Clavijo
- Universidad de los Andes, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0009-0009-4553-5168
| | - Paula A Lara
- Universidad de los Andes, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0009-0000-0080-1084
| | - John Alejandro Murillo Silva
- Internal Medicine Department, Santa Fe Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0001-7450-8286
| | - Iván Camilo Triana
- Internal Medicine Department, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0002-8349-5576
| | - Henry Alexander Vargas
- Internal Medicine Department, ICCAL, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0003-2039-1857
| | - Luis Eduardo Pino
- Internal Medicine Department, ICCAL, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0003-4475-7470
| | - Javier Mauricio Segovia
- Internal Medicine Department, ICCAL, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0001-8971-0911
| | - Erick Andrés Cantor
- Internal Medicine Department, ICCAL, Fundacion Santa Fe de Bogota, Bogota 110111, Colombia
- https://orcid.org/0000-0002-0920-219X
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Stühler V, Herrmann L, Rausch S, Stenzl A, Bedke J. Real world data on IO-based therapy for metastatic renal cell carcinoma. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04173-0. [PMID: 35907009 DOI: 10.1007/s00432-022-04173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/25/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Immune-based (IO)-combinations are the backbone in the systemic therapy of metastatic renal cell carcinoma (mRCC). Despite phase III clinical trial data, real world data are of special importance to reflect clinical practice. METHODS This retrospective study included 201 mRCC patients receiving first-line systemic therapy from January 2006. Clinicopathological and treatment-related data were recorded. Progression-free (PFS) and overall survival (OS) were analyzed using descriptive statistics and Kaplan-Meier analysis. RESULTS Over the years, IO-based therapies have increased significantly. The collective comprises 76 patients with first-line IO-based therapy (IO-IO:55, TKI-IO:21) and 125 patients with TKI-monotherapy. PFS was significantly improved with TKI-IO combinations if compared to both TKI-monotherapy (23.9 vs. 10.3 months, HR 0.48, p = 0.034) and IO-IO combination (23.9 vs. 6.1 months, HR 0.37, p = 0.012). OS for TKI-IO treated patients was longer compared to TKI-monotherapy (HR 0.37, p = 0.050) at median follow-up of 24.1 versus 29.9 months. In a subanalysis of nivolumab treated patients, starting from second-line (n = 40), PFS was 5.5 months. The addition of nivolumab either in second-or later lines improved OS compared to repeated TKI- or mTOR-therapies alone (6.13 vs. 2.61 years, HR 0.46, p = 0.003). CONCLUSION Both first-line IO-based combinations and nivolumab after first-line TKI-monotherapy prolong OS in a real-world setting.
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Affiliation(s)
- Viktoria Stühler
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Lisa Herrmann
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Jens Bedke
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany.
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Ishihara H, Nemoto Y, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Hashimoto Y, Takagi T, Ishida H, Kondo T, Tanabe K. Outcomes of nivolumab monotherapy for previously treated metastatic renal cell carcinoma: a real-world multi-institution data with a minimum of 2 years of follow-up. Jpn J Clin Oncol 2022; 52:785-790. [PMID: 35373823 DOI: 10.1093/jjco/hyac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate the long-term follow-up outcomes of nivolumab monotherapy for previously treated metastatic renal cell carcinoma, using real-world data. METHODS A total of 121 patients were treated with nivolumab monotherapy as subsequent therapy after the failure of prior tyrosine kinase inhibitor therapy between January 2013 and December 2021 at four affiliated institutions. To evaluate the outcome after 2 years or more, we selected patients in whom nivolumab therapy was started in December 2019 or earlier because data collection was performed until the end of December 2021. RESULTS Seventy-four patients were evaluated. During the median follow-up period of 25.8 months, 62 (84%) and 40 (54%) patients had disease progression and died, respectively. Nivolumab was administered as second-line therapy in 43 patients (58%). The median progression-free survival and overall survival were 5.52 and 31.1 months, respectively, and objective response rate was 36%. There was no difference in progression-free survival or overall survival based on the treatment line of nivolumab (P = 0.915, P = 0.559). The magnitude of tumor response and development of immune-related adverse events were significantly associated with progression-free survival (P < 0.0001, P < 0.0001, respectively) and overall survival (P < 0.0001, P = 0.0002, respectively). Treatment-related adverse events developed in 38 patients (51%), including 33 (45%) who had immune-related adverse events. Steroid administration was needed in nine patients (12%). CONCLUSIONS The present real-world multi-institution study with long-term follow-up data demonstrates that nivolumab monotherapy is effective for previously treated metastatic renal cell carcinoma, prolonging survival, improving tumor response and has a manageable safety profile.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Yuki Nemoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi-city, Saitama, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi-city, Saitama, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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