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Ishida K, Ogose A, Kawaguchi G, Hasegawa G, Ikeda Y, Hara N, Nishiyama T. Bladder Cancer Invading the Prostate and Penis and Multiple Bone Metastases Showing Significant Improvement after a Short-Term Pembrolizumab Therapy following Radiation and Gemcitabine and Cisplatin Therapy Leading to a Pathologically Complete Remission. Case Rep Urol 2024; 2024:7525757. [PMID: 38882557 PMCID: PMC11178393 DOI: 10.1155/2024/7525757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/17/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
A 65-year-old man was diagnosed with bladder cancer invading the prostate and penis and multiple bone metastases. He underwent palliative radiation (30 Gy/10 fr) through vertebral bones (Th3 and Th12-L5) and pelvic bones for pain control. The patient received pembrolizumab therapy after three courses of gemcitabine and cisplatin therapy. CT four weeks after starting pembrolizumab therapy showed that both the primary and metastatic lesions had notably reduced in size, and no new lesion was detected. He subsequently fell, resulting in a femoral neck pathological fracture, and underwent hemiarthroplasty. Pathological examination of the pathological fracture site revealed no residual tumor tissue.
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Affiliation(s)
- Kyohei Ishida
- Department of Urology Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Gen Kawaguchi
- Department of Radiotherapy Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Go Hasegawa
- Department of Pathology Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Yohei Ikeda
- Department of Diagnostic Radiology Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Noboru Hara
- Department of Urology Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
| | - Tsutomu Nishiyama
- Department of Urology Uonuma Institute of Community Medicine Niigata University Medical and Dental Hospital, Minamiuonuma, Niigata, Japan
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The Current and Future Promises of Combination Radiation and Immunotherapy for Genitourinary Cancers. Cancers (Basel) 2022; 15:cancers15010127. [PMID: 36612124 PMCID: PMC9818005 DOI: 10.3390/cancers15010127] [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: 11/13/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
As the indications for the use of immunotherapy in genitourinary malignancies expand, its role in combination with standard or conventional therapies has become the subject of contemporary studies. Radiotherapy has multiple immunomodulating effects on anti-tumor immune response, which highlights potential synergistic role with immunotherapy agents. We sought to review the body of published data studying the combination of immunotherapy and radiotherapy as well as the rationale for combination therapy. Trial information and primary articles were obtained using the following terms "immunotherapy", "radiotherapy", "prostate cancer", and "bladder cancer." All articles and trials were screened to ensure they included combination radiotherapy and immunotherapy. The effects of radiation on the immune system, including both immunogenic and immunosuppressive effects, have been reported. There is a potential for combinatorial or synergistic effects between radiation therapy and immunotherapy in treating bladder and prostate cancers. However, results from ongoing and future clinical trials are needed to best integrate immunotherapy into current standard of care treatments for GU cancers.
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Vilotte F, Pasquier D, Blanchard P, Supiot S, Khalifa J, Schick U, Lacornerie T, Vieillevigne L, Marre D, Chapet O, Latorzeff I, Magne N, Meyer E, Cao K, Belkacemi Y, Bibault J, Berge-Lefranc M, Faivre J, Gnep K, Guimas V, Hasbini A, Langrand-Escure J, Hennequin C, Graff P. Recommendations for stereotactic body radiation therapy for spine and non-spine bone metastases. A GETUG (French society of urological radiation oncolgists) consensus using a national two-round modified Delphi survey. Clin Transl Radiat Oncol 2022; 37:33-40. [PMID: 36052019 PMCID: PMC9424259 DOI: 10.1016/j.ctro.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background and purpose The relevance of metastasis-directed stereotactic body radiation therapy (SBRT) remains to be demonstrated through phase III trials. Multiple SBRT procedures have been published potentially resulting in a disparity of practices. Therefore, the french society of urological radiation oncolgists (GETUG) recognized the need for joint expert consensus guidelines for metastasis-directed SBRT in order to standardize practice in trials carried out by the group. Materials and methods After a comprehensive literature review, 97 recommendation statements were created regarding planning and delivery of spine bone (SBM) and non-spine bone metastases (NSBM) SBRT. These statements were then submitted to a national online two-round modified Delphi survey among main GETUG investigators. Consensus was achieved if a statement received ≥ 75 % agreements, a trend to consensus being defined as 65-74 % agreements. Any statement without consensus at round one was re-submitted in round two. Results Twenty-one out of 29 (72.4%) surveyed experts responded to both rounds. Seventy-five statements achieved consensus at round one leaving 22 statements needing a revote of which 16 achieved consensus and 5 a trend to consensus. The final rate of consensus was 91/97 (93.8%). Statements with no consensus concerned patient selection (3/19), dose and fractionation (1/11), prescription and dose objectives (1/9) and organs at risk delineation (1/15). The voting resulted in the writing of step-by-step consensus guidelines. Conclusion Consensus guidelines for SBM and NSBM SBRT were agreed upon using a validated modified Delphi approach. These guidelines will be used as per-protocole recommendations in ongoing and further GETUG clinical trials.
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Affiliation(s)
- F. Vilotte
- Department of Radiation Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33076 Bordeaux, France
| | - D. Pasquier
- Department of Radiation Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - P. Blanchard
- Department of Radiation Oncology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - S. Supiot
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Boulevard Professeur Jacques Monod, 44800 Saint Herblain, France
| | - J. Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 AV Irène Joliot Curie, 31059 Toulouse, France
| | - U. Schick
- Department of Radiation Oncology, CHU de Brest, Hôpital Morvan, avenue Foch, 29200 Brest, France
| | - T. Lacornerie
- Division of Radiation Medical Physics, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - L. Vieillevigne
- Division of Radiation Medical Physics, Institut Universitaire du Cancer de Toulouse-Oncopole, 1 AV Irène Joliot Curie, 31059 Toulouse, France
| | - D. Marre
- Division of Radiation Medical Physics, Groupe ONCORAD Garonne, Clinique Pasteur, Bât Atrium, 1 rue de la petite vitesse, 31300 Toulouse, France
| | - O. Chapet
- Department of Radiation Oncology, CH Lyon Sud 165 Chemin Du Grand Revoyet, 69310 Pierre-bénite, France
| | - I. Latorzeff
- Department of Radiation Oncology, Groupe ONCORAD Garonne, Clinique Pasteur, Bât Atrium, 1 rue de la petite vitesse, 31300 Toulouse, France
| | - N. Magne
- Department of Radiation Oncology, Institut de cancérologie Lucien Neuwirth, 108 bis AV Albert Raimond, 42270 Saint Priest en Jarez, France
| | - E. Meyer
- Department of Radiation Oncology, Centre François Baclesse, 3 Av. du Général Harris, 14000 Caen, France
| | - K. Cao
- Department of Radiation Oncology, Institut Curie Paris, 26 rue d’Ulm, 75005 Paris, France
| | - Y. Belkacemi
- Department of Radiation Oncology, Hôpital Henri-Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France
| | - J.E. Bibault
- Department of Radiation Oncology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France
| | - M. Berge-Lefranc
- Department of Radiation Oncology, Centre Saint Michel, rue du Docteur Schweitzer, 17000 La Rochelle, France
| | - J.C. Faivre
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, 6 Av. de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - K. Gnep
- Department of Radiation Oncology, Centre Eugène Marquis, AV de la Bataille Flandres Dunkerque, 35000 Rennes, France
| | - V. Guimas
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Boulevard Professeur Jacques Monod, 44800 Saint Herblain, France
| | - A. Hasbini
- Department of Radiation Oncology, Clinique Pasteur, 32 r Auguste Kervern, 29200 Brest, France
| | - J. Langrand-Escure
- Department of Radiation Oncology, Institut de cancérologie Lucien Neuwirth, 108 bis AV Albert Raimond, 42270 Saint Priest en Jarez, France
| | - C. Hennequin
- Department of Radiation Oncology, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - P. Graff
- Department of Radiation Oncology, Institut Curie Saint Cloud, 35 rue Dailly, 92210 Saint Cloud, France
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Boosting the Immune Response—Combining Local and Immune Therapy for Prostate Cancer Treatment. Cells 2022; 11:cells11182793. [PMID: 36139368 PMCID: PMC9496996 DOI: 10.3390/cells11182793] [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: 07/24/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Due to its slow progression and susceptibility to radical forms of treatment, low-grade PC is associated with high overall survival (OS). With the clinical progression of PC, the therapy is becoming more complex. The immunosuppressive tumor microenvironment (TME) makes PC a difficult target for most immunotherapeutics. Its general immune resistance is established by e.g., immune evasion through Treg cells, synthesis of immunosuppressive mediators, and the defective expression of surface neoantigens. The success of sipuleucel-T in clinical trials initiated several other clinical studies that specifically target the immune escape of tumors and eliminate the immunosuppressive properties of the TME. In the settings of PC treatment, this can be commonly achieved with radiation therapy (RT). In addition, focal therapies usually applied for localized PC, such as high-intensity focused ultrasound (HIFU) therapy, cryotherapy, photodynamic therapy (PDT), and irreversible electroporation (IRE) were shown to boost the anti-cancer response. Nevertheless, the present guidelines restrict their application to the context of a clinical trial or a prospective cohort study. This review explains how RT and focal therapies enhance the immune response. We also provide data supporting the combination of RT and focal treatments with immune therapies.
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Abstract
Muscle invasive bladder cancer (MIBC) carries a poor prognosis with a 5-year overall survival rate of 40-50%. For localized disease, radical treatment options are cystectomy or radiotherapy with or without a radiosensitiser. Neoadjuvant or adjuvant chemotherapy is often delivered in addition to either. Metastatic disease can be treated with palliative systemic chemotherapy or immunotherapy. Standard clinicopathological information is insufficient to guide treatment decisions in several clinical scenarios in MIBC and there has been substantial effort to identify predictive and prognostic biomarkers. Despite this, no biomarker has been sufficiently qualified in prospective clinical trials to justify routine use. In this chapter we discuss these biomarkers and provide insight into the significant unmet need for robust biomarkers to inform treatment decisions and ultimately improve outcomes for bladder cancer patients.
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Affiliation(s)
- Fiona Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nuradh Joseph
- Ministry of Health, Colombo, Sri Lanka; Sri Lanka Cancer Research Group, Colombo, Sri Lanka
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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6
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Danckaert W, Spaas M, Vandecasteele K, De Wagter C, Ost P. Impact of radiotherapy parameters on the risk of lymphopenia in urological tumors: a systematic review of the literature. Radiother Oncol 2022; 170:64-69. [DOI: 10.1016/j.radonc.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
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7
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van Moorselaar RJA, Hulshof MCCM, Pieters BR. Radiotherapy is the Preferred Primary Tumor Treatment in Oligometastatic Prostate Cancer. EUR UROL SUPPL 2022; 35:70-71. [PMID: 35024635 PMCID: PMC8738892 DOI: 10.1016/j.euros.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Konieczkowski DJ, Efstathiou JA, Mouw KW. Contemporary and Emerging Approaches to Bladder-Preserving Trimodality Therapy for Muscle-Invasive Bladder Cancer. Hematol Oncol Clin North Am 2021; 35:567-584. [PMID: 33958151 DOI: 10.1016/j.hoc.2021.02.006] [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: 11/26/2022]
Abstract
Bladder-preserving trimodality therapy (TMT), consisting of trans-urethral bladder tumor resection followed by concurrent chemoradiotherapy, is an established standard of care for patients with muscle-invasive bladder cancer. For appropriately selected patients, TMT offers oncologic outcomes comparable to radical cystectomy while preserving the patient's native bladder. Optimal TMT outcomes require careful patient selection, which is currently based on clinical and pathologic factors. The role of immune checkpoint blockade (ICB) in TMT is currently being investigated in several on-going clinical trials. In the future, molecular features associated with response to TMT or ICB may further improve patient selection and guide post-treatment surveillance.
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Affiliation(s)
- David J Konieczkowski
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University, 460 West 10th Avenue, 2nd Floor, Columbus, OH 43210, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Cox 3, Boston, MA 02114, USA
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham & Women's Hospital, Harvard Medical School, 450 Brookline Avenue, HIM 328, Boston, MA 02215, USA.
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9
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Wilkins A, Ost P, Sundahl N. Is There a Benefit of Combining Immunotherapy and Radiotherapy in Bladder Cancer? Clin Oncol (R Coll Radiol) 2021; 33:407-414. [PMID: 33726945 DOI: 10.1016/j.clon.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 01/13/2023]
Abstract
Immune checkpoint inhibitors have transformed the management of patients with metastatic urothelial cancer, by leading to long-term response and prolongation of survival in a subset of patients. Unfortunately, only one in five patients with metastatic urothelial cancer responds to anti-programmed death ligand-1 ([AQ1]anti-PD-1) monotherapy. Preclinical and early clinical evidence indicates that radiotherapy not only acts locally, but also exerts systemic anti-tumour effects by modulating the immune system. It is hypothesised that combining checkpoint inhibitors with radiotherapy might enhance an anti-tumour immune response and increase response rates. So far, a handful of early phase clinical trials have been performed seeking to answer this question in urothelial cancer patients. The current review summarises the available preclinical and clinical evidence on radiotherapy/immunotherapy combinations in locally advanced and metastatic bladder cancer and suggests future avenues worthy of exploration.
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Affiliation(s)
- A Wilkins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - P Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - N Sundahl
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK; Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.
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10
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de Jong FC, Rutten VC, Zuiverloon TCM, Theodorescu D. Improving Anti-PD-1/PD-L1 Therapy for Localized Bladder Cancer. Int J Mol Sci 2021; 22:2800. [PMID: 33802033 PMCID: PMC7998260 DOI: 10.3390/ijms22062800] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
In high-risk non-muscle invasive bladder cancer (HR-NMIBC), patient outcome is negatively affected by lack of response to Bacillus-Calmette Guérin (BCG) treatment. Lack of response to cisplatin-based neoadjuvant chemotherapy and cisplatin ineligibility reduces successful treatment outcomes in muscle-invasive bladder cancer (MIBC) patients. The effectiveness of PD-1/PD-L1 immune checkpoint inhibitors (ICI) in metastatic disease has stimulated its evaluation as a treatment option in HR-NMIBC and MIBC patients. However, the observed responses, immune-related adverse events and high costs associated with ICI have provided impetus for the development of methods to improve patient stratification, enhance anti-tumorigenic effects and reduce toxicity. Here, we review the challenges and opportunities offered by PD-1/PD-L1 inhibition in HR-NMIBC and MIBC. We highlight the gaps in the field that need to be addressed to improve patient outcome including biomarkers for response stratification and potentially synergistic combination therapy regimens with PD-1/PD-L1 blockade.
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Affiliation(s)
- Florus C. de Jong
- Department of Urology, Erasmus University Medical Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (F.C.d.J.); (V.C.R.); (T.C.M.Z.)
| | - Vera C. Rutten
- Department of Urology, Erasmus University Medical Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (F.C.d.J.); (V.C.R.); (T.C.M.Z.)
| | - Tahlita C. M. Zuiverloon
- Department of Urology, Erasmus University Medical Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (F.C.d.J.); (V.C.R.); (T.C.M.Z.)
| | - Dan Theodorescu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Departments of Surgery (Urology) and Pathology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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11
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Peng M, Xiao D, Bu Y, Long J, Yang X, Lv S, Yang X. Novel Combination Therapies for the Treatment of Bladder Cancer. Front Oncol 2021; 10:539527. [PMID: 33585182 PMCID: PMC7873600 DOI: 10.3389/fonc.2020.539527] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022] Open
Abstract
Bladder cancer is the ninth most frequently diagnosed cancer world-wide and ranks 13th in cancer-related deaths. Two tremendous breakthroughs in bladder cancer therapy over the last decades are the approval of immune checkpoint inhibitors(ICIs)and the fibroblast growth factor receptor tyrosine kinase inhibitor (FGFR-TKI) erdafitinib for treating this deadly disease. Despite the beneficial effects of these approaches, the low response rate and the potential resistance of the cancer are major concerns. Hence, novel combination therapies to overcome these limitations have been investigated. In this context, combining immunotherapy with targeted drugs is an appealing therapeutic option to improve response and reduce the emergence of resistance in the management of bladder cancer. In this review, the rationale of using different therapeutic combinations is discussed according to the mechanistic differences, emphasizing the efficacy and safety based on evidence collected from preclinical and clinical studies. Finally, we highlight the limitations of these combinations and provide suggestions for further efforts in this challenging field.
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Affiliation(s)
- Mei Peng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, China
| | - Di Xiao
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, China
| | - Yizhi Bu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, China
| | - Jiahui Long
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, China
| | - Xue Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Shuhe Lv
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, China
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12
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Frontiers in combining immune checkpoint inhibitors for advanced urothelial cancer management. Curr Opin Urol 2020; 30:457-466. [PMID: 32235284 DOI: 10.1097/mou.0000000000000765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of currently ongoing clinical trials evaluating the combination of immune checkpoint inhibitors (CPI) with other therapies in locally advanced or metastatic urothelial cancer and the rationale for this combination approach. We discuss the preliminary results from early data presented at recent meetings regarding the efficacy and safety of novel combination therapies including a CPI for metastatic urothelial cancer. RECENT FINDINGS CPI emerged as novel first-line or second-line treatment options in advanced and metastatic urothelial cancer (mUC). Although the response rates and their sustainability are promising, it is far from a home run. Combination therapies have already shown improved efficacy in several other tumor entities. SUMMARY Numerous clinical trials currently investigate combinations of CPI with other CPI, previously established systemic chemotherapy, targeted therapies, vaccines, or accompanied with radiotherapy. Preliminary data shows promising results. These results suggest that targeting pathways of immune response combined with established or novel oncological therapies may lead to a synergistic antitumor effect.
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Tholomier C, Marcq G, Shinde-Jadhav S, Ayoub M, Huang JM, Kool R, Skowronski R, Brimo F, Mansure JJ, Kassouf W. Optimizing Sequence of PD-L1 Immune-Checkpoint Inhibitors and Radiation Therapy in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: New bladder preserving strategies are needed for muscle invasive bladder cancer (MIBC). Combined therapy of immune-checkpoint inhibitors and radiation was shown to have synergistic antitumoral effects in preclinical studies. OBJECTIVES: We aim to evaluate whether the sequence of administration of this combined therapy impacts antitumoral response. METHODS: We developed an in-vivo syngeneic MIBC mouse model where murine bladder cancer cells (MB49) were injected subcutaneously in the right flank of C57BL/6 mice. Mice were then randomized to the following treatments: control, anti-programmed cell death ligand 1 (PD-L1) alone, radiation alone (XRT) consisting of 6.25 Gy x2 fractions, concurrent anti-PD-L1 with XRT, neoadjuvant anti-PD-L1 followed by XRT, or XRT followed by adjuvant anti-PD-L1 therapy. Tumor growth, survival, and rate of response were analyzed. RESULTS: Total of 60 mice were randomized. One-way analysis of variance showed statistically significant difference in tumor growth rate across the treatment arms (p = 0.029). Importantly, timing of immunotherapy (neoadjuvant, concurrent, or adjuvant) did not alter either tumor growth or survival (p > 0.05). The rate of response was also similar in each combination arm (p > 0.05). CONCLUSION: Combining anti-PD-L1 immunotherapy and radiation therapy offers optimal antitumoral responses. Timing of immunotherapy (neoadjuvant, concurrent, or adjuvant) does not appear to affect outcomes. Whether the toxicity profile differs across various sequential deliveries of combination therapy requires further evaluation.
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Affiliation(s)
- Côme Tholomier
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gautier Marcq
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Surashri Shinde-Jadhav
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Mina Ayoub
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jia Min Huang
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ronald Kool
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Rodrigo Skowronski
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University, McGill University Health Center, Montréal, QC, Canada
| | - Jose Joao Mansure
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Surgery>, Division of Urology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- Urologic oncology Research Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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14
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Kojima T. Editorial Comment from Dr Kojima to Possible abscopal effect after discontinuation of nivolumab in metastatic renal cell carcinoma. IJU Case Rep 2020; 3:219. [PMID: 32914082 PMCID: PMC7469796 DOI: 10.1002/iju5.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Takahiro Kojima
- Department of Urology Faculty of Medicine University of Tsukuba Tsukuba Japan
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Conteduca V, Caffo O, Scarpi E, Sepe P, Galli L, Fratino L, Maines F, Chiuri VE, Santoni M, Zanardi E, Massari F, Toma I, Lolli C, Schepisi G, Sbrana A, Kinspergher S, Cursano MC, Casadei C, Modonesi C, Santini D, Procopio G, De Giorgi U. Immune Modulation in Prostate Cancer Patients Treated with Androgen Receptor (AR)-Targeted Therapy. J Clin Med 2020; 9:jcm9061950. [PMID: 32580478 PMCID: PMC7356925 DOI: 10.3390/jcm9061950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Androgen deprivation therapy (ADT) is a cornerstone of treatment for prostate cancer and, in recent years, androgen receptor (AR)-targeted therapies (abiraterone and enzalutamide) have both been used for the treatment of castration-resistant prostate cancer (CRPC). In our study, we sought to investigate the association between ADT and immune disorders, considering a potential role of androgens in the immune modulation. We retrospectively evaluated CRPC patients treated with abiraterone/enzalutamide between July 2011 and December 2018. We assessed the risk of developing immune alterations and their impact on outcome. We included 844 CRPC patients receiving AR-directed therapies, of whom 36 (4.3%) had autoimmune diseases and 47 (5.6%) second tumors as comorbidities. Median age was 70 years [interquartile range (IQR) = 63–75)]. We showed higher significant incidence of autoimmune diseases during their hormone sensitive status (p = 0.021) and the presence of autoimmune comorbidities before starting treatment with abiraterone/enzalutamide was significantly associated with worse overall survival (OS) (10.1 vs. 13.7 months, HR = 1.59, 95% CI 1.03–2.27, p = 0.038). In a multivariate analysis, the presence of autoimmune disorders was an independent predictor of OS (HR = 1.65, 95% CI 1.05–2.60, p = 0.031). In conclusion, CRPC patients with autoimmune alterations before starting AR-directed therapies may have worse prognosis. Further prospective studies are warranted to assess the role of immune modulation in the management of prostate cancer patients.
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Affiliation(s)
- Vincenza Conteduca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
- Correspondence: ; Tel.: +39-0543-739100; Fax: +39-0543-739151
| | - Orazio Caffo
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | - Emanuela Scarpi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Pierangela Sepe
- Medical Oncology Department, Fondazione Istituto Nazionale dei Tumori, 20133 Milano, Italy; (P.S.); (G.P.)
| | - Luca Galli
- Medical Oncology Unit 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (L.G.); (A.S.)
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, 33081 Aviano-Pordenone, Italy;
| | - Francesca Maines
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | | | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy;
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy;
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Francesco Massari
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Ilaria Toma
- Clinical Oncology, Arcispedale Sant’Anna University Hospital, 44124 Ferrara, Italy;
| | - Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Giuseppe Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | - Andrea Sbrana
- Medical Oncology Unit 2, Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (L.G.); (A.S.)
| | - Stefania Kinspergher
- Department of Oncology, Ospedale Santa Chiara, 38122 Trento, Italy; (O.C.); (F.M.); (S.K.)
| | - Maria Concetta Cursano
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
| | | | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione Istituto Nazionale dei Tumori, 20133 Milano, Italy; (P.S.); (G.P.)
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, Italy; (E.S.); (C.L.); (G.S.); (M.C.C.); (C.C.); (U.D.G.)
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Miccio JA, Oladeru OT, Jun Ma S, Johung KL. Radiation Therapy for Patients with Advanced Renal Cell Carcinoma. Urol Clin North Am 2020; 47:399-411. [PMID: 32600541 DOI: 10.1016/j.ucl.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Stereotactic radiosurgery and stereotactic body radiation therapy (SBRT) have led to a resurgence of the use of radiotherapy in the management of advanced renal cell carcinoma (RCC). These techniques provide excellent local control and palliation of metastatic sites of disease with minimal toxicity. Additionally, SBRT to the primary tumor may be efficacious and well tolerated in select patients that are not surgical candidates. Emerging data suggest that SBRT may potentiate the immune response, and current and future study will evaluate if SBRT can improve survival outcomes in patients with metastatic RCC.
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Affiliation(s)
- Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park Street, New Haven, CT 06519, USA
| | | | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Kimberly L Johung
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park Street, New Haven, CT 06519, USA.
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Abstract
The current therapies against cancer showed limited success. Nanotechnology is a promising strategy for cancer tracking, diagnosis, and therapy. The hybrid nanotechnology assembled several materials in a multimodal system to develop multifunctional approaches to cancer treatment. The quantum dot and polymer are some of these hybrid nanoparticle platforms. The quantum dot hybrid system possesses photonic and magnetic properties, allowing photothermal therapy and live multimodal imaging of cancer. These quantum dots were used to convey medicines to cancer cells. Hybrid polymer nanoparticles were utilized for the systemic delivery of small interfering RNA to malignant tumors and metastasis. They allowed non-invasive imaging to track in real-time the biodistribution of small interfering RNA in the whole body. They offer an opportunity to treat cancers by specifically silencing target genes. This review highlights the major nanotechnology approaches to effectively treat cancer and metastasis.
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Sublethal Radiation Affects Antigen Processing and Presentation Genes to Enhance Immunogenicity of Cancer Cells. Int J Mol Sci 2020; 21:ijms21072573. [PMID: 32272797 PMCID: PMC7178186 DOI: 10.3390/ijms21072573] [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: 03/11/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023] Open
Abstract
While immunotherapy in cancer is designed to stimulate effector T cell response, tumor-associated antigens have to be presented on malignant cells at a sufficient level for recognition of cancer by T cells. Recent studies suggest that radiotherapy enhances the anti-cancer immune response and also improves the efficacy of immunotherapy. To understand the molecular basis of such observations, we examined the effect of ionizing X-rays on tumor antigens and their presentation in a set of nine human cell lines representing cancers of the esophagus, lung, and head and neck. A single dose of 7.5 or 15 Gy radiation enhanced the New York esophageal squamous cell carcinoma 1 (NY-ESO-1) tumor-antigen-mediated recognition of cancer cells by NY-ESO-1-specific CD8+ T cells. Irradiation led to significant enlargement of live cells after four days, and microscopy and flow cytometry revealed multinucleation and polyploidy in the cells because of dysregulated mitosis, which was also revealed in RNA-sequencing-based transcriptome profiles of cells. Transcriptome analyses also showed that while radiation had no universal effect on genes encoding tumor antigens, it upregulated the expression of numerous genes involved in antigen processing and presentation pathways in all cell lines. This effect may explain the immunostimulatory role of cancer radiotherapy.
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Gakis G. Management of Muscle-invasive Bladder Cancer in the 2020s: Challenges and Perspectives. Eur Urol Focus 2020; 6:632-638. [PMID: 31987763 DOI: 10.1016/j.euf.2020.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
Despite an increased use of neoadjuvant and adjuvant chemotherapy, the long-term survival rates after radical cystectomy or trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) remain basically unchanged for decades. Detection and effective treatment of micrometastatic disease are still a clinical dilemma. Assessment of circulating tumor DNA in combination with improved imaging modalities may improve the prediction of micrometastatic disease. Different genetic subtypes of MIBC show varying degrees of chemosensitivity. Further progress needs to be made in order to develop a common molecular classifier that can be used easily for daily clinical decision making. With the advent on immuno-oncology, bladder-sparing protocols are on the rise as an alternative to surgery. The extent of transurethral bladder tumor resection has a marked impact on the response rates to TMT and neoadjuvant chemotherapy. This review focuses on strategies regarding how to integrate surgery, radiotherapy, and molecular-based systemic treatment for improved oncological outcomes of patients with MIBC. PATIENT SUMMARY: Effective treatment of micrometastatic disease is the key to improved oncological outcomes in muscle-invasive bladder cancer and requires a multidisciplinary approach.
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Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, Julius Maximillians University, Würzburg, Germany.
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Iwata T, Kimura S, Abufaraj M, Janisch F, Karakiewicz PI, Seebacher V, Rouprêt M, Nasu Y, Shariat SF. The role of adjuvant radiotherapy after surgery for upper and lower urinary tract urothelial carcinoma: A systematic review. Urol Oncol 2019; 37:659-671. [DOI: 10.1016/j.urolonc.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 01/20/2023]
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Using Stereotactic Body Radiotherapy to Overcome the Radioresistant Reputation of Renal Cell Carcinoma. Eur Urol Oncol 2019; 2:524-525. [DOI: 10.1016/j.euo.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022]
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[Organ preservation by chemoradiation for bladder cancer]. Cancer Radiother 2019; 23:732-736. [PMID: 31400955 DOI: 10.1016/j.canrad.2019.06.005] [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: 05/31/2019] [Accepted: 06/26/2019] [Indexed: 11/21/2022]
Abstract
When localized, the reference treatment of urothelial, muscle-invasive bladder tumours relies on radical cystectomy with reconstruction by enterocystoplasty if possible or Bricker bypass. Trimodal therapy combining transurethral resection of the tumour followed by concomitant chemotherapy may be considered as a therapeutic alternative to radical cystectomy in well-selected patients with unifocal tumours, stage T2, non-diverticular location, without in situ carcinoma or hydronephrosis and with macroscopically complete transurethral resection. The functional prognosis of the bladder and quality of life should be discussed with the patient as well as the need for salvage surgery for persistent tumour at a 45-Gy dose level, the latter being a highly unfavourable prognosis factor. On the other hand, this trimodal treatment is the reference in case of surgical contraindication. This article details the methods and results of the main series available in the literature in terms of local control, survival, bladder preservation rates and complications, as well as study prospects.
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Tselis N, Chatzikonstantinou G. Treating the Chameleon: Radiotherapy in the management of Renal Cell Cancer. Clin Transl Radiat Oncol 2019; 16:7-14. [PMID: 30886912 PMCID: PMC6403071 DOI: 10.1016/j.ctro.2019.01.007] [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: 09/30/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/05/2023] Open
Abstract
Conventional fractionated radiotherapy (RT) is predominantly used for the palliation of symptomatic metastatic disease. Hypofractionated stereotactic RT is increasingly adopted for the treatment of locally recurrent and oligometastatic disease. High-dose radiation seems to have an immunogenic effect in patients with renal cell cancer. Combinations of ablative RT with immunotherapies are promising approaches that might improve outcomes.
Purpose To review the role of radiotherapy (RT) in the treatment of renal cell cancer (RCC) in the curative and palliative setting. Content Details related to the clinical outcomes of primary, preoperative, postoperative and palliative RT are discussed, along with a presentation of the established role of surgery and systemic therapy. An overview of data derived from mono- and multi-institutional trials is provided. Conclusion Radiotherapy has been shown to provide good symptom palliation and local control in RCC depending on the dose that can be delivered. There is emerging data suggesting that with the use of high-precision RT methods the indication spectrum of RT can be exploited covering different clinical situations particularly for unresectable local recurrences and oligometastatic disease.
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