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Bilen MA, Vo BT, Liu Y, Greenwald R, Davarpanah AH, McGuire D, Shiradkar R, Li L, Nazha B, Brown JT, Williams S, Session W, Russler G, Caulfield S, Joshi SS, Narayan VM, Filson CP, Ogan K, Kucuk O, Carthon BC, Del Balzo L, Cohen A, Boyanton A, Prokhnevska N, Cardenas MA, Sobierajska E, Jansen CS, Patil DH, Nicaise E, Osunkoya AO, Kissick H, Master VA. Neoadjuvant cabozantinib restores CD8+ T cells in patients with locally advanced non-metastatic clear cell renal cell carcinoma: a phase 2 trial. RESEARCH SQUARE 2024:rs.3.rs-4849400. [PMID: 39149474 PMCID: PMC11326393 DOI: 10.21203/rs.3.rs-4849400/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Cabozantinib is an oral multikinase inhibitor approved for treatment in metastatic renal cell carcinoma (RCC). We hypothesized that neoadjuvant cabozantinib could downstage localized tumors, facilitating partial nephrectomy, and facilitating surgery in patients with locally advanced tumors that would require significant adjacent organ resection. We, therefore, conducted a phase 2, single-arm trial of cabozantinib treatment for 12 weeks in 17 patients with locally advanced biopsy-proven non-metastatic clear cell RCC before surgical resection. Six patients (35%) experienced a partial response, and 11 patients (65%) had stable disease. We identified that plasma cell-free DNA (cfDNA), VEGF, c-MET, Gas6, and AXL were significantly increased while VEGFR2 decreased during cabozantinib treatments. There was a trend towards CD8+ T cells becoming activated in the blood, expressing the proliferation marker Ki67 and activation markers HLA-DR and CD38. Cabozantinib treatment depleted myeloid populations acutely. Importantly, immune niches made up of the stem-like CD8+ T cells and antigen presenting cells were increased in every patient. These data suggest that cabozantinib treatment was clinically active and safe in the neoadjuvant setting in patients with locally advanced non-metastatic clear cell RCC and activated the anti-tumor CD8+ T cell response. The trial is registered at ClinicalTrials.gov under registration no. NCT04022343.
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Affiliation(s)
- Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - BaoHan T Vo
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Greenwald
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald McGuire
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Rakesh Shiradkar
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Liping Li
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Bassel Nazha
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacqueline T Brown
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sierra Williams
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wilena Session
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Greta Russler
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Sarah Caulfield
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Shreyas S Joshi
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vikram M Narayan
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kenneth Ogan
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Omer Kucuk
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bradley Curtis Carthon
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luke Del Balzo
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Athena Cohen
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana Boyanton
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Ewelina Sobierajska
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline S Jansen
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edouard Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adeboye O Osunkoya
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Haydn Kissick
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
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2
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Borchiellini D, Bensalah K. Perioperative immunotherapy in renal cell carcinoma. Lancet Oncol 2024; 25:950-951. [PMID: 38942045 DOI: 10.1016/s1470-2045(24)00268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice 06189, France.
| | - Karim Bensalah
- Department of Urology, Université de Rennes, Rennes, France
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Allaf ME, Kim SE, Master V, McDermott DF, Harshman LC, Cole SM, Drake CG, Signoretti S, Akgul M, Baniak N, Li-Ning E, Palmer MB, Emamekhoo H, Adra N, Kaimakliotis H, Ged Y, Pierorazio PM, Abel EJ, Bilen MA, Ogan K, Moon HH, Ramaswamy KA, Singer EA, Mayer TM, Lohrey J, Margulis V, Gills J, Delacroix SE, Waples MJ, James AC, Wang P, Choueiri T, Michaelson MD, Kapoor A, Heng DY, Shuch B, Leibovich BC, Lara PN, Manola J, Maskens D, Battle D, Uzzo R, Bratslavsky G, Haas NB, Carducci MA. Perioperative nivolumab versus observation in patients with renal cell carcinoma undergoing nephrectomy (PROSPER ECOG-ACRIN EA8143): an open-label, randomised, phase 3 study. Lancet Oncol 2024; 25:1038-1052. [PMID: 38942046 PMCID: PMC11323681 DOI: 10.1016/s1470-2045(24)00211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The standard of care for patients with intermediate-to-high risk renal cell carcinoma is partial or radical nephrectomy followed by surveillance. We aimed to investigate use of nivolumab before nephrectomy followed by adjuvant nivolumab in patients with high-risk renal cell carcinoma to determine recurrence-free survival compared with surgery only. METHODS In this open-label, randomised, phase 3 trial (PROSPER EA8143), patients were recruited from 183 community and academic sites across the USA and Canada. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-1, with previously untreated clinical stage T2 or greater or Tany N+ renal cell carcinoma of clear cell or non-clear cell histology planned for partial or radical nephrectomy. Selected patients with oligometastatic disease, who were disease free at other disease sites within 12 weeks of surgery, were eligible for inclusion. We randomly assigned (1:1) patients using permuted blocks (block size of 4) within stratum (clinical TNM stage) to either nivolumab plus surgery, or surgery only followed by surveillance. In the nivolumab group, nivolumab 480 mg was administered before surgery, followed by nine adjuvant doses. The primary endpoint was investigator-reviewed recurrence-free survival in patients with renal cell carcinoma assessed in all randomly assigned patients regardless of histology. Safety was assessed in all randomly assigned patients who started the assigned protocol treatment. This trial is registered with ClinicalTrials.gov, NCT03055013, and is closed to accrual. FINDINGS Between Feb 2, 2017, and June 2, 2021, 819 patients were randomly assigned to nivolumab plus surgery (404 [49%]) or surgery only (415 [51%]). 366 (91%) of 404 patients assigned to nivolumab plus surgery and 387 (93%) of 415 patients assigned to surgery only group started treatment. Median age was 61 years (IQR 53-69), 248 (30%) of 819 patients were female, 571 (70%) were male, 672 (88%) were White, and 77 (10%) were Hispanic or Latino. The Data and Safety Monitoring Committee stopped the trial at a planned interim analysis (March 25, 2022) because of futility. Median follow-up was 30·4 months (IQR 21·5-42·4) in the nivolumab group and 30·1 months (21·9-41·8) in the surgery only group. 381 (94%) of 404 patients in the nivolumab plus surgery group and 399 (96%) of 415 in the surgery only group had renal cell carcinoma and were included in the recurrence-free survival analysis. As of data cutoff (May 24, 2023), recurrence-free survival was not significantly different between nivolumab (125 [33%] of 381 had recurrence-free survival events) versus surgery only (133 [33%] of 399; hazard ratio 0·94 [95% CI 0·74-1·21]; one-sided p=0·32). The most common treatment-related grade 3-4 adverse events were elevated lipase (17 [5%] of 366 patients in the nivolumab plus surgery group vs none in the surgery only group), anaemia (seven [2%] vs nine [2%]), increased alanine aminotransferase (ten [3%] vs one [<1%]), abdominal pain (four [1%] vs six [2%]), and increased serum amylase (nine [2%] vs none). 177 (48%) patients in the nivolumab plus surgery group and 93 (24%) in the surgery only group had grade 3-5 adverse events due to any cause, the most common of which were anaemia (23 [6%] vs 19 [5%]), hypertension (27 [7%] vs nine [2%]), and elevated lipase (18 [5%] vs six [2%]). 48 (12%) of 404 patients in the nivolumab group and 40 (10%) of 415 in the surgery only group died, of which eight (2%) and three (1%), respectively, were determined to be treatment-related. INTERPRETATION Perioperative nivolumab before nephrectomy followed by adjuvant nivolumab did not improve recurrence-free survival versus surgery only followed by surveillance in patients with high-risk renal cell carcinoma. FUNDING US National Institutes of Health National Cancer Institute and Bristol Myers Squibb.
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Affiliation(s)
- Mohamad E Allaf
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Se-Eun Kim
- Department of Data Science, Dana-Farber Cancer Institute/ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Viraj Master
- Department of Urology, Emory University, Altanta, GA, USA
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Lauren C Harshman
- Department of Internal Medicine, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Suzanne M Cole
- Department of Internal Medicine, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | | | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahmut Akgul
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Nicholas Baniak
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Elsa Li-Ning
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew B Palmer
- Department of Pathology and Laboratory Medcine, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA, USA
| | - Hamid Emamekhoo
- Department of Medicine, Wisconsin Institute for Medical Research, Madison, WI, USA
| | - Nabil Adra
- Department of Hematology/Oncology, Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Hristos Kaimakliotis
- Department of Urology, Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Yasser Ged
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- Division of Urology, Department of Surgery, Penn Presbyterian Medical Center, Penn Medicine, Philadelphia, PA, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University/Winship Cancer Institute, Atlanta, GA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University/Winship Cancer Institute, Atlanta, GA, USA
| | - Helen H Moon
- Department of Research and Evaluation, Kaiser Permanente, Riverside, CA, USA
| | - Krishna A Ramaswamy
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Eric A Singer
- Department of Urology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Tina M Mayer
- Deparment of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jay Lohrey
- Department of Internal Medicine, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, UT Southwestern/Simmons Cancer Center-Dallas, Dallas, TX, USA
| | - Jessie Gills
- Department of Urology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Scott E Delacroix
- Department of Urology, Louisiana Cancer Research Center, New Orleans, LA, USA
| | - Mark J Waples
- Department of Urology, Aurora Urology, Milwaukee, WI, USA
| | - Andrew C James
- Department of Urology, University of Kentucky/Markey Cancer Center, Lexington, KY, USA
| | - Peng Wang
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - M Dror Michaelson
- Department of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Anil Kapoor
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Daniel Y Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Brian Shuch
- Department of Urology, UCLA/Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - Primo N Lara
- Division Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Judith Manola
- Department of Data Science, Dana-Farber Cancer Institute/ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Deborah Maskens
- International Kidney Cancer Coalition, Amsterdam NL, Guelph, ON, Canada
| | - Dena Battle
- Kidney Cancer Research Alliance, Alexandria, VA, USA
| | - Robert Uzzo
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical Center-Community Campus, Syracuse, NY, USA
| | - Naomi B Haas
- Department of Medicine, University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA, USA; Perelman Center for Advanced Medicine, Philadelphia, PA, USA.
| | - Michael A Carducci
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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4
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Silberg M, Krabbe LM, Bögemann M, Schrader AJ, Tully K, Schlack K. Immune-Related Adverse Events Can Predict Progression-Free and Overall Survival In Patients With Metastatic Renal Cell Carcinoma Treated With Immune Checkpoint Inhibitors. Clin Genitourin Cancer 2024:102164. [PMID: 39153900 DOI: 10.1016/j.clgc.2024.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Different combination therapies using anti - PD-1 / PD-L1 or CTLA-4 immune checkpoint inhibition (ICI) are widely used in patients with metastatic renal cell carcinoma (mRCC). In the absents of established biomarkers, immune-related adverse events (irAEs) have been discussed as potential predictors of response. METHODS In this retrospective cohort study, data of 134 patients with mRCC undergoing ICI treatment (Nivolumab, Ipilimumab and Nivolumab, Pembrolizumab and Axitinib or Avelumab and Axitinib) between 2015 and 2021 were analyzed. To examine the utility of irAEs as predictors of overall survival (OS) and progression-free survival (PFS), separate Kaplan-Meier analyses and Cox proportional regression analyses were applied. Landmark analysis was conducted after 12 weeks to reduce immortal time bias. RESULT irAEs were observed in 85 patients (63.4%). Cutaneous (n = 52, 38.8%), endocrine (n = 33, 24.6%) and hepatic (n = 19, 14.2%) irAEs were most commonly observed. In Kaplan-Meier analysis, patients experiencing irAEs showed favorable median PFS (15 months, 95% CI, 9.91-20.09) compared to the non-irAE group (5 months, 95% CI, 3.56-6.44, P < .001). The median OS was 25 months (95% CI, 16.79-33.21) in the non-irAE group, while it was not reached in the irAE group (P = .002). In multivariable analysis, the presence of any irAE was associated with favorable PFS (HR 0.46 [95% CI, 0.26-0.82] P = .008) and OS (HR: 0.28 [95% CI, 0.12-0.63] P = .002), respectively. Landmark analysis after 12 weeks showed mixed results depending on the classification of the irAE group at the landmark time. CONCLUSION The presence of irAEs under ICI therapy in patients with mRCC is associated with better PFS and OS. Thus, manageable irAEs should not be cause for premature discontinuation of ICI therapy, as they seem to indicate favorable outcomes. Considering the time-dependent nature of irAEs is crucial estimating their value as predictive markers.
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Affiliation(s)
- Matteo Silberg
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University of Bochum, Herne, Germany.
| | | | - Martin Bögemann
- Department of Urology, University Hospital Muenster, Muenster, Germany
| | | | - Karl Tully
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University of Bochum, Herne, Germany
| | - Katrin Schlack
- Department of Urology, University Hospital Muenster, Muenster, Germany
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5
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Chen WJ, Pan XW, Song X, Liu ZC, Xu D, Chen JX, Dong KQ, Di SC, Ye JQ, Gan SS, Wang LH, Zhou W, Cui XG. Preoperative neoadjuvant targeted therapy remodels intra-tumoral heterogeneity of clear-cell renal cell carcinoma and ferroptosis inhibition induces resistance progression. Cancer Lett 2024; 593:216963. [PMID: 38768682 DOI: 10.1016/j.canlet.2024.216963] [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: 01/06/2024] [Revised: 04/15/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
Neoadjuvant tyrosine kinase inhibitor (TKI) therapy is an important treatment option for advanced renal cell carcinoma (RCC). Many RCC patients may fail to respond or be resistant to TKI therapy. We aimed to explore the key mechanisms of neoadjuvant therapy résistance. We obtained tumor samples from matched pre-treatment biopsy and post-treatment surgical samples and performed single-cell RNA sequencing. Sunitinib-resistant ccRCC cell lines were established. Ferroptosis was detected by ferrous ion and lipid peroxidation levels. Tumor growth and resistance to Sunitinib was validated in vitro and vivo. Immunohistochemistry was used to validate the levels key genes and lipid peroxidation. Multi-center cohorts were included, including TCGA, ICGC, Checkmate-025 and IMmotion151 clinical trial. Survival analysis was performed to identify the associated clinical and genomic variables. Intratumoral heterogeneity was first described in the whole neoadjuvant management. The signature of endothelial cells was correlated with drug sensitivity and progression-free survival. Ferroptosis was shown to be the key biological program in malignant cell resistance. We observed tissue lipid peroxidation was negatively correlated with IL6 and tumor response. TKI-resistant cell line was established. SLC7A11 knockdown promoted cell growth and lipid peroxidation, increased the ferroptosis level, and suppressed the growth of tumor xenografts significantly (P < 0.01). IL6 could reverse the ferroptosis and malignant behavior caused by SLC7A11 (-) via JAK2/STAT3 pathway, which was rescued by the ferroptosis inducer Erastin. Our data indicate that ferroptosis is a novel strategy for advanced RCC treatment, which activated by IL6, providing a new idea for resistance to TKIs.
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Affiliation(s)
- Wen-Jin Chen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China; Depanrtment of Urology, Third Affiliated Hospital of the Naval Medical University, Shanghai, 201805, China.
| | - Xiu-Wu Pan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xu Song
- Department of Urology, Shanghai Seventh People's Hospital, Shanghai, 200137, China.
| | - Zi-Chang Liu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Da Xu
- Depanrtment of Urology, Third Affiliated Hospital of the Naval Medical University, Shanghai, 201805, China.
| | - Jia-Xin Chen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Ke-Qin Dong
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Si-Chen Di
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Jian-Qing Ye
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Si-Shun Gan
- Depanrtment of Urology, Third Affiliated Hospital of the Naval Medical University, Shanghai, 201805, China.
| | - Lin-Hui Wang
- Department of Urology, Changhai Hospital of Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Wang Zhou
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xin-Gang Cui
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China; Depanrtment of Urology, Third Affiliated Hospital of the Naval Medical University, Shanghai, 201805, China.
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6
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Huang J, Wang Y, Xu F, Wang Z, Wu G, Kong W, Cheoklong NG, Tricard T, Wu X, Zhai W, Zhang W, Zhang J, Zhang D, Chen S, Lian Y, Chen Y, Zhang J, Huang Y, Xue W. Neoadjuvant toripalimab combined with axitinib in patients with locally advanced clear cell renal cell carcinoma: a single-arm, phase II trial. J Immunother Cancer 2024; 12:e008475. [PMID: 38862251 PMCID: PMC11168135 DOI: 10.1136/jitc-2023-008475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND A combination of axitinib and immune checkpoint inhibitors (ICIs) demonstrated promising efficacy in the treatment of advanced renal cell carcinoma (RCC). This study aims to prospectively evaluate the safety, efficacy, and biomarkers of neoadjuvant toripalimab plus axitinib in non-metastatic clear cell RCC. METHODS This is a single-institution, single-arm phase II clinical trial. Patients with non-metastatic biopsy-proven clear cell RCC (T2-T3N0-1M0) are enrolled. Patients will receive axitinib 5 mg twice daily combined with toripalimab 240 mg every 3 weeks (three cycles) for up to 12 weeks. Patients then will receive partial (PN) or radical nephrectomy (RN) after neoadjuvant therapy. The primary endpoint is objective response rate (ORR). Secondary endpoints include disease-free survival, safety, and perioperative complication rate. Predictive biomarkers are involved in exploratory analysis. RESULTS A total of 20 patients were enrolled in the study, with 19 of them undergoing surgery. One patient declined surgery. The primary endpoint ORR was 45%. The posterior distribution of πORR had a mean of 0.44 (95% credible intervals: 0.24-0.64), meeting the predefined primary endpoint with an ORR of 32%. Tumor shrinkage was observed in 95% of patients prior to nephrectomy. Furthermore, four patients achieved a pathological complete response. Grade ≥3 adverse events occurred in 25% of patients, including hypertension, hyperglycemia, glutamic pyruvic transaminase/glutamic oxaloacetic transaminase (ALT/AST) increase, and proteinuria. Postoperatively, one grade 4a and eight grade 1-2 complications were noted. In comparison to patients with stable disease, responders exhibited significant differences in immune factors such as Arginase 1(ARG1), Melanoma antigen (MAGEs), Dendritic Cell (DC), TNF Superfamily Member 13 (TNFSF13), Apelin Receptor (APLNR), and C-C Motif Chemokine Ligand 3 Like 1 (CCL3-L1). The limitation of this trial was the small sample size. CONCLUSION Neoadjuvant toripalimab combined with axitinib shows encouraging activity and acceptable toxicity in locally advanced clear cell RCC and warrants further study. TRIAL REGISTRATION NUMBER clinicaltrials.gov, NCT04118855.
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Affiliation(s)
- Jiwei Huang
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yueming Wang
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Fan Xu
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zaoyu Wang
- Department of Pathology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Guangyu Wu
- Department of Radiology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wen Kong
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - N G Cheoklong
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Thibault Tricard
- Department of Urology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Xiaorong Wu
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei Zhai
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | | | | | - Ding Zhang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Shuyin Chen
- Shanghai Junshi Biosciences Co Ltd, Shanghai, China
| | - Yuqing Lian
- Shanghai Junshi Biosciences Co Ltd, Shanghai, China
| | - Yonghui Chen
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jin Zhang
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yiran Huang
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, RenJi Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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7
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Nguyen NP, Chirila ME, Page BR, Vinh-Hung V, Gorobets O, Mohammadianpanah M, Giap H, Arenas M, Bonet M, Lara PC, Kim L, Dutheil F, Lehrman D, Montes LZ, Tlili G, Dahbi Z, Loganadane G, Blanco SC, Bose S, Natoli E, Li E, Mallum A, Morganti AG. Immunotherapy and stereotactic body radiotherapy for older patients with non-metastatic renal cancer unfit for surgery or decline nephrectomy: practical proposal by the International Geriatric Radiotherapy Group. Front Oncol 2024; 14:1391464. [PMID: 38854736 PMCID: PMC11162108 DOI: 10.3389/fonc.2024.1391464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
The standard of care for non-metastatic renal cancer is surgical resection followed by adjuvant therapy for those at high risk for recurrences. However, for older patients, surgery may not be an option due to the high risk of complications which may result in death. In the past renal cancer was considered to be radio-resistant, and required a higher dose of radiation leading to excessive complications secondary to damage of the normal organs surrounding the cancer. Advances in radiotherapy technique such as stereotactic body radiotherapy (SBRT) has led to the delivery of a tumoricidal dose of radiation with minimal damage to the normal tissue. Excellent local control and survival have been reported for selective patients with small tumors following SBRT. However, for patients with poor prognostic factors such as large tumor size and aggressive histology, there was a higher rate of loco-regional recurrences and distant metastases. Those tumors frequently carry program death ligand 1 (PD-L1) which makes them an ideal target for immunotherapy with check point inhibitors (CPI). Given the synergy between radiotherapy and immunotherapy, we propose an algorithm combining CPI and SBRT for older patients with non-metastatic renal cancer who are not candidates for surgical resection or decline nephrectomy.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Monica-Emilia Chirila
- Department of Clinical Development, MVision AI, Helsinki, Finland
- Department of Radiation Oncology, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, United States
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier Public du Contentin, Cherbourg-en-Contentin, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira, I Virgili, Tarragona, Spain
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Pedro Carlos Lara
- Department of Radiation Oncology, Fernando Pessoria Canarias Las Palmas University, Las Palmas, Spain
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY, United States
| | - Fabien Dutheil
- Department of Radiation Oncology, Clinique Sainte Clotilde, Saint-Denis, Reunion Island, France
| | - David Lehrman
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | | | - Ghassen Tlili
- Department of Urology, Sahloul University Hospital, Sousse, Tunisia
| | - Zineb Dahbi
- Department of Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Sergio Calleja Blanco
- Department of Oral Maxillofacial Surgery, Howard University, Washington, DC, United States
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Elena Natoli
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studorium, Bologna University, Bologna, Italy
| | - Eric Li
- Department of Pathology, Howard University, Washington, DC, United States
| | - Abba Mallum
- Department of Radiation Oncology, University of KwaZulu Natal, Durban, South Africa
| | - Alessio G. Morganti
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studorium, Bologna University, Bologna, Italy
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8
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Goswamy R, Kalemoglu E, Master V, Bilen MA. Perioperative systemic treatments in renal cell carcinoma. Front Oncol 2024; 14:1362172. [PMID: 38841158 PMCID: PMC11151741 DOI: 10.3389/fonc.2024.1362172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
In this review, we aim to provide a comprehensive assessment of the evolving landscape of the perioperative management in renal cell carcinoma (RCC), emphasizing its dynamic and intricate nature. We explore academic and clinical insights into the perioperative treatment paradigm of RCC. Up-to-date treatment options are discussed and the evolving role of neoadjuvant and adjuvant therapy in RCC is highlighted.
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Affiliation(s)
- Rohit Goswamy
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Ecem Kalemoglu
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, United States
| | - Viraj Master
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
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9
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Ghoreifi A, Vaishampayan U, Yin M, Psutka SP, Djaladat H. Immune Checkpoint Inhibitor Therapy Before Nephrectomy for Locally Advanced and Metastatic Renal Cell Carcinoma: A Review. JAMA Oncol 2024; 10:240-248. [PMID: 38095885 DOI: 10.1001/jamaoncol.2023.5269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Importance The therapeutic landscape of advanced renal cell carcinoma (RCC) has rapidly evolved in the past 2 decades, with the advent of cytokines therapy followed by targeted therapies and novel immune checkpoint inhibitors (ICI). This article aims to review the current evidence and ongoing trials of neoadjuvant or prenephrectomy ICI therapy in patients with locally advanced and metastatic RCC. Observations A literature search was performed using the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and PubMed as well as relevant medical society meetings for English-language studies, articles, and abstracts published before January 31, 2023. Currently, level I evidence supports the use of ICI-based combination therapy as the first-line treatment of patients with metastatic RCC with the potential option of deferred nephrectomy in those who respond to treatment. Nevertheless, limited prospective data are available regarding the role and outcomes of nephrectomy (cytoreductive or consolidative) in conjunction with ICI therapy in both metastatic and locally advanced RCC. Although data from retrospective case series confirmed the feasibility and safety of deferred nephrectomy in this setting, the sequence of nephrectomy and whether it should be considered in patients with metastatic RCC is a common clinical dilemma. However, although neoadjuvant targeted therapy for nonmetastatic RCCs has been associated with some advantages yet not accepted as a standard, current data from a phase 3 randomized clinical trial failed to demonstrate the oncologic benefit of neoadjuvant nivolumab for locally advanced RCC. Conclusion and Relevance The findings of this review suggest that ICI-based combination therapy is the standard of care as the first-line treatment of patients with metastatic RCC. However, the role of neoadjuvant ICIs in locally advanced RCC is an active area of investigation. Deferred nephrectomy after ICI-based immunotherapy for metastatic RCC is feasible and safe yet should be performed in high-volume health centers by experienced surgeons. The multidisciplinary and careful approach is critical for treatment decisions.
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Affiliation(s)
- Alireza Ghoreifi
- Institute of Urology, Norris Cancer Center, University of Southern California, Los Angeles
| | - Ulka Vaishampayan
- Division of Hematology and Oncology, University of Michigan, Ann Arbor
| | - Ming Yin
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University College of Medicine, Columbus
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle
| | - Hooman Djaladat
- Institute of Urology, Norris Cancer Center, University of Southern California, Los Angeles
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10
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Singla N, Nirschl TR, Obradovic AZ, Shenderov E, Lombardo K, Liu X, Pons A, Zarif JC, Rowe SP, Trock BJ, Hammers HJ, Bivalacqua TJ, Pierorazio PM, Deutsch JS, Lotan TL, Taube JM, Ged YMA, Gorin MA, Allaf ME, Drake CG. Immunomodulatory response to neoadjuvant nivolumab in non-metastatic clear cell renal cell carcinoma. Sci Rep 2024; 14:1458. [PMID: 38228729 PMCID: PMC10792074 DOI: 10.1038/s41598-024-51889-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/10/2024] [Indexed: 01/18/2024] Open
Abstract
Novel perioperative strategies are needed to reduce recurrence rates in patients undergoing nephrectomy for high-risk, non-metastatic clear cell renal cell carcinoma (ccRCC). We conducted a prospective, phase I trial of neoadjuvant nivolumab prior to nephrectomy in 15 evaluable patients with non-metastatic ccRCC. We leveraged tissue from that cohort to elucidate the effects of PD-1 inhibition on immune cell populations in ccRCC and correlate the evolving immune milieu with anti-PD-1 response. We found that nivolumab durably induces a pro-inflammatory state within the primary tumor, and baseline immune infiltration within the primary tumor correlates with nivolumab responsiveness. Nivolumab increases CTLA-4 expression in the primary tumor, and subsequent nephrectomy increases circulating concentrations of sPD-L1, sPD-L3 (sB7-H3), and s4-1BB. These findings form the basis to consider neoadjuvant immune checkpoint inhibition (ICI) for high-risk ccRCC while the tumor remains in situ and provide the rationale for perioperative strategies of novel ICI combinations.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA.
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
| | - Thomas R Nirschl
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Pathobiology Graduate Program, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Eugene Shenderov
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Kara Lombardo
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA
| | - Xiaopu Liu
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Alice Pons
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Jelani C Zarif
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce J Trock
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA
| | - Hans J Hammers
- Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Trinity J Bivalacqua
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Phillip M Pierorazio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Julie S Deutsch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janis M Taube
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yasser M A Ged
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mohamad E Allaf
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA
- Department of Oncology, Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Charles G Drake
- Immuno-Oncology, The Janssen Pharmaceutical Companies of Johnson & Johnson, Raritan, NJ, USA
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11
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Hakimi K, Saidian A, Panian J, Barata P, Berg S, Chang SL, Saliby RM, Dzimitrowicz H, Emamekhoo H, Gross E, Kilari D, Lam E, Nguyen M, Meagher M, Wang L, Rauterkus GP, D'Andrea V, Yim K, Psutka S, Thapa B, Weise N, Zhang T, McKay RR, Derweesh IH. Outcomes of Consolidative Nephrectomy following Primary Immunotherapy in Advanced Renal Cell Carcinoma: A Multicenter Analysis. Clin Genitourin Cancer 2023; 21:694-702. [PMID: 37558529 DOI: 10.1016/j.clgc.2023.07.007] [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: 03/20/2023] [Revised: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND To evaluate effect and outcomes of combination primary immunotherapy (IO) and nephrectomy for advanced renal cell carcinoma (RCC). METHODS We conducted a multicenter, retrospective analysis of patients with advanced/metastatic RCC who received IO followed by nephrectomy. Primary outcome was Bifecta (negative surgical margins and no 30-day surgical complications). Secondary outcomes included progression-free survival (PFS) following surgery, reduction in tumor/thrombus size, RENAL score, and clinical/pathologic downstaging. Cox regression multivariable analysis was conducted for predictors of Bifecta and PFS. Kaplan-Meier analysis assessed PFS, comparing Bifecta and non-Bifecta groups. RESULTS A total of 56 patients were analyzed (median age 63 years; median follow-up 22.5 months). A total of 40 (71.4%) patients were intermediate IMDC risk. Patients were treated with immunotherapy for median duration of 8.1 months. Immunotherapy resulted in reductions in tumor size (P < .001), thrombus size (P = .02), and RENAL score (P < .001); 38 (67.9%) patients were clinically downstaged on imaging (P < .001) and 25 (44.6%) patients were pathologically downstaged following surgery (P < .001). Bifecta was achieved in 38 (67.9%) patients. Predictors for bifecta achievement included decreasing tumor size (HR 1.08, P = .043) and pathological downstaging (HR 2.13, P = .047). Bifecta (HR 5.65, P = .009), pathologic downstaging (HR 5.15, P = .02), and increasing reduction in tumor size (HR 1.2, P = .007) were associated with improved PFS. Bifecta patients demonstrated improved 2-year PFS (84% vs. 71%, P = .019). CONCLUSIONS Primary immunotherapy reduced tumor/thrombus size and complexity. Pathologically downstaged patients were more likely to achieve bifecta, and these patients displayed improved 2-year PFS. Our study supports further inquiry in the use of CRN following primary immunotherapy for advanced renal cancer.
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Affiliation(s)
- Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Ava Saidian
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Justine Panian
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Pedro Barata
- Department of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, LA
| | - Stephanie Berg
- Department of Hematology and Medical Oncology, Loyola University Medical Center, Maywood, IL
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, MA
| | - Renee M Saliby
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hamid Emamekhoo
- Department of Hematology and Medical Oncology, University of Wisconsin School of Medicine, Madison, WI
| | - Evan Gross
- Department of Hematology and Medical Oncology, University of Washington School of Medicine, Seattle, WA
| | - Deepak Kilari
- Division of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Elaine Lam
- Department of Hematology and Medical Oncology, University of Colorado School of Medicine, Aurora, CO
| | - Mimi Nguyen
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Luke Wang
- Department of Urology, UC San Diego School of Medicine, San Diego, CA
| | - Grant P Rauterkus
- Department of Hematology and Medical Oncology, Tulane University School of Medicine, New Orleans, LA
| | - Vincent D'Andrea
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kendrick Yim
- Lark Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sarah Psutka
- Department of Hematology and Medical Oncology, University of Washington School of Medicine, Seattle, WA
| | - Bicky Thapa
- Division of Hematology and Medical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Nicole Weise
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Tian Zhang
- Department of Hematology and Medical Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rana R McKay
- Deparment of Internal Medicine, Division of Hematology and Medical Oncology, UC San Diego School of Medicine, San Diego, CA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, San Diego, CA.
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12
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Chen YW, Wang L, Panian J, Dhanji S, Derweesh I, Rose B, Bagrodia A, McKay RR. Treatment Landscape of Renal Cell Carcinoma. Curr Treat Options Oncol 2023; 24:1889-1916. [PMID: 38153686 PMCID: PMC10781877 DOI: 10.1007/s11864-023-01161-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
OPINION STATEMENT The treatment landscape of renal cell carcinoma (RCC) has evolved significantly over the past three decades. Active surveillance and tumor ablation are alternatives to extirpative therapy in appropriately selected patients. Stereotactic body radiation therapy (SBRT) is an emerging noninvasive alternative to treat primary RCC tumors. The advent of immune checkpoint inhibitors (ICIs) has greatly improved the overall survival of advanced RCC, and now the ICI-based doublet (dual ICI-ICI doublet; or ICI in combination with a vascular endothelial growth factor tyrosine kinase inhibitor, ICI-TKI doublet) has become the standard frontline therapy. Based on unprecedented outcomes in the metastatic with ICIs, they are also being explored in the neoadjuvant and adjuvant setting for patients with high-risk disease. Adjuvant pembrolizumab has proven efficacy to reduce the risk of RCC recurrence after nephrectomy. Historically considered a radioresistant tumor, SBRT occupies an expanding role to treat RCC with oligometastasis or oligoprogression in combination with systemic therapy. Furthermore, SBRT is being investigated in combination with ICI-doublet in the advanced disease setting. Lastly, given the treatment paradigm is shifting to adopt ICIs at earlier disease course, the prospective studies guiding treatment sequencing in the post-ICI setting is maturing. The effort is ongoing in search of predictive biomarkers to guide optimal treatment option in RCC.
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Affiliation(s)
- Yu-Wei Chen
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, USA
| | - Luke Wang
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Justine Panian
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sohail Dhanji
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Brent Rose
- Department of Radiation Oncology, University of California San Diego, San Diego, CA, USA
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Rana R McKay
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, USA.
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13
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Das A, Shapiro DD, Craig JK, Abel EJ. Understanding and integrating cytoreductive nephrectomy with immune checkpoint inhibitors in the management of metastatic RCC. Nat Rev Urol 2023; 20:654-668. [PMID: 37400492 DOI: 10.1038/s41585-023-00776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 07/05/2023]
Abstract
Cytoreductive nephrectomy became accepted as standard of care for selected patients with metastatic renal cell carcinoma (mRCC) because of improved survival observed in patients treated with cytoreductive nephrectomy in combination with interferon-α in two randomized clinical trials published in 2001. Over the past two decades, novel systemic therapies have shown higher treatment response rates and improved survival outcomes compared with interferon-α. During this rapid evolution of mRCC treatments, systemic therapies have been the primary focus of clinical trials. Results from multiple retrospective studies continue to suggest an overall survival benefit for selected patients treated with nephrectomy in combination with systemic mRCC treatments, with the notable exception of one debated clinical trial. The optimal timing for surgery is unknown, and proper patient selection remains crucial to improving surgical outcomes. As systemic therapies continue to evolve, clinicians have an increasing need to understand how to incorporate cytoreductive nephrectomy into the management of mRCC.
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Affiliation(s)
- Arighno Das
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel D Shapiro
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Juliana K Craig
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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14
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Kuusk T, Bex A. Adjuvant and Neoadjuvant Therapy in Renal Cell Carcinoma. Hematol Oncol Clin North Am 2023; 37:907-920. [PMID: 37369611 DOI: 10.1016/j.hoc.2023.05.020] [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] [Indexed: 06/29/2023]
Abstract
In locally advanced RCC, 6 phase 3 randomized controlled trials (RCTs) were designed in the perioperative setting with immune checkpoint inhibitor (ICI) monotherapy or combinations. Adjuvant trials with atezolizumab, pembrolizumab, and nivolumab with ipilimumab reported results, as did the only perioperative trial with nivolumab. Of these, only 1 year of adjuvant pembrolizumab improved disease-free survival (DFS) versus placebo, with the other trials showing no improvement in DFS. In the purely neoadjuvant setting, phase 1 b/2 ICI trials have demonstrated safety, efficacy, and dynamic changes of immune infiltrates, and provide a rationale for randomized trial concepts.
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Affiliation(s)
- Teele Kuusk
- Homerton University Hospital, London, UK; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK; Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
| | - Axel Bex
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK; Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands; Division of Surgery and Interventional Science, University College London, Pond Street, London NW3 2QG, UK.
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15
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Kaur J, Patil G, Geynisman DM, Ghatalia P. Role of perioperative immunotherapy in localized renal cell carcinoma. Ther Adv Med Oncol 2023; 15:17588359231181497. [PMID: 37529159 PMCID: PMC10387776 DOI: 10.1177/17588359231181497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
Immunotherapy has proven effective in metastatic renal cell carcinoma (RCC). The current standard of treatment in localized RCC is partial or complete nephrectomy. However, after surgery, there is a high recurrence rate and survival rates ranging from 53% to 85% depending on the stage of disease at presentation. Given clinical response to immunotherapies in metastatic RCC, these therapies are being tested as monotherapy and in combination with vascular endothelial growth factor receptor tyrosine kinase inhibitors in the (neo)adjuvant setting. Here we describe the current landscape of these treatments in localized RCC.
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Affiliation(s)
- Jasmeet Kaur
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Daniel M. Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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16
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Zemankova A, Studentova H, Kopova A, Tichy T, Student V, Melichar B. Neoadjuvant nivolumab and cabozantinib in advanced renal cell carcinoma in a horseshoe kidney - how to achieve a safe and radical resection? a case report and review of the literature. Front Oncol 2023; 13:1115901. [PMID: 37519822 PMCID: PMC10380977 DOI: 10.3389/fonc.2023.1115901] [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: 12/04/2022] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Neoadjuvant nivolumab and cabozantinib in locally advanced renal cell carcinoma in a horseshoe kidney is a novel therapeutic approach in the preoperative setting. Methods We report a case of a 52-year old male who presented with a large inoperable tumor of the horseshoe kidney and achieved major partial radiologic response after neoadjuvant therapy with nivolumab and cabozantinib leading to radical resection of the tumor. The patient remains tumor free on the subsequent follow-up and his renal function is only mildly decreased. The systemic treatment was complicated by hepatotoxicity leading to early nivolumab withdrawal. Results Currently, the combination therapy based on immune checkpoint inhibitors and tyrosine kinase inhibitors represents the treatment of choice in treatment-naïve patients with metastatic renal cell carcinoma in any prognostic group. The neoadjuvant treatment approach is being tested in prospective clinical trials and results are eagerly awaited. Renal cell carcinoma in a horseshoe kidney is an uncommon finding that is always challenging. Additionally, management guidance in this patient population is lacking. In some patients neoadjuvant therapy could be the only way to preserve kidney function. The initial treatment strategy should be individualized to patient needs aiming at the radical resection of the primary tumor as the only chance of getting the tumor under control in the long term. Conclusion Herein, we highlight the feasibility of neoadjuvant systemic therapy with nivolumab and cabozantinib allowing the subsequent performance of radical tumor resection with negative margins in a patient with advanced renal cell carcinoma in a horseshoe kidney, removing the primary tumor while sparing the patient from lifelong dialysis.
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Affiliation(s)
- Anezka Zemankova
- Department of Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
| | - Hana Studentova
- Department of Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
| | - Andrea Kopova
- Department of Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
| | - Tomas Tichy
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
| | - Vladimir Student
- Department of Urology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czechia
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17
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Panian J, Saidian A, Hakimi K, Ajmera A, Anderson WJ, Barata P, Berg S, Signoretti S, Lee Chang S, D'Andrea V, George D, Dzimitrowicz H, El Zarif T, Emamekhoo H, Gross E, Kilari D, Lam E, Lashgari I, Psutka S, Rauterkus GP, Shabaik A, Thapa B, Wang L, Weise N, Yim K, Zhang T, Derweesh I, McKay RR. Pathological Outcomes of Patients With Advanced Renal Cell Carcinoma Who Receive Nephrectomy Following Immunotherapy. Oncologist 2023:oyad166. [PMID: 37368355 DOI: 10.1093/oncolo/oyad166] [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: 12/10/2022] [Accepted: 01/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Even though cytoreductive nephrectomy (CN) was once the standard of care for patients with advanced renal cell carcinoma (RCC), its role in treatment has not been well analyzed or defined in the era of immunotherapy (IO). MATERIALS AND METHODS This study analyzed pathological outcomes in patients with advanced or metastatic RCC who received IO prior to CN. This was a multi-institutional, retrospective study of patients with advanced or metastatic RCC. Patients were required to receive IO monotherapy or combination therapy prior to radical or partial CN. The primary endpoint assessed surgical pathologic outcomes, including American Joint Committee on Cancer (AJCC) staging and frequency of downstaging, at the time of surgery. Pathologic outcomes were correlated to clinical variables using a Wald-chi squared test from Cox regression in a multi-variable analysis. Secondary outcomes included objective response rate (ORR) defined by response evaluation criteria in solid tumors (RECIST) version 1.1 and progression-free survival (PFS), which were estimated using the Kaplan-Meier method with reported 95% CIs. RESULTS Fifty-two patients from 9 sites were included. Most patients were male (65%), 81% had clear cell histology, 11% had sarcomatoid differentiation. Overall, 44% of patients experienced pathologic downstaging, and 13% had a complete pathologic response. The ORR immediately prior to nephrectomy was stable disease in 29% of patients, partial response in 63%, progressive disease in 4%, and 4% unknown. Median follow-up for the entire cohort was 25.3 months and median PFS was 3.5 years (95% CI, 2.1-4.9). CONCLUSIONS IO-based interventions prior to CN in patients with advanced or metastatic RCC demonstrates efficacy, with a small fraction of patients showing a complete response. Additional prospective studies are warranted to investigate the role of CN in the modern IO-era.
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Affiliation(s)
- Justine Panian
- University of California San Diego, Department of Medicine, Division of Hematology-Oncology La Jolla, CA, USA
| | - Ava Saidian
- University of California San Diego, Department of Urology, La Jolla, CA, USA
| | - Kevin Hakimi
- University of California San Diego, Department of Urology, La Jolla, CA, USA
| | - Archana Ajmera
- University of California San Diego, Department of Medicine, Division of Hematology-Oncology, La Jolla, CA, USA
| | | | - Pedro Barata
- Tulane University, Deming Department of Medicine, New Orleans, LA, USA
| | - Stephanie Berg
- Loyola University Chicago, Department of Cancer Biology and Internal Medicine, Maywood, IL, USA
| | - Sabina Signoretti
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, USA
| | - Steven Lee Chang
- Brigham and Women's Hospital, Division of Urology, Boston, MA, USA
| | - Vincent D'Andrea
- Brigham and Women's Hospital, Division of Urology, Boston, MA, USA
| | - Daniel George
- Duke Cancer Institute, Department of Medicine, Durham, NC, USA
| | | | - Talal El Zarif
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA
| | - Hamid Emamekhoo
- University of Wisconsin, Department of Medicine, Madison, WI, USA
| | - Evan Gross
- The University of Washington, Department of Urology, Seattle, WA, USA
| | - Deepak Kilari
- Medical College of Wisconsin, Department of Internal Medicine, Milwaukee, WI, USA
| | - Elaine Lam
- University of Colorado Cancer Center, Division of Medical Oncology, Aurora, CO, USA
| | - Isabel Lashgari
- San Diego State University, Department of Cell and Molecular Biology, San Diego, CA, USA
| | - Sarah Psutka
- The University of Washington, Department of Urology, Seattle, WA, USA
| | - Grant P Rauterkus
- Tulane University, Deming Department of Medicine, New Orleans, LA, USA
| | - Ahmed Shabaik
- University of California San Diego, Department of Pathology, La Jolla, CA, USA
| | - Bicky Thapa
- Medical College of Wisconsin, Department of Internal Medicine, Milwaukee, WI, USA
| | - Luke Wang
- University of California San Diego, Department of Urology, La Jolla, CA, USA
| | - Nicole Weise
- University of California San Diego, Department of Medicine, Division of Hematology-Oncology La Jolla, CA, USA
| | - Kendrick Yim
- Brigham and Women's Hospital, Division of Urology, Boston, MA, USA
| | - Tian Zhang
- UT Southwestern, Department of Internal Medicine, Dallas, TX, USA
| | - Ithaar Derweesh
- University of California San Diego, Department of Urology, La Jolla, CA, USA
| | - Rana R McKay
- University of California San Diego, Department of Medicine, Department of Urology, La Jolla, CA, USA
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18
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Ali M, Wood S, Pryor D, Moon D, Bressel M, Azad AA, Mitchell C, Murphy D, Zargar H, Hardcastle N, Kearsley J, Eapen R, Wong LM, Cuff K, Lawrentschuk N, Neeson PJ, Siva S. NeoAdjuvant pembrolizumab and STEreotactic radiotherapy prior to nephrectomy for renal cell carcinoma (NAPSTER): A phase II randomised clinical trial. Contemp Clin Trials Commun 2023; 33:101145. [PMID: 37168818 PMCID: PMC10164766 DOI: 10.1016/j.conctc.2023.101145] [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: 08/16/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
Background Surgery remains the standard of care for localised renal cell carcinoma (RCC). Nevertheless, nearly 50% of patients with high-risk disease experience relapse after surgery, with distant sites being common. Considering improved outcomes in terms of disease-free survival with adjuvant immunotherapy with pembrolizumab, we hypothesise that neoadjuvant SABR with or without the addition of pembrolizumab before nephrectomy will lead to improved disease outcomes by evoking better immune response in the presence of an extensive reserve of tumor-associated antigens. Methods and analysis This prospective, open-label, phase II, randomised, non-comparative, clinical trial will investigate the use of neoadjuvant stereotactic ablative body radiotherapy (SABR) with or without pembrolizumab prior to nephrectomy. The trial will be conducted at two centres in Australia that are well established for delivering SABR to primary RCC patients. Twenty-six patients with biopsy-proven clear cell RCC will be recruited over two years. Patients will be randomised to either SABR or SABR/pembrolizumab. Patients in both arms will undergo surgery at 9 weeks after completion of experimental treatment. The primary objectives are to describe major pathological response and changes in tumour-responsive T-cells from baseline pre-treatment biopsy in each arm. Patients will be followed for sixty days post-surgery. Outcomes and significance We hypothesize that SABR alone or SABR plus pembrolizumab will induce significant tumor-specific immune response and major pathological response. In that case, either one or both arms could justifiably be used as a neoadjuvant treatment approach in future randomized trials in the high-risk patient population.
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Affiliation(s)
- Muhammad Ali
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Corresponding author. 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
| | - Simon Wood
- Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Department of Urology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, QLD, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Daniel Moon
- Deapartment of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Arun A. Azad
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Declan Murphy
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Homi Zargar
- Deapartment of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Hardcastle
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia
| | - Jamie Kearsley
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Renu Eapen
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lih Ming Wong
- Deapartment of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Department of Urology, St Vincent's Health, Melbourne, VIC, Australia
| | - Katharine Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nathan Lawrentschuk
- Deapartment of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul J. Neeson
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
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19
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Karam JA, Msaouel P, Haymaker CL, Matin SF, Campbell MT, Zurita AJ, Shah AY, Wistuba II, Marmonti E, Duose DY, Parra ER, Soto LMS, Laberiano-Fernandez C, Lozano M, Abraham A, Hallin M, Chin CD, Olson P, Der-Torossian H, Yan X, Tannir NM, Wood CG. Phase II trial of neoadjuvant sitravatinib plus nivolumab in patients undergoing nephrectomy for locally advanced clear cell renal cell carcinoma. Nat Commun 2023; 14:2684. [PMID: 37164948 PMCID: PMC10172300 DOI: 10.1038/s41467-023-38342-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
Sitravatinib is an immunomodulatory tyrosine kinase inhibitor that can augment responses when combined with programmed death-1 inhibitors such as nivolumab. We report a single-arm, interventional, phase 2 study of neoadjuvant sitravatinib in combination with nivolumab in patients with locally advanced clear cell renal cell carcinoma (ccRCC) prior to curative nephrectomy (NCT03680521). The primary endpoint was objective response rate (ORR) prior to surgery with a null hypothesis ORR = 5% and the alternative hypothesis set at ORR = 30%. Secondary endpoints were safety; pharmacokinetics (PK) of sitravatinib; immune effects, including changes in programmed cell death-ligand 1 expression; time-to-surgery; and disease-free survival (DFS). Twenty patients were evaluable for safety and 17 for efficacy. The ORR was 11.8%, and 24-month DFS probability was 88·0% (95% CI 61.0 to 97.0). There were no grade 4/5 treatment-related adverse events. Sitravatinib PK did not change following the addition of nivolumab. Correlative blood and tissue analyses showed changes in the tumour microenvironment resulting in an immunologically active tumour by the time of surgery (median time-to-surgery: 50 days). The primary endpoint of this study was not met as short-term neoadjuvant sitravatinib and nivolumab did not substantially increase ORR.
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Affiliation(s)
- Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Pavlos Msaouel
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Cara L Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amado J Zurita
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Enrica Marmonti
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Dzifa Y Duose
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Edwin R Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Luisa Maren Solis Soto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Caddie Laberiano-Fernandez
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Marisa Lozano
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Alice Abraham
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Max Hallin
- Mirati Therapeutics, Inc., San Diego, CA, 92121, USA
| | - Curtis D Chin
- Mirati Therapeutics, Inc., San Diego, CA, 92121, USA
| | | | | | - Xiaohong Yan
- Mirati Therapeutics, Inc., San Diego, CA, 92121, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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20
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Long GV, Menzies AM, Scolyer RA. Neoadjuvant Checkpoint Immunotherapy and Melanoma: The Time Is Now. J Clin Oncol 2023:JCO2202575. [PMID: 37104746 DOI: 10.1200/jco.22.02575] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
The role of neoadjuvant therapy is undergoing an historic shift in oncology. The emergence of potent immunostimulatory anticancer agents has transformed neoadjuvant therapy from a useful tool in minimizing surgical morbidity to a life-saving treatment with curative promise, led by research in the field of melanoma. Health practitioners have witnessed remarkable improvements in melanoma survival outcomes over the past decade, beginning with checkpoint immunotherapies and BRAF-targeted therapies in the advanced setting that were successfully adopted into the postsurgical adjuvant setting for high-risk resectable disease. Despite substantial reductions in postsurgical recurrence, high-risk resectable melanoma has remained a life-altering and potentially fatal disease. In recent years, data from preclinical models and early-phase clinical trials have pointed to the potential for greater clinical efficacy when checkpoint inhibitors are administered in the neoadjuvant rather than adjuvant setting. Early feasibility studies showed impressive pathologic response rates to neoadjuvant immunotherapy, which were associated with recurrence-free survival rates of over 90%. Recently, the randomized phase II SWOG S1801 trial (ClinicalTrials.gov identifier: NCT03698019) reported a 42% reduction in 2-year event-free survival risk with neoadjuvant versus adjuvant pembrolizumab in resectable stage IIIB-D/IV melanoma (72% v 49%; hazard ratio, 0.58; P = .004), establishing neoadjuvant single-agent immunotherapy as a new standard of care. A randomized phase III trial of neoadjuvant immunotherapy in resectable stage IIIB-D melanoma, NADINA (ClinicalTrials.gov identifier: NCT04949113), is ongoing, as are feasibility studies in high-risk stage II disease. With a swathe of clinical, quality-of-life, and economic benefits, neoadjuvant immunotherapy has the potential to redefine the contemporary management of resectable tumors.
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Affiliation(s)
- Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
- Mater Hospital, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
- Mater Hospital, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- NSW Health Pathology, Sydney, NSW, Australia
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21
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Tang Q, Zhao S, Zhou N, He J, Zu L, Liu T, Song Z, Chen J, Peng L, Xu S. PD‑1/PD‑L1 immune checkpoint inhibitors in neoadjuvant therapy for solid tumors (Review). Int J Oncol 2023; 62:49. [PMID: 36866750 PMCID: PMC10019757 DOI: 10.3892/ijo.2023.5497] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/09/2022] [Indexed: 03/04/2023] Open
Abstract
A comprehensive search regarding programmed cell death protein 1 (PD‑1)/programmed death‑ligand 1 (PD‑L1) inhibitor monotherapy or combination therapy in neoadjuvant settings of 11 types of solid cancer was performed using the PubMed, Cochrane and Embase databases, and the abstracts of various conferences were screened. Data presented in 99 clinical trials indicated that preoperative treatment with PD‑1/PD‑L1 combined therapy, particularly immunotherapy plus chemotherapy, could achieve a higher objective response rate, a higher major pathologic response rate and a higher pathologic complete response rate, as well as a lower number of immune‑related adverse events compared with PD‑1/PD‑L1 monotherapy or dual immunotherapy. Although PD‑1/PD‑L1 inhibitor combination caused more treatment‑related adverse events (TRAEs) in patients, most of the TRAEs were acceptable and did not cause marked delays in operation. The data suggest that patients with pathological remission after neoadjuvant immunotherapy exhibit improved postoperative disease‑free survival compared with those without pathological remission. Further studies are still required to evaluate the long‑term survival benefit of neoadjuvant immunotherapy.
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Affiliation(s)
- Quanying Tang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shikang Zhao
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ning Zhou
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jinling He
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Lingling Zu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Tingwen Liu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zuoqing Song
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jun Chen
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ling Peng
- Department of Respiratory Disease, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang 310000, P.R. China
- Dr Ling Peng, Department of Respiratory Disease, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, 158 Shangtang Road, Hangzhou, Zhejiang 310000, P.R. China, E-mail:
| | - Song Xu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
- Correspondence to: Dr Song Xu, Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping, Tianjin 300052, P.R. China, E-mail:
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22
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Schmeusser BN, Manalo TA, Liu Y, Shah YB, Ali A, Armas-Phan M, Patil DH, Nabavizadeh R, Ogan K, Master VA. Mayo Adhesive Probability Score Does Not Have Prognostic Ability in Locally Advanced Renal Cell Carcinoma. J Kidney Cancer VHL 2023; 10:19-25. [PMID: 36969300 PMCID: PMC10036918 DOI: 10.15586/jkcvhl.v10i1.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
Abstract
Nephrectomy remains standard treatment for renal cell carcinoma (RCC). The Mayo Adhesive Probability (MAP) score is predictive of adherent perinephric fat and associated surgical complexity, and is determined by assessing perinephric fat and stranding. MAP has additionally predicted progression-free survival (PFS), though primarily reported in stage T1-T2 RCC. Here, we examine MAP's ability to predict overall survival (OS) and PFS in T3-T4 RCC. From our prospectively maintained RCC database, patients that underwent radical nephrectomy (2009-2016) with available abdominal imaging (<90 days preop) and T3/T4 RCC underwent MAP scoring. Survival analyses were conducted with MAP scores as individual (0-5) and dichotomized (0-3 vs 4-5) using Kaplan-Meier method. Multivariable Cox proportional hazard regression models for PFS and OS were built with backward elimination. 141 patients were included. 134 (95%) and 7 (5%) had pT3 and pT4 disease, respectively. 46.1% of patients had an inferior vena cava thrombus. Mean MAP score was 3.22±1.52, with 75 (53%) patients having a score between 0-3 and 66 (47%) having a score of 4-5. Both male gender (p=0.006) and clear cell histology (p=0.012) were associated with increased MAP scores. On Kaplan-Meier and multivariable analysis, no significant associations were identified between MAP and PFS (HR=1.01, 95% CI 0.85-1.20, p=0.93) or OS (HR=1.01, 95% CI 0.84-1.21, p=0.917). In this cohort of patients with locally advanced RCC, high MAP scores were not predictive of worse PFS or OS.
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Affiliation(s)
| | - Tad A. Manalo
- Department of Urology, University of Colorado School of Medicine, Denver, CO, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Yash B. Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adil Ali
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Manuel Armas-Phan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya H. Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
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23
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Aragon-Ching JB, Uzzo R. Multidisciplinary treatment (MDT) perspectives in renal cell carcinoma. Ther Adv Urol 2023; 15:17562872231182216. [PMID: 37359736 PMCID: PMC10286529 DOI: 10.1177/17562872231182216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
| | - Robert Uzzo
- Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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24
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Berg SA, McGregor BA. The Continuing Question of Adjuvant Therapy in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2022; 14:6018. [PMID: 36551504 PMCID: PMC9776072 DOI: 10.3390/cancers14246018] [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: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment advances in kidney cancer continually evolve. The focus of treatment options continues with oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) or intravenous immune checkpoint inhibitors (ICIs). Multiple trials exploring the role of adjuvant treatment after cytoreductive nephrectomy in high-risk clear cell renal cell carcinoma are currently ongoing. The discovery of biomarkers may help determine which patients benefit from these treatments, but these are not yet available outside clinical studies. Trials with combination therapies are also ongoing, especially using novel therapies with new mechanisms of action, and will hopefully provide more clues on proper patient and therapy selection in the adjuvant setting.
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Affiliation(s)
- Stephanie A. Berg
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bradley A. McGregor
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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25
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Mebroukine S, Yacoub M, Michiels C, Ravaud A, Gross-Goupil M, Bernhard JC. Feasibility of robotic-assisted partial nephrectomy for complete remission of metastatic renal cell carcinoma after long exposure to immune checkpoint inhibitors (UroCCR-106). J Surg Case Rep 2022; 2022:rjac560. [PMCID: PMC9731613 DOI: 10.1093/jscr/rjac560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Immune checkpoint inhibitors used for metastatic clear cell renal cell carcinoma treatment show significant rates of complete response on metastatic sites. Feasibility of delayed surgery on primitive tumors remains questionable, especially regarding conservative procedures. We present here the first reported case of robotic-assisted partial nephrectomy (RAPN) and concomitant metastasectomy after long exposure to immunotherapy. We performed an imperative salvage RAPN and metastasectomy in a 79-year-old woman with history of right radical nephrectomy for oligometastatic clear cell renal cell carcinoma, previous open partial nephrectomy and ablative treatment on the remaining left kidney. In fact, after complete response on the metastatic sites, the patient experienced progression on the solitary kidney despite immunotherapy. This limited experience of RAPN and metastasectomy after long exposure to immunotherapy appears to be feasible safe and efficient both on the oncological and functional point of view.
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Affiliation(s)
- Samy Mebroukine
- University Hospital of Bordeaux , Urology Department, Bordeaux , France
| | - Mokrane Yacoub
- University Hospital of Bordeaux , Pathology Department, Bordeaux , France
| | - Clément Michiels
- University Hospital of Bordeaux , Urology Department, Bordeaux , France
| | - Alain Ravaud
- University Hospital of Bordeaux , Oncology Department, Bordeaux , France
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26
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Jones JO, Ince WHJ, Welsh SJ, Stewart GD. Activity of Immunotherapy Regimens on Primary Renal Tumours: A Systematic Review. KIDNEY CANCER 2022. [DOI: 10.3233/kca-220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND: Immune checkpoint inhibitors (ICPIs) are widely used in treating metastatic renal cell carcinoma (RCC). Cytoreductive nephrectomy (CN) forms part of multimodality treatment in advanced disease, however there is no prospective evidence for its use in the ICPI era. Trials of neoadjuvant ICPIs in RCC are underway; understanding the anticipated effect of ICPIs on the primary tumour may help clinical decision making in both localised and advanced settings. METHODS: A systematic search (PubMed, Web of Science, clinicaltrials.gov) of English literature from 2012 to 2022 was performed according to PRISMA guidelines. 2,398 records were identified, 54 were included in the analysis. RESULTS: In the metastatic setting, response in the primary tumour (≥30% reduction in size) is seen in 33–56% of patients treated with dual ICPI or ICPI + VEGFR-TKI. Pathological complete response rates were 14% for patients undergoing CN after a period of ICPI therapy. In the neoadjuvant setting there is a single published trial of VEGFR-TKI + ICPI, 30% of patients had a≥30% reduction in size of the primary. This appears superior to single agent ICPI. Grade 3 adverse event rates are comparable to the metastatic setting. CONCLUSIONS: A period of ICPI combination therapy followed by nephrectomy may be considered for selected patients as a strategy to manage metastatic disease. In the neoadjuvant setting, it is not clear whether ICPI + VEGFR-TKI is superior to VEGFR-TKI alone. There is minimal data on whether either CN after ICPI in metastatic patients, or neoadjuvant ICPI therapy for localised disease, improves long term survival.
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Affiliation(s)
- James O. Jones
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | | | - Sarah J. Welsh
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Grant D. Stewart
- University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
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27
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Shao Y, Li W, Zhang L, Xue B, Chen Y, Zhang Z, Wang D, Wu B. CDH13 is a prognostic biomarker and a potential therapeutic target for patients with clear cell renal cell carcinoma. Am J Cancer Res 2022; 12:4520-4544. [PMID: 36381315 PMCID: PMC9641392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
CDH13 is an atypical member of the cadherin family and is closely related to the clinicopathological factors and prognosis of many types of cancer. However, the role of CDH13 in clear cell renal cell carcinoma (ccRCC) remains unknown. Therefore, we comprehensively analyzed the expression level, diagnostic efficacy, clinical significance, prognostic value, immune infiltration, methylation status, genetic alteration, and biological functions of CDH13 in ccRCC patients. The results showed that CDH13 was significantly upregulated in ccRCC and strongly correlated with better survival, lower cancer stages, and lower tumor grades of ccRCC patients. Additionally, the immune infiltration analysis indicated that CDH13 might play a crucial role in regulating the tumor microenvironment of ccRCC. The results of methylation analysis showed that the epigenetic status of CDH13 was altered, and the prognosis of ccRCC patients was related not only to DNA methylation but also to m6A modification of CDH13. Finally, the results based on clinical samples further elucidated the expression pattern of CDH13 in ccRCC. In conclusion, CDH13 might be a novel prognostic biomarker and therapeutic target for patients with ccRCC. And our study provides new insights into the potential molecular changes and strategies for the treatment of ccRCC.
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Affiliation(s)
- Yuan Shao
- Department of Urology, The Second Hospital of Tianjin Medical UniversityTianjin 300070, China
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Wenxia Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical UniversityTianjin 300350, China
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Lin Zhang
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Bo Xue
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Yongquan Chen
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Zikuan Zhang
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
| | - Dongwen Wang
- Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen 518116, Guangdong, China
| | - Bo Wu
- Department of Urology, First Hospital of Shanxi Medical UniversityTaiyuan 030001, Shanxi, China
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28
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Renner A, Rojas C, Walton-Diaz A, Burotto M. Adjuvant therapy for renal cell carcinoma, finally a new standard? Front Oncol 2022; 12:926661. [PMID: 36249058 PMCID: PMC9557147 DOI: 10.3389/fonc.2022.926661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Localized renal cell carcinoma (RCC) has the potential to be cured with surgery alone; however, some patients have a high risk of relapse and may benefit from additional treatment. Several efforts have been made to identify effective strategies, with mostly negative results. However, recent results with immune checkpoint inhibitors may change the current standard, and several ongoing trials are exploring new alternatives. In this perspective, we aim to provide an overview of previous adjuvant therapy efforts, current data supporting the use of checkpoint blockade, and a future outlook for adjuvant therapy in renal cell carcinoma.
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Affiliation(s)
- Alex Renner
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
| | - Carlos Rojas
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
| | - Annerleim Walton-Diaz
- Department of Urology, Chilean National Cancer Institute, Urofusion Spa, and Department of Urology, Universidad de Chile, Santiago, Chile
| | - Mauricio Burotto
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
- *Correspondence: Mauricio Burotto,
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29
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Patel HD, Srivastava A. Editorial: Optimizing surgical procedures in renal cancers to improve patient outcomes. Front Oncol 2022; 12:1019946. [PMID: 36237338 PMCID: PMC9552350 DOI: 10.3389/fonc.2022.1019946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hiten D. Patel
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Hiten D. Patel,
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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30
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Role of cytoreductive surgery in the era of immunotherapy. Curr Opin Urol 2022; 32:618-626. [PMID: 36081404 DOI: 10.1097/mou.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI + TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap. RECENT FINDINGS Data from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited. SUMMARY Although the optimal selection criteria and timing for CN remains to be established for patients with mRCC in the immunotherapy era, the available body of evidence underscores the importance of careful patient selection. Ongoing prospective studies, such as Cyto-KIK, PROBE, and NORDIC-SUN, will better define the role of CN in the rapidly evolving treatment landscape for mRCC.
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31
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Pallauf M, Ged Y, Singla N. A Swinging Pendulum: Bringing Back Cytoreductive Nephrectomy in the Era of Immune Checkpoint Inhibition. Eur Urol Oncol 2022; 5:585-586. [PMID: 35965196 DOI: 10.1016/j.euo.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Maximilian Pallauf
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, Salzburg, Austria
| | - Yasser Ged
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirmish Singla
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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32
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Wang Y, Huang J, Zhang C, Hu X, Wang P, Shi G, Zhang J, Kong W, Chen Y, Huang Y, Ye D, Xia D, Guo J, He Z, Xue W. Special issue "The advance of solid tumor research in China": Presurgical therapy in the management of local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Int J Cancer 2022; 152:24-30. [PMID: 35712762 DOI: 10.1002/ijc.34173] [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: 11/18/2021] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/08/2022]
Abstract
Local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) is rare in patients with renal cell carcinoma (RCC); however, it is associated with poor prognosis and lacks standard treatment. Our study aimed to assess oncological outcomes and prognostic factors of patients that underwent targeted therapy for RPR after RN, and to evaluate the role of presurgical targeted therapy in this context. This was a retrospective multicenter study of 85 patients with RPR treated with targeted therapy for RPR after RN (July 2008-October 2020). Clinical and pathological characteristics were reported using descriptive statistics. Cancer-specific survival (CSS) was examined using the Cox proportional hazards model. The median follow-up time was 50 months (95% confidence interval [CI]: 33.3-66.7) after the RPR diagnosis. The median CSS was 96 months in the presurgical targeted therapy followed by surgical resection group and 42 months (95% CI: 28.8-55.2) in the targeted therapy alone group (P = .0011). In multivariate analysis, International Metastatic RCC Database Consortium classification intermediate/poor risk, number of recurrence lesions and surgical resection were independent predictors of CSS. Presurgical targeted therapy may increase the feasibility of tumor resection for RPR after RN. Patients who underwent surgical resection following presurgical targeted therapy had better CSS than those treated with targeted therapy alone.
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Affiliation(s)
- Yueming Wang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwei Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cuijian Zhang
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Wang
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jin Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Kong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dan Xia
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhisong He
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Carlo MI, Attalla K, Mazaheri Y, Gupta S, Yildirim O, Murray SJ, Coskey DT, Kotecha R, Lee CH, Feldman DR, Russo P, Patil S, Motzer RJ, Coleman JA, Durack JC, Chen YB, Akin O, Ari Hakimi A, Voss MH. Phase II Study of Neoadjuvant Nivolumab in Patients with Locally Advanced Clear Cell Renal Cell Carcinoma Undergoing Nephrectomy. Eur Urol 2022; 81:570-573. [PMID: 35183395 PMCID: PMC9156541 DOI: 10.1016/j.eururo.2022.01.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 01/22/2023]
Abstract
Immune checkpoint inhibitor therapy improves survival in patients with metastatic renal cell carcinoma (RCC) but has not been studied well preoperatively in patients with localized disease undergoing nephrectomy. We conducted a single-center study to evaluate the safety and feasibility of neoadjuvant nivolumab in patients undergoing nephrectomy for localized RCC. Eligible patients had a >20% risk of recurrence, as estimated by a preoperative nomogram. Patients received nivolumab every 2 wk for four treatments prior to surgery. The primary endpoints were feasibility, defined as completing at least three treatments without significant surgical delay, and safety, defined as the rate of surgical complications. Treatment effects were assessed by radiomics and immunohistochemistry. A total of 18 patients (11 men; median age 60 yr) with clear cell RCC were enrolled. All received at least one dose of nivolumab and proceeded to nephrectomy without delay; 16/18 patients completed all four doses. Two patients discontinued nivolumab for immune-related adverse events, and four had surgical complications as per the Clavien-Dindo classification. Integrated pathology plus radiomic analysis demonstrated an association between post-treatment immune infiltration and low entropy apparent diffusion coefficient on magnetic resonance imaging. Nivolumab prior to nephrectomy was safe and feasible, without significant surgical delays and with an expected rate of immune-related adverse events. PATIENT SUMMARY: We evaluated the outcomes for patients with localized kidney cancer who received immunotherapy prior to surgery to remove their kidney tumor. In a small group of patients who had cancer confined to the kidney, this approach appeared safe and feasible.
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Affiliation(s)
- Maria I Carlo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kyrollis Attalla
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yousef Mazaheri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samuel J Murray
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Devyn T Coskey
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ritesh Kotecha
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chung-Han Lee
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeremy C Durack
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Marandino L, Raggi D, Necchi A, Capitanio U. Neoadjuvant Treatment in Renal Cell Carcinoma: Transforming Challenges into Opportunities. Eur Urol 2022; 81:574-575. [DOI: 10.1016/j.eururo.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
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Studentova H, Zemankova A, Spisarova M, Skanderova D, Tudos Z, Melichar B, Student V. A Pathological Complete Response to the Combination of Ipilimumab and Nivolumab in a Patient with Metastatic Renal Cell Carcinoma. Medicina (B Aires) 2022; 58:medicina58030336. [PMID: 35334512 PMCID: PMC8951627 DOI: 10.3390/medicina58030336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 01/05/2023] Open
Abstract
Background and Objectives: Complete pathological response after ipilimumab and nivolumab combination therapy in a patient with intermediate prognosis renal cell carcinoma is an uncommon finding. Case presentation: A 60-year-old man presented with synchronous solitary metastatic bone lesion and renal cell carcinoma and achieved a complete pathological response after surgical resection of the bone lesion, followed by ipilimumab and nivolumab combination therapy and nephrectomy. The treatment was complicated by hypophysitis and oligoarthritis more than a year after the initiation of the therapy. Conclusions: Currently, the combination therapy based on immune checkpoint inhibitors represents the treatment of choice in patients with intermediate- and poor-risk prognosis metastatic renal cell carcinoma. In the present case, preoperative therapy with ipilimumab and nivolumab resulted in a complete pathological response in the renal tumor. Vigilance concerning potential immune-related side effects is warranted throughout the course of therapy and the subsequent follow-up.
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Affiliation(s)
- Hana Studentova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic; (H.S.); (A.Z.); (M.S.); (B.M.)
| | - Anezka Zemankova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic; (H.S.); (A.Z.); (M.S.); (B.M.)
| | - Martina Spisarova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic; (H.S.); (A.Z.); (M.S.); (B.M.)
| | - Daniela Skanderova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic;
| | - Zbynek Tudos
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic;
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic; (H.S.); (A.Z.); (M.S.); (B.M.)
| | - Vladimir Student
- Department of Urology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P. Pavlova 6, 77900 Olomouc, Czech Republic
- Correspondence:
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Locally Advanced Kidney Cancer: A New Space for Immunotherapy? Eur Urol Oncol 2021; 5:118-119. [PMID: 34112623 DOI: 10.1016/j.euo.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/20/2022]
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