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Patient selection for cytoreductive nephrectomy in combination with targeted therapies or immune checkpoint inhibitors. Curr Opin Urol 2019; 29:513-520. [DOI: 10.1097/mou.0000000000000658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Bamias A, Tzannis K, Papatsoris A, Oudard S, Beuselinck B, Escudier B, Liontos M, Elaidi TR, Chrisofos M, Stravodimos K, Anastasiou I, Mitropoulos D, Deliveliotis C, Constantinides C, Dimopoulos MA, Bamia C. Prognostic significance of cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma treated with first-line sunitinib: a European multiinstitutional study. Clin Genitourin Cancer 2014; 12:373-83. [PMID: 24819319 DOI: 10.1016/j.clgc.2014.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/BACKGROUND The aim of this study was to evaluate the prognostic role of CN in patients with mRCC and synchronous metastases treated with the VEGF receptor TKI, sunitinib. PATIENTS AND METHODS Patients with a diagnosis of metastases before, at the time of, or within 3 months from the diagnosis of renal cell carcinoma (RCC) and first-line treatment with sunitinib were included. Baseline characteristics were correlated with overall survival (OS) according to hazard ratios estimated from univariate Cox proportional hazards models. Significant factors were then included in a multivariate Cox proportional hazards model. RESULTS One hundred eighty-six patients treated between January 2006 and March 2012 were selected. Thirty-six (19%) had not undergone CN. CN was offered to younger patients with better prognoses. Patients who underwent CN lived significantly longer than patients without CN (median OS, 23.9 [95% confidence interval (CI), 20.8-28.8] vs. 9 [95% CI, 4-16.4] months; P < .001). Multivariate analysis showed that CN had an independent prognostic significance. No specific subgroup benefiting from CN was identified. CONCLUSION CN was an independent favorable prognostic factor in patients with synchronous metastases from RCC, treated with sunitinib. Information regarding the selection of mRCC patients likely to benefit from CN might be derived by ongoing phase III trials.
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Affiliation(s)
- Aristotle Bamias
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG).
| | - Kimon Tzannis
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG)
| | - Athanasios Papatsoris
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Stéphane Oudard
- Dept of General Medical Oncology and Laboratory for Experimental Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | | | - Michalis Liontos
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece
| | | | - Michael Chrisofos
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Konstantinos Stravodimos
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | | | - Dionisios Mitropoulos
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Constantinos Constantinides
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | | | - Christina Bamia
- Hellenic Genito-Urinary Cancer Group (HGUCG); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Athens, Greece
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Köpke T, Bierer S, Wülfing C, Tiemann A, Hertle L, Herrmann E. Multimodality treatment paradigms for renal cell carcinoma: surgery versus targeted agents. Expert Rev Anticancer Ther 2014; 9:763-71. [DOI: 10.1586/era.09.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Oh JJ, Byun SS, Lee SE, Hong SK, Lee ES, Kim HH, Kwak C, Ku JH, Jeong CW, Kim YJ, Kang SH, Hong SH. Partial nephrectomy versus radical nephrectomy for non-metastatic pathological T3a renal cell carcinoma: a multi-institutional comparative analysis. Int J Urol 2013; 21:352-7. [PMID: 24118633 DOI: 10.1111/iju.12283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/18/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the recurrence-free survival of partial nephrectomy and radical nephrectomy in patients with non-metastatic pathological T3a renal cell carcinoma. METHODS We reviewed the records of 3567 patients who had undergone a nephrectomy for renal cell carcinoma at five institutions in Korea from January 2000 to December 2010. The clinical data of 45 patients with pathological T3a renal cell carcinoma in the partial nephrectomy group were compared with 298 patients with pathological T3a renal cell carcinoma in the radical nephrectomy group. The effects of surgical methods on recurrence-free survival were assessed by a multivariate Cox proportional hazard analysis. All comparisons were repeated in subgroup analysis on 63 clinical T1a patients with tumors ≤4 cm. RESULTS During a median 43-month follow-up period, disease recurrence occurred in two patients (4.4%) in the partial nephrectomy group, and 94 patients (31.5%) in the radical nephrectomy group. The results from a multivariate model showed that radical nephrectomy was a significant predictor of recurrence. However, in subgroup analysis that included 63 clinical T1a pathological T3a patients, the recurrence-free survival rates were not significantly different between the two cohorts. The renal function was significantly better preserved in the partial nephrectomy cohort than in the radical nephrectomy cohort. CONCLUSIONS Partial nephrectomy provides similar recurrence-free survival outcomes compared with radical nephrectomy in patients with clinical T1a pathological T3a renal cell carcinoma. However, there seems to be a higher risk of recurrence for large pathological T3a tumors treated by radical nephrectomy compared with small tumors treated by partial nephrectomy. Thus, large tumors with the same pathological T3a renal cell carcinoma grade could have hidden aggressive features.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Darwish OM, Kapur P, Youssef RF, Bagrodia A, Belsante M, Alhalabi F, Sagalowsky AI, Lotan Y, Margulis V. Cumulative number of altered biomarkers in mammalian target of rapamycin pathway is an independent predictor of outcome in patients with clear cell renal cell carcinoma. Urology 2013; 81:581-6. [PMID: 23290145 DOI: 10.1016/j.urology.2012.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/24/2012] [Accepted: 11/19/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the association of the altered expression of the mammalian target of rapamycin (mTOR) pathway components with oncologic outcomes in patients with nonmetastatic clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS Immunohistochemistry for phosphorylated-S6, phosphorylated-mTOR, mTOR, phosphorylated-AKT, hypoxia inducible factor-1α, Raptor, phosphatase and tensin homolog (PTEN), phosphoinositide 3-kinase (PI3K), and phosphorylated 4E-binding protein-1 was performed on tissue microarray constructs of patients treated for nonmetastatic kidney cancer from 1997 to 2010. The relationship between individual altered marker expression and a prognostic marker score (low, intermediate, and high, defined as ≤ 3, 4-5, >5 altered biomarkers, respectively) and oncologic outcome was assessed. RESULTS The study included 419 patients with nonmetastatic ccRCC, with a median follow-up period of 26 months (range 6-150). The tumors were nonorgan confined (pT3-T4) in 86 (20.5%) and high Fuhrman nuclear grade (3-4) in 131 (31%). A low, intermediate, and high prognostic marker score was found in 214 (51%), 152 (36%), and 53 (13%) patients, respectively. Kaplan-Meier analysis demonstrated a statistically significant correlation between the risk groups and disease recurrence and cancer-specific survival. In a multivariate Cox regression analysis controlling for tumor stage and grade, a high marker score was an independent predictor of disease recurrence (hazard ratio 3.3, 95% confidence interval 1.33-8.39, P = .01), and a combination of a high and an intermediate score was an independent predictor of survival (hazard ratio 4.8, 95% confidence interval 1.27-4.78, P = .008). CONCLUSION The cumulative number of aberrantly expressed biomarkers correlated with aggressive tumor biology and inferior oncologic outcomes in patients with ccRCC. Our data support prospective pathway-based exploration of the mTOR signaling cascade to augment current clinicopathologic predictors of oncologic outcomes in patients with ccRCC.
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Affiliation(s)
- Oussama M Darwish
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
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Bex A, Powles T. Selecting patients for cytoreductive nephrectomy in advanced renal cell carcinoma: who and when. Expert Rev Anticancer Ther 2012; 12:787-97. [PMID: 22716495 DOI: 10.1586/era.12.54] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Renal cell carcinoma presents with metastatic disease in approximately 30% of patients at the time of diagnosis. Cytoreductive nephrectomy (CN) of the primary tumor in the face of metastatic disease is part of a multimodality approach including systemic therapy that is based on evidence from randomized trials in the cytokine era. Data from the pretargeted therapy era showed that CN had a clear role in metastatic renal cell carcinoma, increasing life expectancy by approximately 6 months. The substantial improvement in outcomes reported for targeted therapy has challenged the previous role of CN. However, despite the absence of data from Phase III trials, available evidence suggests that some patients may benefit substantially from CN in the era of targeted therapy. This review summarizes current arguments for CN and how to best select patients for surgery. Ongoing trials are key in generating evidence towards a personalized approach to debulking nephrectomy.
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Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Division of Surgical Oncology, Department of Urology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Kenney PA, Wood CG. Integration of surgery and systemic therapy for renal cell carcinoma. Urol Clin North Am 2012; 39:211-31, vii. [PMID: 22487764 DOI: 10.1016/j.ucl.2012.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Proper integration of surgery and systemic therapy is essential for improving outcomes in renal cell carcinoma (RCC). There is no current role for adjuvant therapy after nephrectomy for clinically localized disease. The potential benefits of neoadjuvant therapy for locally advanced nonmetastatic disease are in need of further study. In metastatic disease, the proper integration of cytoreductive surgery and systemic therapy remains to be elucidated. Presurgical targeted therapy is feasible and may be beneficial. Pending the results of randomized controlled trials, upfront cytoreductive nephrectomy in appropriate patients will likely continue as the paradigm of choice in metastatic RCC.
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Affiliation(s)
- Patrick A Kenney
- Urologic Oncology, Department of Urology, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA
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Bessede T, Pignot G, Patard JJ. Safety Issues and Rationale for Neoadjuvant Approaches in Renal Cell Carcinoma. Eur Urol 2011; 60:972-4. [DOI: 10.1016/j.eururo.2011.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 06/03/2011] [Indexed: 10/18/2022]
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Margulis V, Master VA, Cost NG, Leibovich BC, Joniau S, Kuczyk M, Mulders PF, Kirkali Z, Wirth MP, Hirao Y, Rawal S, Chong TW, Wood CG. International consultation on urologic diseases and the European Association of Urology international consultation on locally advanced renal cell carcinoma. Eur Urol 2011; 60:673-83. [PMID: 21752533 DOI: 10.1016/j.eururo.2011.06.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/20/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Although an ever-increasing number of patients are being incidentally diagnosed with small renal masses, there is still a sizable portion of patients with renal cell carcinoma (RCC) who present with locally advanced or metastatic disease. Those with locally advanced disease present a challenge because they may be difficult to distinguish from those with organ-confined disease at the time of diagnosis. However, this distinction is important because they may require a different management strategy. These advanced RCC patients include those with venous tumour thrombi, extracapsular tumour extension, adjacent organ involvement, as well as nodal disease. EVIDENCE ACQUISITION A thorough literature search of the following terms was undertaken: advanced renal cell carcinoma, renal cell carcinoma venous tumour thrombi, renal cell carcinoma extra-capsular extension, renal cell carcinoma nodal metastasis, and locally recurrent renal cell carcinoma. An international expert panel convened by the International Consultation on Urologic Diseases and the European Association of Urology reviewed these articles. EVIDENCE SYNTHESIS Review of the available literature allowed for assessment of the level of evidence for the diagnosis, management, and therapy of locally advanced RCC with the ultimate goal of providing a synthesis of this information with a consensus statement from leaders in the field. CONCLUSIONS Despite the advances in prognostic markers and targeted molecular therapies for RCC, currently the only curative treatment for locally advanced RCC is aggressive surgical resection.
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Kondo T, Hashimoto Y, Kobayashi H, Iizuka J, Nishikawa T, Nakano M, Tanabe K. Presurgical targeted therapy with tyrosine kinase inhibitors for advanced renal cell carcinoma: clinical results and histopathological therapeutic effects. Jpn J Clin Oncol 2010; 40:1173-9. [PMID: 20696817 DOI: 10.1093/jjco/hyq150] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We retrospectively analyzed our patients with advanced renal cell carcinoma who underwent presurgical targeted therapy with tyrosine kinase inhibitors to clarify the safety and clinical benefit. The histopathological effect of this treatment was also examined. METHODS Between July 2005 and February 2010, nine patients with advanced renal cell carcinoma who were treated with tyrosine kinase inhibitors before surgery were the subjects of this study. Consolidative surgery was considered when these tumors showed clinical response or stable disease while on targeted therapy without evidence of disease progression at other sites. RESULTS The agents used were sorafenib in seven patients and sunitinib in two. The median duration of presurgical therapy was 12.2 weeks, and seven patients had less than 4 months of treatment. Tumor reduction at 10-30% was obtained in all patients but one. Perioperative complications were observed in five of nine patients. Major complications occurred in two patients, including intraoperative excessive bleeding and delayed localized intraperitoneal abscess. Minor complications were found in three. The characteristics of the histopathological effect of tyrosine kinase inhibitors consisted of marked atrophy of the capillary sinus, confirming the pharmacological mechanisms of these agents. Other findings included nuclear pyknosis and degeneration of tumor cells. CONCLUSIONS Presurgical targeted therapy with tyrosine kinase inhibitors appears to be feasible in most patients with advanced renal cell carcinoma. However, the indications, the clinical benefit and the standard protocol still remain to be determined. Therapeutic effects in the histology were compatible to their pharmacological effects.
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Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Bex A, Van der Veldt AAM, Blank C, Meijerink MR, Boven E, Haanen JBAG. Progression of a caval vein thrombus in two patients with primary renal cell carcinoma on pretreatment with sunitinib. Acta Oncol 2010; 49:520-3. [PMID: 20105087 DOI: 10.3109/02841860903521111] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kutikov A, Uzzo RG, Caraway A, Reese CT, Egleston BL, Chen DYT, Viterbo R, Greenberg RE, Wong YN, Raman JD, Boorjian SA. Use of systemic therapy and factors affecting survival for patients undergoing cytoreductive nephrectomy. BJU Int 2009; 106:218-23. [PMID: 19922542 DOI: 10.1111/j.1464-410x.2009.09079.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a multi-institutional experience evaluating the use of systemic therapy in patients undergoing cytoreductive nephrectomy (CN), as prospective randomized trials showed a survival benefit for CN in patients with metastatic renal cell carcinoma treated with immunotherapy, and these data have been extrapolated to support CN in the era of targeted therapy, but the likelihood that patients with metastatic kidney cancer who undergo CN will receive systemic treatment afterward remains poorly defined. PATIENTS AND METHODS In all, 141 patients who underwent CN between 1990 and 2008 were identified from our Institutional Kidney Cancer Registries. Kaplan-Meier analyses and Cox regression models were used to assess the effect of clinicopathological and perioperative variables on patients' subsequent receipt of systemic therapy, and survival after CN. RESULTS Overall, 98 of the 141 patients (69.5%) received postoperative systemic treatment, at a median (range) of 2.5 (0.1-61.5) months after CN. In this group, 52 (53%) patients received immunotherapy, 34 (35%) targeted agents, and 12 (12%) other regimens. By contrast, 43 patients (31%) did not receive systemic therapy, because of rapid disease progression (13, 30%), decision for surveillance by medical oncology (nine, 21%), patient refusal (10, 23%), perioperative death (eight, 19%), and unknown reasons in three (7%). The median (range) survival after CN was 16.7 (0-120) months. The risk of death after surgery correlated with the number of metastatic sites (P = 0.012) and symptoms (P = 0.001) at presentation, poor performance status (P = 0.001), high tumour grade (P = 0.006), and presence of sarcomatoid features (P < 0.024). CONCLUSION Nearly a third of patients undergoing CN did not receive systemic treatment. While some were electively observed or declined therapy, others did not receive treatment due to rapidly progressive disease. Further investigation is warranted to identify those patients at highest risk of rapid postoperative disease progression who might benefit instead from an initial approach to treatment with systemic therapy.
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Affiliation(s)
- Alexander Kutikov
- Department of Urological Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Di Lorenzo G, Autorino R, Sternberg CN. Metastatic renal cell carcinoma: recent advances in the targeted therapy era. Eur Urol 2009; 56:959-71. [PMID: 19748725 DOI: 10.1016/j.eururo.2009.09.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 09/01/2009] [Indexed: 12/18/2022]
Abstract
CONTEXT The treatment of metastatic renal cell carcinoma (mRCC) has recently evolved from being predominantly cytokine based to being grounded in the use of targeted agents. OBJECTIVE To analyse current evidence on the medical management of mRCC. EVIDENCE ACQUISITION The PubMed and Medline databases were searched for articles published as of 15 July 2009. Only articles published in English were considered. The search terms were metastatic renal cell cancer, targeted therapy, and immunotherapy. Proceedings from the 2000-2009 conferences of the American Society of Clinical Oncology, the American Urological Association, and the European Association of Urology were also searched for relevant abstracts. EVIDENCE SYNTHESIS Sunitinib has recently emerged as a front-line standard of care in mRCC. Temsirolimus is considered a first-line therapy for patients with poor risk features. Bevacizumab/interferon is likely to be the next U.S. Food and Drug Administration-approved first-line treatment. The use of sorafenib has moved toward second-line and later therapy. Everolimus was the first agent to show clinical benefit post-tyrosine kinase inhibitor failure in a phase 3 study and is considered the standard of care in this setting. Temsirolimus provided benefit to patients with non-clear-cell histology. In preliminary results, a favourable risk-benefit ratio has been shown with pazopanib and axitinib as first- and second-line treatment. Until combination therapy is clearly shown to be superior to monotherapy, it should be used in the context of a clinical trial. Deciding which is the best sequence to use in mRCC patients remains up to the best judgement of the treating physician. Cytoreductive nephrectomy in the presence of metastatic disease is often indicated as part of an integrated management strategy. CONCLUSIONS Given considerable advances in understanding the biology of mRCC, several new drugs have recently been developed, offering an increasing number of treatment options. A treatment algorithm based on the best available evidence so far can be therefore postulated, though it continues to evolve as data from ongoing trials become available.
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Affiliation(s)
- Giuseppe Di Lorenzo
- Cattedra di Oncologia Medica, Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Università degli Studi Federico II, Napoli, Italy.
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Abel EJ, Wood CG. Cytoreductive nephrectomy for metastatic RCC in the era of targeted therapy. Nat Rev Urol 2009; 6:375-83. [PMID: 19528960 DOI: 10.1038/nrurol.2009.102] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastatic renal cell carcinoma (RCC) has traditionally been associated with a poor prognosis with few effective treatments. In the multimodal treatment of metastatic RCC, cytoreductive nephrectomy (CN) became the standard of care after two randomized trials demonstrated a benefit in overall survival in patients who received CN prior to treatment with interferon. More recently, several agents (sunitinib, sorafenib, temsirolimus, everolimus and bevacizumab) have been developed that target angiogenesis and the cellular growth pathways involved in metastatic RCC. These targeted agents have demonstrated improved outcomes compared to cytokine therapy, and have transformed metastatic RCC treatment. Targeted agents are being used as a first-line systemic treatment in patients with metastatic RCC with unprecedented success, and many studies are now focusing on the role of CN in combination with these agents for patients with metastatic RCC.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Jeldres C, Patard JJ, Capitanio U, Perrotte P, Suardi N, Crepel M, Ficarra V, Cindolo L, de La Taille A, Tostain J, Pfister C, Albouy B, Colombel M, Méjean A, Lang H, Jacqmin D, Bernhard JC, Ferrière JM, Bensalah K, Karakiewicz PI. Partial Versus Radical Nephrectomy in Patients With Adverse Clinical or Pathologic Characteristics. Urology 2009; 73:1300-5. [PMID: 19376568 DOI: 10.1016/j.urology.2008.08.492] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/21/2008] [Accepted: 08/25/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Claudio Jeldres
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Health Center, Montreal, Quebec, Canada
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Polcari AJ, Gorbonos A, Milner JE, Flanigan RC. The role of cytoreductive nephrectomy in the era of molecular targeted therapy. Int J Urol 2009; 16:227-33. [DOI: 10.1111/j.1442-2042.2008.02245.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sonpavde G. Neoadjuvant therapy as a paradigm to develop systemic cancer therapy. Drug Dev Res 2008. [DOI: 10.1002/ddr.20270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The role of cytoreductive nephrectomy for renal cell carcinoma in the era of targeted therapy. ACTA ACUST UNITED AC 2008; 5:698-9. [PMID: 18852722 DOI: 10.1038/ncponc1256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 09/08/2008] [Indexed: 11/08/2022]
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The New Medical Treatment of Metastatic Renal Cell Carcinoma: A Good Debut, A Lot of Open Questions. Eur Urol 2008; 54:252-5. [DOI: 10.1016/j.eururo.2008.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 01/16/2023]
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