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Klontzas ME, Koltsakis E, Kalarakis G, Trpkov K, Papathomas T, Sun N, Walch A, Karantanas AH, Tzortzakakis A. A pilot radiometabolomics integration study for the characterization of renal oncocytic neoplasia. Sci Rep 2023; 13:12594. [PMID: 37537362 PMCID: PMC10400617 DOI: 10.1038/s41598-023-39809-9] [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: 01/20/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Differentiating benign renal oncocytic tumors and malignant renal cell carcinoma (RCC) on imaging and histopathology is a critical problem that presents an everyday clinical challenge. This manuscript aims to demonstrate a novel methodology integrating metabolomics with radiomics features (RF) to differentiate between benign oncocytic neoplasia and malignant renal tumors. For this purpose, thirty-three renal tumors (14 renal oncocytic tumors and 19 RCC) were prospectively collected and histopathologically characterised. Matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI-MSI) was used to extract metabolomics data, while RF were extracted from CT scans of the same tumors. Statistical integration was used to generate multilevel network communities of -omics features. Metabolites and RF critical for the differentiation between the two groups (delta centrality > 0.1) were used for pathway enrichment analysis and machine learning classifier (XGboost) development. Receiver operating characteristics (ROC) curves and areas under the curve (AUC) were used to assess classifier performance. Radiometabolomics analysis demonstrated differential network node configuration between benign and malignant renal tumors. Fourteen nodes (6 RF and 8 metabolites) were crucial in distinguishing between the two groups. The combined radiometabolomics model achieved an AUC of 86.4%, whereas metabolomics-only and radiomics-only classifiers achieved AUC of 72.7% and 68.2%, respectively. Analysis of significant metabolite nodes identified three distinct tumour clusters (malignant, benign, and mixed) and differentially enriched metabolic pathways. In conclusion, radiometabolomics integration has been presented as an approach to evaluate disease entities. In our case study, the method identified RF and metabolites important in differentiating between benign oncocytic neoplasia and malignant renal tumors, highlighting pathways differentially expressed between the two groups. Key metabolites and RF identified by radiometabolomics can be used to improve the identification and differentiation between renal neoplasms.
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Affiliation(s)
- Michail E Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Heraklion, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Crete, Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Emmanouil Koltsakis
- Department of Diagnostic Radiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Georgios Kalarakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Diagnostic Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- University of Crete, School of Medicine, 71500, Heraklion, Greece
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Alberta Precision Labs, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Thomas Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Clinical Pathology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Na Sun
- Research Unit Analytical Pathology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Apostolos H Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Heraklion, Greece
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), Crete, Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece
| | - Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
- Medical Radiation Physics and Nuclear Medicine, Section for Nuclear Medicine, Karolinska University Hospital, Huddinge, C2:74, 14 186, Stockholm, Sweden.
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Zhang H, Zhang L, Chen S, Yao M, Ma Z, Yuan Y. Yeast-based evolutionary modeling of androgen receptor mutations and natural selection. PLoS Genet 2022; 18:e1010518. [PMID: 36459502 PMCID: PMC9718406 DOI: 10.1371/journal.pgen.1010518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
Cancer progression is associated with the evolutionary accumulation of genetic mutations that are biologically significant. Mutations of the androgen receptor (AR) are associated with the development of prostate cancer (PCa) by responding to non-androgenic hormones, and the lack of annotations in their responsiveness to hormone ligands remains a daunting challenge. Here, we have used a yeast reporter system to quickly evaluate the responsiveness of all fifty clinical AR mutations to a variety of steroidal ligands including dihydrotestosterone (DHT), 17β-estradiol (E2), progesterone (PROG), and cyproterone acetate (CPA). Based on an AR-driven reporter that synthesizes histidine, a basic amino acid required for yeast survival and propagation, the yeast reporter system enabling clonal selection was further empowered by combining with a random DNA mutagenesis library to simulate the natural evolution of AR gene under the selective pressures of steroidal ligands. In a time-frame of 1-2 weeks, 19 AR mutants were identified, in which 11 AR mutants were validated for activation by tested steroidal compounds. The high efficiency of our artificial evolution strategy was further evidenced by a sequential selection that enabled the discovery of multipoint AR mutations and evolution directions under the pressure of steroidal ligands. In summary, our designer yeast is a portable reporter module that can be readily adapted to streamline high-throughput AR-compound screening, used as a PCa clinical reference, and combined with additional bioassay systems to further extend its potential.
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Affiliation(s)
- Haoran Zhang
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, People’s Republic of China
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People’s Republic of China
| | - Lu Zhang
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, People’s Republic of China
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People’s Republic of China
| | - Shaoyong Chen
- Hematology-Oncology Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mingdong Yao
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, People’s Republic of China
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People’s Republic of China
| | - Zhenyi Ma
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, People’s Republic of China
| | - Yingjin Yuan
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, People’s Republic of China
- School of Chemical Engineering and Technology, Tianjin University, Tianjin, People’s Republic of China
- * E-mail:
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Bhandari NR, Kamel MH, Kent EE, McAdam-Marx C, Ounpraseuth ST, Tilford JM, Payakachat N. Association of Health-Related Quality of Life with Overall Survival in Older Americans with Kidney Cancer: A Population-Based Cohort Study. Healthcare (Basel) 2021; 9:healthcare9101344. [PMID: 34683025 PMCID: PMC8544450 DOI: 10.3390/healthcare9101344] [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: 09/06/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Our purpose was to evaluate associations between health-related quality of life (HRQoL) and overall survival (OS) in a population-based sample of kidney cancer (KC) patients in the US. Methods: We analyzed a longitudinal cohort (n = 188) using the Surveillance, Epidemiology, and End Results (SEER) database linked with the Medicare Health Outcomes Survey (MHOS; 1998–2014). We included KC patients aged ≥65 years, with a completed MHOS during baseline (pre-diagnosis) and another during follow-up (post-diagnosis). We reported HRQoL as physical component summary (PCS) and mental component summary (MCS) scores and OS as number of months from diagnosis to death/end-of-follow-up. Findings were reported as adjusted hazard ratios (aHRs (95% CI)) from Cox Proportional Hazard models. Results: The aHRs associated with a 3-point lower average (baseline and follow-up) or a 3-point within-patient decline (change) in HRQoL with OS were: (a) baseline: PCS (1.08 (1.01–1.16)) and MCS (1.09 (1.01–1.18)); (b) follow-up: PCS (1.21 (1.12–1.31)) and MCS (1.11 (1.04–1.19)); and (c) change: PCS (1.10 (1.02–1.18)) and MCS (1.02 (0.95–1.10)). Conclusions: Reduced HRQoL was associated with worse OS and this association was strongest for post-diagnosis PCS, followed by change in PCS and pre-diagnosis PCS. Findings highlight the prognostic value of HRQoL on OS, emphasize the importance of monitoring PCS in evaluating KC prognosis, and contribute additional evidence to support the implementation of patient-reported outcomes in clinical settings.
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Affiliation(s)
- Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA;
| | - Mohamed H. Kamel
- Department of Urology, University of Cincinnati, Cincinnati, OH 45221, USA;
- Department of Urology, Ain Shams University, Cairo 11566, Egypt
| | - Erin E. Kent
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27514, USA
| | - Carrie McAdam-Marx
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Songthip T. Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA;
| | - J. Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA;
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205, USA;
- Correspondence:
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Mkhobongo B, Chandran R, Abrahamse H. The Role of Melanoma Cell-Derived Exosomes (MTEX) and Photodynamic Therapy (PDT) within a Tumor Microenvironment. Int J Mol Sci 2021; 22:ijms22189726. [PMID: 34575889 PMCID: PMC8465141 DOI: 10.3390/ijms22189726] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
Photodynamic Therapy (PDT), an unconventional cancer therapy with optimistic desirable effects, utilizes the delivery of a photosensitizer (PS) that is activated by light at a particular wavelength and inducing oxidative cytotoxic damage of a tumor and its surrounding vasculature. Deeper seated tumors such as internally metastasized melanomas are more difficult to treat with PDT as the penetration of laser light to those sites is less. Limitations in targeting melanomas can also be attributed to melanin pigments that hinder laser light from reaching targeted sites. Exosomes serve as naturally occurring nanoparticles that can be re-assembled with PSs, improving targeted cellular absorption of photosensitizing agents during PDT. Additionally, studies indicate that exosomes released from PDT-treated tumor cells play a critical role in mediating anti-tumor immune responses. This review collates the role of Melanoma Cell-Derived Exosomes (MTEX) in immune response mediation and metastasis. Tumor Cell-Derived Exosomes (TEX) post PDT treatment are also reviewed, as well as the effects of exosomes as carriers of photosensitizers and delivery systems for PDT. The understanding and research on the role of melanoma exosomes induced by Photodynamic Therapy and their tumor microenvironment will assist in future research in treatment prospects and implications.
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Dragomir I, Akbar A, Cassidy JW, Patel N, Clifford HW, Contino G. Identifying Cancer Drivers Using DRIVE: A Feature-Based Machine Learning Model for a Pan-Cancer Assessment of Somatic Missense Mutations. Cancers (Basel) 2021; 13:cancers13112779. [PMID: 34205004 PMCID: PMC8199862 DOI: 10.3390/cancers13112779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Sporadic cancer develops from the accrual of somatic mutations. Out of all small-scale somatic aberrations in coding regions, 95% are base substitutions, with 90% being missense mutations. While multiple studies focused on the importance of this mutation type, a machine learning method based on the number of protein-protein interactions (PPIs) has not been fully explored. This study aims to develop an improved computational method for driver identification, validation and evaluation (DRIVE), which is compared to other methods for assessing its performance. DRIVE aims at distinguishing between driver and passenger mutations using a feature-based learning approach comprising two levels of biological classification for a pan-cancer assessment of somatic mutations. Gene-level features include the maximum number of protein-protein interactions, the biological process and the type of post-translational modifications (PTMs) while mutation-level features are based on pathogenicity scores. Multiple supervised classification algorithms were trained on Genomics Evidence Neoplasia Information Exchange (GENIE) project data and then tested on an independent dataset from The Cancer Genome Atlas (TCGA) study. Finally, the most powerful classifier using DRIVE was evaluated on a benchmark dataset, which showed a better overall performance compared to other state-of-the-art methodologies, however, considerable care must be taken due to the reduced size of the dataset. DRIVE outlines the outstanding potential that multiple levels of a feature-based learning model will play in the future of oncology-based precision medicine.
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Affiliation(s)
- Ionut Dragomir
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- Centre for Computational Biology, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Adnan Akbar
- Cambridge Cancer Genomics, Cambridge CB2 1QN, UK; (A.A.); (J.W.C.); (N.P.); (H.W.C.)
| | - John W. Cassidy
- Cambridge Cancer Genomics, Cambridge CB2 1QN, UK; (A.A.); (J.W.C.); (N.P.); (H.W.C.)
| | - Nirmesh Patel
- Cambridge Cancer Genomics, Cambridge CB2 1QN, UK; (A.A.); (J.W.C.); (N.P.); (H.W.C.)
| | - Harry W. Clifford
- Cambridge Cancer Genomics, Cambridge CB2 1QN, UK; (A.A.); (J.W.C.); (N.P.); (H.W.C.)
| | - Gianmarco Contino
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- Von Hügel Institute, St Edmund College, University of Cambridge, Cambridge CB3 0BN, UK
- Queen Elizabeth Hospital, University of Birmingham Hospital Trust, Edgbaston, Birmingham B15 2GW, UK
- Correspondence:
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Cechova M, Chocholaty M, Babjuk M, Zima T, Havlova K, Koldova M, Schmidt M, Kalousova M. Diagnostic and prognostic value of placental growth factor serum concentration in clear cell renal cell carcinoma. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:375-379. [PMID: 33612835 DOI: 10.5507/bp.2021.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND AIM Placental Growth Factor (PlGF) plays a crucial role in angiogenesis and was identified as a potential prognostic biomarker in various types of cancer. Therefore, we evaluated the diagnostic accuracy and prognostic value of PlGF serum concentration in patients with clear cell renal cell carcinoma (ccRCC). PATIENTS AND METHODS A total of 49 patients subjected to partial or radical nephrectomy for ccRCC [localized without relapse (lccRCC; n=31), localized with later relapse (rccRCC; n=8), primary metastatic cancer (mccRCC; n=10); median of follow-up 4.4 years] were enrolled in a prospective study to assess the significance of PlGF serum concentration. PlGF was measured prior to surgery and 3 months postoperatively. Our control group consisted of 38 healthy subjects. RESULTS PlGF serum concentration was significantly higher in ccRCC compared to controls (P=0.002). The cut-off value of PlGF concentration for the risk of ccRCC was determined at 12.71 pg/mL (AUC=0.729; P=0.0001). Prior to surgery, among ccRCC subgroups, significantly higher PlGF concentration was detected in mccRCC compared to lccRCC (P=0.002). Postoperatively, we observed a tendency to higher PlGF serum concentration in rccRCC compared to lccRCC subgroup, however without significance (P=0.17). The cut-off value for the risk of relapse was 11.41 pg/mL (AUC=0.792; P=0.0003). In subjects with localized ccRCC with PlGF concentration below 11.41 pg/mL 3-years cancer specific survival was 93% compared to 61% in subject with concentration above the cut-off value (P=0.018). CONCLUSION Based on our findings, PlGF serum concentration seems to be a useful biomarker in diagnostics and prediction of prognosis in ccRCC.
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Affiliation(s)
| | | | - Marek Babjuk
- Department of Urology, University Hospital Motol and 2
| | - Tomas Zima
- Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and 1
| | - Klara Havlova
- Department of Urology, University Hospital Motol and 2
| | | | - Marek Schmidt
- Department of Urology, University Hospital Motol and 2
| | - Marta Kalousova
- Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital and 1
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Pan KH, Jian L, Chen WJ, Nikzad AA, Kong FQ, Bin X, Wang YL, Chen M. Diagnostic Performance of Contrast-Enhanced Ultrasound in Renal Cancer: A Meta-Analysis. Front Oncol 2020; 10:586949. [PMID: 33312952 PMCID: PMC7703431 DOI: 10.3389/fonc.2020.586949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Contrast-enhanced ultrasound (CEUS) is an examination mode for detecting blood vessels in tissues, and it has been gradually used in the diagnosis of kidney cancer in recent years. This study explores the value of contrast-enhanced ultrasound in the clinical diagnosis of renal cancer, and provides an accurate and effective method for clinical diagnosis of renal cancer. Methods CEUS and RCC were selected as the keywords. Searching the PubMed and Embase from 2007 to 2020, the original data were abstracted and performed heterogeneity test with the Meta-Disc software. The weighted sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were calculated, as well as the summary receiver operating characteristic (SROC) curve. Further estimated the diagnostic value of CEUS in the research of renal cancer by calculating the area under the curve (AUC). The quality of evidence in researches was evaluated by QUADAS items. Meta-disc, Review Manager 5.3, and STATA 13 were used. Results A total of 20 studies were adopted for Meta-analysis. The weighted sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.97, 0.86, 6.8, 0.04 and 171, respectively; and AUC was 0.97. The results showed that there was high heterogeneity. Conclusion CEUS technology has a good diagnostic value for RCC.
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Affiliation(s)
- Ke-Hao Pan
- Affiliated Zhongda Hospital of Southeast University, Southeast University, Nanjing, China
| | - Li Jian
- Department of Urology, Jinhu People's Hospital, Jinghua, China
| | - Wei-Jun Chen
- Department of Urology, JinTan People's Hospital, Changzhou, China
| | - Abdul Aziz Nikzad
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Fang Q Kong
- Department of Nosocomial Infection, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Xu Bin
- Affiliated Zhongda Hospital of Southeast University, Southeast University, Nanjing, China
| | - Ya-Li Wang
- Affiliated Zhongda Hospital of Southeast University, Southeast University, Nanjing, China
| | - Ming Chen
- Affiliated Zhongda Hospital of Southeast University, Southeast University, Nanjing, China
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Khetani VV, Portal DE, Shah MR, Mayer T, Singer EA. Combination drug regimens for metastatic clear cell renal cell carcinoma. World J Clin Oncol 2020; 11:541-562. [PMID: 32879843 PMCID: PMC7443831 DOI: 10.5306/wjco.v11.i8.541] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/11/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinomas (RCC) make up about 90% of kidney cancers, of which 80% are of the clear cell subtype. About 20% of patients are already metastatic at the time of diagnosis. Initial treatment is often cytoreductive nephrectomy, but systemic therapy is required for advanced RCC. Single agent targeted therapies are moderately toxic and only somewhat effective, leading to development of immunotherapies and combination therapies. This review identifies limitations of monotherapies for metastatic renal cell carcinoma, discusses recent advances in combination therapies, and highlights therapeutic options under development. The goal behind combining various modalities of systemic therapy is to potentiate a synergistic antitumor effect. However, combining targeted therapies may cause increased toxicity. The initial attempts to create therapeutic combinations based on inhibition of the vascular endothelial growth factor or mammalian target of rapamycin pathways were largely unsuccessful in achieving a profile of increased synergy without increased toxicity. To date, five combination therapies have been approved by the U.S. Food and Drug Administration, with the most recently approved therapies being a combination of checkpoint inhibition plus targeted therapy. Several other combination therapies are under development, including some in the phase 3 stage. The new wave of combination therapies for metastatic RCC has the potential to increase response rates and improve survival outcomes while maintaining tolerable side effect profiles.
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Affiliation(s)
- Viraj V Khetani
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
| | - Daniella E Portal
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
| | - Mansi R Shah
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
| | - Tina Mayer
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
| | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, United States
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Singh P, Somani K. Latent distant metastasis of renal cell carcinoma to skin: A case report. Clin Case Rep 2020; 8:1138-1141. [PMID: 32695344 PMCID: PMC7364088 DOI: 10.1002/ccr3.2844] [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: 01/10/2020] [Revised: 02/29/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
Renal cell carcinoma (RCC) is known to recur decades after nephrectomy; however, isolated cutaneous metastasis is rare. Previous clinical history plays vital role. Newly occurring skin lesions in follow-through patients of RCC should be carefully evaluated, and possibility of its metastasis should be acknowledged. Disease-free survival postmetastasectomy is possible.
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Affiliation(s)
- Pretty Singh
- Department of PathologyApollomedics Super Speciality HospitalLucknowIndia
| | - Kavita Somani
- Department of PathologyApollomedics Super Speciality HospitalLucknowIndia
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10
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Wang W, Cao K, Jin S, Zhu X, Ding J, Peng W. Differentiation of renal cell carcinoma subtypes through MRI-based radiomics analysis. Eur Radiol 2020; 30:5738-5747. [PMID: 32367419 DOI: 10.1007/s00330-020-06896-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/02/2020] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To explore whether clear cell renal cell carcinoma (ccRCC), papillary renal cell carcinoma (pRCC), and chromophobe renal cell carcinoma (cRCC) can be distinguished using radiomics features extracted from magnetic resonance (MR) images. METHODS Seventy-seven patients (ccRCC = 32, pRCC = 23, cRCC = 22) underwent MRI before surgery between May 2013 and August 2018 in this retrospective study. Thirty-nine radiomics features were extracted from tumor volumes on three sequences (T2WI, EN-T1WI CMP, and EN-T1WI NP). The Kruskal-Wallis test with Bonferonni correction and variance threshold were used for feature selection among the three RCC subtypes. ROC curves for the three subtypes were generated based on radiomics features. AUC, accuracy, sensitivity, and specificity for subtype differentiation are reported. Linear discriminant analysis (LDA) was used to assess the discriminative ability of these radiomics features. RESULTS Significant radiomics features among the three subtypes were identified, and ROC curves achieved excellent AUCs for T2WI, EN-T1WI CMP, EN-T1WI NP, and combined three MR sequences (0.631, 0.790, 0.959, and 0.959 between ccRCC and cRCC; 0.688, 0.854, 0.909, and 0.955 between pRCC and cRCC; 0.747, 0.810, 0.814, and 0.890 between ccRCC and pRCC). In addition, LDA demonstrated the three RCC subtypes were correctly classified by radiomics analysis (66.2% for EN-T1WI CMP, 71.4% for EN-T1WI NP, 55.8% for T2WI, and 71.4% for the combined three MR sequences). CONCLUSIONS Radiomics analysis can be used to differentiate among ccRCC, pRCC, and cRCC based on radiomics features extracted from multiple-sequence MRI and may help diagnose and treat RCC patients in the future, while further study is still needed. KEY POINTS • Radiomics features on multiple-sequence MRI can help differentiate the three subtypes of renal cell carcinoma (clear cell, papillary renal cell, and chromophobe renal cell carcinoma). • Radiomics features based on MRI indicate greater textural heterogeneity on ccRCCs than pRCCs and cRCCs (the highest AUCs on EN-T1WI NP are 0.814 for ccRCCs vs pRCCs and 0.959 for ccRCCs vs cRCCs, respectively). • There is a significant difference in the textural heterogeneity of radiomics features between pRCCs and cRCCs (the AUC is 0.909, 0.854, and 0.688 on EN-T1WI NP, EN-T1WI CMP, and T2WI, respectively).
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Affiliation(s)
- Wei Wang
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.
| | - KaiMing Cao
- Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150, Jimo Rd, Shanghai, 200120, People's Republic of China
| | - ShengMing Jin
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Urology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - XiaoLi Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - JianHui Ding
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
| | - WeiJun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dongan Rd, Shanghai, 200032, People's Republic of China
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Sun SS, Fu Y, Lin JY. Upregulation of MYBL2 independently predicts a poorer prognosis in patients with clear cell renal cell carcinoma. Oncol Lett 2020; 19:2765-2772. [PMID: 32218829 PMCID: PMC7068560 DOI: 10.3892/ol.2020.11408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
MYB protooncogene-like 2 (MYBL2) is a transcription factor that is upregulated and significantly associated with various human cancer types. However, the potential role of MYBL2 in clear cell renal cell carcinoma (ccRCC) is yet to be elucidated. Therefore, the expression and biological functions of MYBL2 in ccRCC were assessed in the current study using The Cancer Genome Atlas (TCGA). A Wilcoxon signed-rank test was performed to compare MYBL2 expression between ccRCC and normal tissues. Moreover, the association between MYBL2 expression and various clinicopathological factors was estimated using both the Wilcoxon signed-rank test and logistic regression. The differences in prognosis between patients with high- and low-MYBL2 expression were analyzed via the Kaplan-Meier method and Cox regression analysis. Finally, gene set enrichment analysis (GSEA) was performed to investigate the biofunctions of MYBL2 in ccRCC. It was revealed that MYBL2 was upregulated in ccRCC, and that the MYBL2 high-expression phenotype was significantly associated with sex, a high histological grade, an advanced clinical stage, tumor stage, lymph node metastasis, distant metastasis and poor overall survival (OS). It was also revealed, via the Cox regression analysis, that the upregulation of MYBL2 expression was able to independently predict a poor prognosis in patients with ccRCC. GSEA indicated that the intestinal immune network for IgA production, primary immunodeficiency, the janus kinase (JAK)-signal transducer and activator of transcription (STAT) signaling pathway, the cytosolic DNA-sensing pathway, the p53 signaling pathway and the chemokine signaling pathway were all enriched in the high-MYBL2 expression datasets. In conclusion, the present findings indicate that MYBL2 may be used as an independent prognostic factor in patients with ccRCC.
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Affiliation(s)
- Shan-Shan Sun
- Department of Pharmacy, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yang Fu
- Department of Urology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Jian-Yang Lin
- Department of Pharmacy, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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12
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Wei W, Peng R, Kuang L, Xu C, Cao Y, Zeng L, Wen X, Qin Q, Zheng C, Li W, Xia S. Evaluation of immunotherapy and targeted therapy treatment on renal cell carcinoma: A Bayesian network analysis. Oncol Lett 2020; 19:261-270. [PMID: 31897138 PMCID: PMC6924115 DOI: 10.3892/ol.2019.11094] [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: 02/28/2019] [Accepted: 10/10/2019] [Indexed: 11/05/2022] Open
Abstract
Clinical trials have previously assessed various therapies for renal cell carcinoma (RCC); however, there is currently a lack of direct comparisons between these therapies. The present study identified published studies on RCC through Web of Science, PubMed, EMBASE, Cochrane Library of Controlled Trials and Clinical trials.gov that were written in the English language and published by February 2019. The data were selected and extracted independently by two reviewers. Standard pair-wise meta-analyses were performed using Stata. Network meta-analyses were subsequently performed using WinBUGS (version 1.4.3). The primary outcome of the present study was progression-free survival (PFS). Secondary outcomes included overall survival (OS), objective response rate (ORR) and adverse events of various targeted therapies. The results were presented as cumulative odds ratio, hazard ratio, corresponding 95% confidence interval and the surface under the cumulative ranking curve, which was used to rank the probabilities and outcome of each treatment in RCC. A total of 31 eligible publications for 18 randomized controlled trials consisting of 11,498 participants were included in the present study. The network meta-analyses revealed that a combination of lenvantinib and everolimus ranked first out of 16 treatments in terms of PFS, OS and ORR (probability of 54.0, 53.4 and 61.0%, respectively).
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Affiliation(s)
- Wei Wei
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Ruihao Peng
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Lishan Kuang
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Changyuan Xu
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Yan Cao
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Luqing Zeng
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Ximei Wen
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Qianqian Qin
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Cuncai Zheng
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Wenyun Li
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
| | - Sujian Xia
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong 510632, P.R. China
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13
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Diagnostic Imaging in Renal Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Wang X, Li R, Chen R, Huang G, Zhou X, Liu J. Prognostic Values of TIGAR Expression and 18F-FDG PET/CT in Clear Cell Renal Cell Carcinoma. J Cancer 2020; 11:1-8. [PMID: 31892967 PMCID: PMC6930409 DOI: 10.7150/jca.33442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
Aim: Evaluation of 18F-FDG accumulation using PET/CT is an potential imaging biomarker to reflect tumor metabolic burdens and to help predict prognosis in renal cell carcinoma (RCC). p53-induced glycolysis and apoptosis regulator (TIGAR) is a protein regulates glycolytic activity and glucose metabolism. The deregulated TIGAR expression has been associated with tumorigenesis and poor disease prognosis in several cancers. The purpose of this study is to evaluate the impact of the TIGAR expression and the maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT on survival for patients with clear cell RCC. Methods: A total of 62 patients with confirmed clear cell RCC were included in this retrospective study. The TIGAR expression of tumors were determined through immunohistochemistry staining. The SUVmax of clear cell RCC lesions were assessed using 18F-FDG PET/CT. The impact of TIGAR expression and SUVmax on overall survival was evaluated by the Cox proportional hazards model and the Kaplan-Meier survival analysis. Results: Increased TIGAR staining was associated in clear cell RCC patients with older age, venous tumor thrombus, or increased SUVmax. A positive correlation was found between TIGAR expression and SUVmax in patients (r=0.396, P=0.001). Patients with positive TIGAR expression had a decreased overall survival time than those with negative TIGAR expression. The overall survival time was significantly shorter in patients with high SUVmax (>5.25) compared with those with low SUVmax (≤5.25). SUVmax and Fuhrman grade were identified as independent prognostic factors in clear cell RCC. Patients with high SUVmax (>5.25) and positive TIGAR expression were associated with a worse disease prognosis. Conclusion: The expression of TIGAR is significantly correlated with SUVmax in clear cell RCC. The combined use of TIGAR expression and 18F-FDG PET/CT can provide additional information for tumor glucose metabolic status and disease prognosis in patients with clear cell RCC.
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Affiliation(s)
- Xiaoyan Wang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Li
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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15
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Pal K, Madamsetty VS, Dutta SK, Wang E, Angom RS, Mukhopadhyay D. Synchronous inhibition of mTOR and VEGF/NRP1 axis impedes tumor growth and metastasis in renal cancer. NPJ Precis Oncol 2019; 3:31. [PMID: 31840081 PMCID: PMC6895165 DOI: 10.1038/s41698-019-0105-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is known for its highly vascular phenotype which is associated with elevated expression of vascular endothelial growth factor A (VEGF), also known as vascular permeability factor (VPF). Accordingly, VEGF has been an attractive target for antiangiogenic therapies in ccRCC. Two major strategies have hitherto been utilized for VEGF-targeted antiangiogenic therapies: targeting VEGF by antibodies, ligand traps or aptamers, and targeting the VEGF receptor signaling via antibodies or small-molecule tyrosine-kinase inhibitors (TKIs). In the present article we utilized two entirely different approaches: targeting mammalian target of rapamycin (mTOR) pathway that is known to be involved in VEGF synthesis, and disruption of VEGF/Neuroplin-1 (NRP1) axis that is known to activate proangiogenic and pro-tumorigenic signaling in endothelial and tumor cells, respectively. Everolimus (E) and a small-molecule inhibitor EG00229 (G) were used for the inhibition of mTOR and the disruption of VEGF/NRP1 axis, respectively. We also exploited a liposomal formulation decorated with a proprietary tumor-targeting-peptide (TTP) to simultaneously deliver these two agents in a tumor-targeted manner. The TTP-liposomes encapsulating both Everolimus and EG00229 (EG-L) demonstrated higher in vitro and in vivo growth retardation than the single drug-loaded liposomes (E-L and G-L) in two different ccRCC models and led to a noticeable reduction in lung metastasis in vivo. In addition, EG-L displayed remarkable inhibition of tumor growth in a highly aggressive syngeneic immune-competent mouse model of ccRCC developed in Balb/c mice. Taken together, this study demonstrates an effective approach to achieve improved therapeutic outcome in ccRCC.
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Affiliation(s)
- Krishnendu Pal
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Vijay Sagar Madamsetty
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Shamit Kumar Dutta
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Enfeng Wang
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL 32224 USA
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16
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Turnquist C, Watson RA, Protheroe A, Verrill C, Sivakumar S. Tumor heterogeneity: does it matter? Expert Rev Anticancer Ther 2019; 19:857-867. [PMID: 31510810 DOI: 10.1080/14737140.2019.1667236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: It has long been recognized that tumors are composed of a mosaic of cells and numerous methods have been developed to detect tumor heterogeneity, including in situ hybridization, multi-regional sampling, cytological assays, and whole genome and single cell sequencing. Using these methods, heterogeneity has been observed at the genetic, epigenetic, and phenotypic level in numerous cancers. With the advent of deep sequencing technology, we now appreciate a greater complexity of distinct genotypes and phenotypes that drive the biological behavior of cancer. Despite decades of progress in detecting tumor heterogeneity, the question remains: to what extent does it matter? Areas covered: This review explores the evidence for and against the importance of tumor heterogeneity in three main areas: prognostication, development of targeted therapeutics and tumor resistance; summarizing current understanding before evaluating ongoing experimental and clinical developments. Expert opinion: Theoretical understanding and in vitro detection of intratumour heterogeneity promises much but is yet to translate into meaningful clinical benefit. However, the recent emergence of a host of technological innovations and upcoming clinical trials may soon change the landscape of this field.
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Affiliation(s)
- Casmir Turnquist
- University of Oxford Medical School, John Radcliffe Hospital , Oxford , UK
| | | | | | - Clare Verrill
- Nuffield Department of Surgical Sciences, Oxford NIHR Biomedical Research Centre , Oxford , UK
| | - Shivan Sivakumar
- Department of Oncology, University of Oxford , Oxford , UK.,Kennedy Institute of Rheumatology, University of Oxford , Oxford , UK
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17
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Pal K, Madamsetty VS, Dutta SK, Mukhopadhyay D. Co-delivery of everolimus and vinorelbine via a tumor-targeted liposomal formulation inhibits tumor growth and metastasis in RCC. Int J Nanomedicine 2019; 14:5109-5123. [PMID: 31371950 PMCID: PMC6636461 DOI: 10.2147/ijn.s204221] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/21/2019] [Indexed: 12/30/2022] Open
Abstract
Background Renal cell carcinoma (RCC) is notorious for its resistance towards chemotherapy and radiation therapy in general. Combination therapy is often helpful in alleviating the resistance mechanisms by targeting multiple signaling pathways but is usually more toxic than monotherapy. Co-encapsulation of multiple therapeutic agents in a tumor-targeted drug delivery platform is a promising strategy to mitigate these limitations. Methods A tumor-targeted liposomal formulation was prepared using phospholipids, cholesterol, DSPE-(PEG)2000-OMe and a proprietary tumor-targeting-peptide (TTP)-conjugated lipopeptide. An efficient method was optimized to encapsulate everolimus and vinorelbine in this liposomal formulation. Single drug-loaded liposomes were also prepared for comparison. Finally, the drug-loaded liposomes were tested in vitro and in vivo in two different RCC cell lines. Results The tumor-targeted liposomal formulation demonstrated excellent tumor-specific uptake. The dual drug-loaded liposomes exhibited significantly higher growth inhibition in vitro compared to the single drug-loaded liposomes in two different RCC cell lines. Similarly, the dual drug-loaded liposomes demonstrated significantly higher suppression of tumor growth compared to the single drug-loaded liposomes in two different subcutaneous RCC xenografts. In addition, the dual drug-loaded liposomes instigated significant reduction in lung metastasis in those experiments. Conclusion Taken together, this study demonstrates that co-delivery of everolimus and vinorelbine with a tumor-targeted liposomal formulation is an effective approach to achieve improved therapeutic outcome in RCC.
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Affiliation(s)
- Krishnendu Pal
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Vijay Sagar Madamsetty
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Shamit Kumar Dutta
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
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18
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Ishtiaq R, Khan Z. Inflammatory lymphadenopathies predicting renal cell carcinoma prognosis: association not so convincing yet. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:164. [PMID: 31168445 PMCID: PMC6526261 DOI: 10.21037/atm.2019.03.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Rizwan Ishtiaq
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
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19
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Zhang F, Li R, Li G, Jin L, Shi Q, Du L. Value of Contrast-Enhanced Ultrasound in the Diagnosis of Renal Cancer and in Comparison With Contrast-Enhanced Computed Tomography: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:903-914. [PMID: 30203542 DOI: 10.1002/jum.14769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this meta-analysis was to assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in renal cancer and to compare it with contrast-enhanced computed tomography (CECT). METHODS A systematic search was performed to recruit eligible original studies published until December 2017. Two reviewers independently extracted data. A meta-analysis was performed, and the pooled sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, diagnostic odds ratio, summary receiver operating characteristic curve, and area under the curve were calculated. The extent and potential sources of heterogeneity were further explored. Moreover, a head-to-head comparison was also performed to compare the diagnostic value between CEUS and CECT in renal cancer. RESULTS Twenty-two studies were included in this meta-analysis. The summary sensitivity and specificity of CEUS for detecting renal cancer were 0.96 (95% confidence interval [CI], 0.94-0.97) and 0.82 (95% CI, 0.74-0.88), respectively. The summary diagnostic odds ratio was 102.04 (95% CI, 49.55-210.13). The area under the summary receiver operating characteristic curve was 0.97 (95% CI, 0.95-0.98). In the head-to-head comparison, CEUS showed higher diagnostic sensitivity than CECT (0.94 versus 0.85) for renal cancer, whereas the specificities were comparable between CEUS and CECT (0.77 versus 0.75). CONCLUSIONS Contrast-enhanced US has high sensitivity and moderate specificity in the differential diagnosis of renal cancer. The diagnostic sensitivity of CEUS in renal cancer was higher than that of CECT, suggesting that CEUS could be used as a preferred diagnostic tool for renal cancer.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Li
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Gang Li
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Hakimi AA, Voss MH, Kuo F, Sanchez A, Liu M, Nixon BG, Vuong L, Ostrovnaya I, Chen YB, Reuter V, Riaz N, Cheng Y, Patel P, Marker M, Reising A, Li MO, Chan TA, Motzer RJ. Transcriptomic Profiling of the Tumor Microenvironment Reveals Distinct Subgroups of Clear Cell Renal Cell Cancer: Data from a Randomized Phase III Trial. Cancer Discov 2019; 9:510-525. [PMID: 30622105 DOI: 10.1158/2159-8290.cd-18-0957] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/09/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
Abstract
Metastasis remains the main reason for renal cell carcinoma (RCC)-associated mortality. Tyrosine kinase inhibitors (TKI) impart clinical benefit for most patients with RCC, but the determinants of response are poorly understood. We report an integrated genomic and transcriptomic analysis of patients with metastatic clear cell RCC (ccRCC) treated with TKI therapy and identify predictors of response. Patients in the COMPARZ phase III trial received first-line sunitinib or pazopanib with comparable efficacy. RNA-based analyses revealed four distinct molecular subgroups associated with response and survival. Characterization of these subgroups identified mutation profiles, angiogenesis, and macrophage infiltration programs to be powerful predictors of outcome with TKI therapy. Notably, predictors differed by the type of TKI received. Our study emphasizes the clinical significance of angiogenesis and immune tumor microenvironment and suggests that the critical effects its various aspects have on TKI efficacy vary by agent. This has broad implications for optimizing precision treatment of RCC. SIGNIFICANCE: The determinants of response to TKI therapy in metastatic ccRCC remain unknown. Our study demonstrates that key angiogenic and immune profiles of the tumor microenvironment may affect TKI response. These findings have the potential to inform treatment personalization in patients with RCC.This article is highlighted in the In This Issue feature, p. 453.
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Affiliation(s)
- A Ari Hakimi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Martin H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Fengshen Kuo
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alejandro Sanchez
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ming Liu
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Briana G Nixon
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lynda Vuong
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irina Ostrovnaya
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ying-Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | | | - Ming O Li
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy A Chan
- Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, New York. .,Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Chappell JC, Payne LB, Rathmell WK. Hypoxia, angiogenesis, and metabolism in the hereditary kidney cancers. J Clin Invest 2019; 129:442-451. [PMID: 30614813 DOI: 10.1172/jci120855] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The field of hereditary kidney cancer has begun to mature following the identification of several germline syndromes that define genetic and molecular features of this cancer. Molecular defects within these hereditary syndromes demonstrate consistent deficits in angiogenesis and metabolic signaling, largely driven by altered hypoxia signaling. The classical mutation, loss of function of the von Hippel-Lindau (VHL) tumor suppressor, provides a human pathogenesis model for critical aspects of pseudohypoxia. These features are mimicked in a less common hereditary renal tumor syndrome, known as hereditary leiomyomatosis and renal cell carcinoma. Here, we review renal tumor angiogenesis and metabolism from a HIF-centric perspective, considering alterations in the hypoxic landscape, and molecular deviations resulting from high levels of HIF family members. Mutations underlying HIF deregulation drive multifactorial aberrations in angiogenic signals and metabolism. The mechanisms by which these defects drive tumor growth are still emerging. However, the distinctive patterns of angiogenesis and glycolysis-/glutamine-dependent bioenergetics provide insight into the cellular environment of these cancers. The result is a scenario permissive for aggressive tumorigenesis especially within the proximal renal tubule. These features of tumorigenesis have been highly actionable in kidney cancer treatments, and will likely continue as central tenets of kidney cancer therapeutics.
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Affiliation(s)
- John C Chappell
- Center for Heart and Regenerative Medicine, Departments of Biomedical Sciences and Biomedical Engineering and Mechanics, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Laura Beth Payne
- Center for Heart and Regenerative Medicine, Departments of Biomedical Sciences and Biomedical Engineering and Mechanics, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - W Kimryn Rathmell
- Vanderbilt-Ingram Cancer Center, Departments of Medicine and Biochemistry, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Abstract
PURPOSE To investigate whether multiphasic MDCT enhancement profiles can help to identify PTEN expression in clear cell renal cell carcinomas (ccRCCs). Lack of PTEN expression is associated with worsened overall survival, a more advanced Fuhrman grade, and a greater likelihood of lymph mode metastasis. METHODS With IRB approval for this retrospective study, we derived a cohort of 103 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001-2013. Following manual segmentation, a computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5-cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Maximal lesion attenuation - cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation in each phase were compared using t tests. The performance of multiphasic enhancement in identifying PTEN expression was assessed with logistic regression analysis. RESULTS PTEN-positive and PTEN-negative ccRCCs both exhibited peak enhancement in the corticomedullary phase. Relative corticomedullary phase attenuation was significantly greater for PTEN-negative ccRCCs in comparison to PTEN-positive ccRCCs (33.7 vs. 9.5, p = 0.03). After controlling for lesion stage and size, relative corticomedullary phase attenuation had an accuracy of 84% (86/103), specificity of 100% (84/84), sensitivity of 11% (2/19), positive predictive value of 100% (2/2), and negative predictive value of 83% (84/101) in identifying PTEN expression. CONCLUSION Relative corticomedullary phase attenuation may help to identify PTEN expression in ccRCCs, if validated prospectively.
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Association of the Gross Appearance of Intratumoral Vascularity at MDCT With the Carbonic Anhydrase IX Score in Clear Cell Renal Cell Carcinoma. AJR Am J Roentgenol 2018; 211:1254-1258. [PMID: 30300009 DOI: 10.2214/ajr.18.19725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether qualitative MDCT features are associated with the carbonic anhydrase IX (CAIX) score of clear cell renal cell carcinoma (RCC). The CAIX score has been previously found to have prognostic significance for disease-free survival, overall survival, and lymph node involvement. MATERIALS AND METHODS A cohort of 105 histologically proven clear cell RCCs in patients who underwent preoperative four-phase renal mass MDCT was derived from 2001 to 2013. Two genitourinary radiologists evaluated each lesion for the gross appearance of intratumoral vascularity, calcification, enhancement pattern, necrosis, margin, collecting system invasion, and renal vein invasion. Immunohistochemical analysis was used to determine the CAIX score (defined as the positive staining percentage multiplied by the staining intensity). Logistic and linear regression analyses were performed. RESULTS In a linear regression model controlled for lesion size and stage, the gross appearance of intratumoral vascularity had a significant positive association with CAIX score (β = 38.33, p = 0.010). In a logistic regression model controlled for lesion size and stage, the gross appearance of intratumoral vascularity had an odds ratio of 2.85 (p = 0.019) in differentiating clear cell RCCs with a CAIX score of 200-300 from clear cell RCCs with a CAIX score of 0-199. CONCLUSION In clear cell RCCs, the gross appearance of intratumoral vascularity at MDCT was significantly associated with CAIX score, a prognostically significant molecular marker. Current assessment of CAIX score requires pathologic tissue sampling and immunohistochemical analysis. A noninvasive imaging biomarker that may help predict CAIX score may be of great clinical value.
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Utility of multiphasic multidetector computed tomography in discriminating between clear cell renal cell carcinomas with high and low carbonic anhydrase-IX expression. Abdom Radiol (NY) 2018. [PMID: 29520426 DOI: 10.1007/s00261-018-1546-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate if multiphasic multidetector computed tomography (MDCT) enhancement profiles can distinguish clear cell renal cell carcinomas (ccRCCs) with high carbonic anhydrase-IX (CA-IX) expression from ccRCCs with low CA-IX expression. METHODS With IRB approval for this retrospective study, we derived a cohort of 105 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001 to 2013. Following manual segmentation, the computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase. CA-IX expression level was determined by immunohistochemical staining of tumor specimens. In the high and low CA-IX expression subgroups, the magnitude of enhancement and washout were compared using t tests; the performance of contrast washout in differentiating between subgroups was assessed with logistic regression analysis. RESULTS ccRCCs with high and low CA-IX expression both exhibited peak enhancement in the corticomedullary phase. ccRCCs with high CA-IX expression demonstrated significantly greater relative nephrographic washout than those with low CA-IX expression (18.4% vs. 7.8%, p = 0.03). ccRCCs with high CA-IX expression had greater relative excretory washout than ccRCCs with low CA-IX expression with a trend toward significance (33.4% vs. 25.2%, p = 0.05). After controlling for tumor size and stage, for distinguishing ccRCCs with high and low CA-IX expression, relative excretory washout had a sensitivity, negative predictive value, accuracy, and positive predictive value of 99% (65/66), 88% (7/8), 69% (72/105), and 67% (65/97), respectively. CONCLUSION Relative nephrographic and excretory washout may have the potential to help distinguish ccRCCs with high and low CA-IX expression, but this requires further validation.
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Flynn M, Pickering L, Larkin J, Turajlic S. Immune-checkpoint inhibitors in melanoma and kidney cancer: from sequencing to rational selection. Ther Adv Med Oncol 2018; 10:1758835918777427. [PMID: 29977349 PMCID: PMC6024333 DOI: 10.1177/1758835918777427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/25/2018] [Indexed: 12/22/2022] Open
Abstract
Immune-checkpoint inhibitors (ICPIs), including antibodies against cytotoxic T-lymphocyte associated antigen 4 and programmed cell death protein 1, have been shown to induce durable complete responses in a proportion of patients in the first-line and refractory setting in advanced melanoma and renal cell carcinoma. In fact, there are several lines of both targeted agents and ICPI that are now feasible treatment options. However, survival in the metastatic setting continues to be poor and there remains a need for improved therapeutic approaches. In order to enhance patient selection for the most appropriate next line of therapy, better predictive biomarkers of responsiveness will need to be developed in tandem with technologies to identify mechanisms of ICPI resistance. Adaptive, biomarker-driven trials will drive this evolution. The combination of ICPI with specific chemotherapies, targeted therapies and other immuno-oncology (IO) drugs in order to circumvent ICPI resistance and enhance efficacy is discussed. Recent data support the role for both targeted therapies and ICPI in the adjuvant setting of melanoma and targeted therapies in the adjuvant setting for renal cell carcinoma, which may influence the consideration of treatment on subsequent relapse. Approaches to select the optimal treatment sequences for these patients will need to be refined.
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Affiliation(s)
| | | | | | - Samra Turajlic
- Department of Medicine, Skin and Renal Units, Royal Marsden Hospital, 203 Fulham Road, Chelsea, London SW3 6JJ, UK
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Gatti-Mays ME, Redman JM, Collins JM, Bilusic M. Cancer vaccines: Enhanced immunogenic modulation through therapeutic combinations. Hum Vaccin Immunother 2017; 13:2561-2574. [PMID: 28857666 DOI: 10.1080/21645515.2017.1364322] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Therapeutic cancer vaccines have gained significant popularity in recent years as new approaches for specific oncologic indications emerge. Three therapeutic cancer vaccines are FDA approved and one is currently approved by the EMA as monotherapy with modest treatment effects. Combining therapeutic cancer vaccines with other treatment modalities like radiotherapy (RT), hormone therapy, immunotherapy, and/or chemotherapy have been investigated as a means to enhance immune response and treatment efficacy. There is growing preclinical and clinical data that combination of checkpoint inhibitors and vaccines can induce immunogenic intensification with favorable outcomes. Additionally, novel methods for identifying targetable neoantigens hold promise for personalized vaccine development. In this article, we review the rationale for various therapeutic combinations, clinical trial experiences, and future directions. We also highlight the most promising developments that could lead to approval of novel therapeutic cancer vaccines.
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Affiliation(s)
- Margaret E Gatti-Mays
- a Medical Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Jason M Redman
- a Medical Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Julie M Collins
- a Medical Oncology Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
| | - Marijo Bilusic
- b Genitourinary Malignancy Branch , National Cancer Institute, National Institutes of Health , Bethesda , MD , USA
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Performance of Relative Enhancement on Multiphasic MRI for the Differentiation of Clear Cell Renal Cell Carcinoma (RCC) From Papillary and Chromophobe RCC Subtypes and Oncocytoma. AJR Am J Roentgenol 2017; 208:812-819. [DOI: 10.2214/ajr.16.17152] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Tzortzakakis A, Gustafsson O, Karlsson M, Ekström-Ehn L, Ghaffarpour R, Axelsson R. Visual evaluation and differentiation of renal oncocytomas from renal cell carcinomas by means of 99mTc-sestamibi SPECT/CT. EJNMMI Res 2017; 7:29. [PMID: 28357787 PMCID: PMC5371538 DOI: 10.1186/s13550-017-0278-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/15/2017] [Indexed: 12/28/2022] Open
Abstract
Background Despite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion. Approximately 10% of all solid renal tumours turn out to be oncocytomas. In actual clinical practice, this is verified only following unnecessary surgery or a renal biopsy/ablation. The objective of our pilot study examines whether 99mTc-sestamibi SPECT/CT can play a crucial role in the characterization of solid renal neoplasms and the differentiation of oncocytomas from renal cell carcinomas. The study included 27 patients identified with 31 solid renal lesions. All patients were discussed in a multidisciplinary conference, and a decision for surgery or biopsy was taken. Prior to invasive procedures, patients underwent a SPECT/CT with 99mTc-sestamibi. Visual evaluation was performed, and any focal 99mTc-sestamibi uptake detected on SPECT in the localisation of tumour was considered as positive. Results Eleven out of 12 oncocytomas (91.6%) displayed positive uptake of 99mTc-sestamibi. Three hybrid tumours (mixed-type oncocytoma and chromophobe renal cancer) were positive on SPECT/CT. One papillary renal cell carcinoma had a slight uptake of 99mTc-sestamibi. The remaining 11 renal cell carcinomas were sestamibi negative. Conclusions Differentiation of benign renal oncocytomas from renal cell carcinomas seems very promising on 99mTc-sestamibi SPECT/CT examination. Additional supplement to visual evaluation, i.e. quantitative tools, should be sought for an accurate estimate of biological behaviour and hence a secure diagnosis.
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Affiliation(s)
- Antonios Tzortzakakis
- Radiology Department, Division of Medical Imaging and Technology, Karolinska University Hospital, C1-46, SE-141 86, Huddinge, Stockholm, Sweden.
| | - Ove Gustafsson
- Division of Urology, Karolinska University Hospital, Huddinge, Sweden.,Division of Radiology, Department for Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute and Medical Physics and Nuclear Medicine, BOF Karolinska University Hospital, Huddinge, Sweden
| | - Mattias Karlsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | | | | | - Rimma Axelsson
- Division of Radiology, Department for Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute and Medical Physics and Nuclear Medicine, BOF Karolinska University Hospital, Huddinge, Sweden.,Medical Radiation Physics and Nuclear Medicine, Imaging and Physiology, Karolinska University Hospital, Huddinge, Sweden
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Chang AY, Marshall WF. Organelles - understanding noise and heterogeneity in cell biology at an intermediate scale. J Cell Sci 2017; 130:819-826. [PMID: 28183729 DOI: 10.1242/jcs.181024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Many studies over the years have shown that non-genetic mechanisms for producing cell-to-cell variation can lead to highly variable behaviors across genetically identical populations of cells. Most work to date has focused on gene expression noise as the primary source of phenotypic heterogeneity, yet other sources may also contribute. In this Commentary, we explore organelle-level heterogeneity as a potential secondary source of cellular 'noise' that contributes to phenotypic heterogeneity. We explore mechanisms for generating organelle heterogeneity and present evidence of functional links between organelle morphology and cellular behavior. Given the many instances in which molecular-level heterogeneity has been linked to phenotypic heterogeneity, we posit that organelle heterogeneity may similarly contribute to overall phenotypic heterogeneity and underline the importance of studying organelle heterogeneity to develop a more comprehensive understanding of phenotypic heterogeneity. Finally, we conclude with a discussion of the medical challenges associated with phenotypic heterogeneity and outline how improved methods for characterizing and controlling this heterogeneity may lead to improved therapeutic strategies and outcomes for patients.
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Affiliation(s)
- Amy Y Chang
- Department of Biochemistry and Biophysics, Center for Cellular Construction, University of California, San Francisco, CA 94158, USA
| | - Wallace F Marshall
- Department of Biochemistry and Biophysics, Center for Cellular Construction, University of California, San Francisco, CA 94158, USA
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Lesion Size and Iodine Quantification to Distinguish Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma Using Dual-Energy Spectral Computed Tomography. J Comput Assist Tomogr 2017; 40:673-7. [PMID: 27224223 DOI: 10.1097/rct.0000000000000441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to assess the utility of lesion size and iodine quantification using dual-energy spectral computed tomography to distinguish between low-grade and high-grade clear cell renal cell carcinomas (ccRCCs). METHODS Spectral parameters of 75 patients with pathologically proven ccRCCs who underwent preoperative dual-energy spectral computed tomography examinations were divided into low-grade and high-grade groups. Independent sample t test, receiver operating characteristic curve analysis, and Spearman rank correlation were analyzed. RESULTS The lesion size was significantly smaller, and spectral parameters were significantly higher in the low-grade ccRCC. The significant correlation (r = -0.412, P < 0.001) by the Spearman rank correlation was between the normalized iodine concentration and lesion size. The receiver operating characteristic analysis demonstrated that 0.710 was the optimal cutoff value, which yielded the following: sensitivity, 97.6%; specificity, 97.1%; positive predictive value, 97.6%; negative predictive value, 97.1%; and accuracy, 97.3%. CONCLUSIONS Iodine quantification can play an important role in distinguishing low-grade from high-grade ccRCC.
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Stühler V, Bedke J. Tumour response in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors - assessment of intra-tumour heterogeneity. BMC Med 2016; 14:201. [PMID: 27923360 PMCID: PMC5141635 DOI: 10.1186/s12916-016-0754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022] Open
Abstract
Intra-tumour heterogeneity is a common molecular phenomenon in metastatic clear cell renal carcinoma (mRCC), representing the genetic complexity of a tumour with multiple metastatic sites. The present commentary discusses the observed phenomena of phenotypic intra-tumour heterogeneity in mRCC patients treated with the tyrosine kinase inhibitors sunitinib or pazopanib. Here, drug response can be different on the level of each evaluated metastasis in the individual patient. This questions the currently used radiologic staging systems of RECIST criteria and demands for a modification of radiologic response assessment with the consequence of a patient-tailored therapy in the clinical setting.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0729-9 .
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Affiliation(s)
- Viktoria Stühler
- Department of Urology, Eberhard Karls University, Hoppe-Seyler- Strasse 3, 72076, Tübingen, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University, Hoppe-Seyler- Strasse 3, 72076, Tübingen, Germany.
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Glen H. Lenvatinib therapy for the treatment of patients with advanced renal cell carcinoma. Future Oncol 2016; 12:2195-204. [DOI: 10.2217/fon-2016-0215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite advances in metastatic renal cell carcinoma (mRCC) treatments, patients eventually progress and develop resistance to therapies targeting a single pathway. Lenvatinib inhibits VEGFR1–3, FGFR1–4, PDGFRβ, RET and KIT proto-oncogenes. In a randomized, Phase II trial evaluating patients with mRCC who had progressed after one prior VEGF-targeted therapy, progression-free survival was significantly improved with lenvatinib alone or in combination with everolimus versus everolimus alone. This review summarizes the clinical development of lenvatinib in mRCC, and how simultaneous targeting of multiple pathways involved in carcinogenesis and/or therapeutic resistance may improve patient outcomes. Lenvatinib plus everolimus may be a promising second-line treatment in patients with mRCC.
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Affiliation(s)
- Hilary Glen
- Department of Medical Oncology, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN, UK
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Gill D, Hahn AW, Sonpavde G, Agarwal N. Immunotherapy of advanced renal cell carcinoma: Current and future therapies. Hum Vaccin Immunother 2016; 12:2997-3004. [PMID: 27494417 DOI: 10.1080/21645515.2016.1212794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Previously a malignancy with few therapeutic options, metastatic renal cell carcinoma (mRCC) treatment is rapidly evolving. Although cytokine therapies (interferon-a, interleukin-2) have been used less frequently over the past decade, recent approval of an immune checkpoint inhibitor, nivolumab, has led to a resurgence in immune therapy for mRCC. With greater understanding of the complex and dynamic interaction between the tumor and the immune system, numerous new immunotherapies are being studied for mRCC. In this article, we review the mechanism of action, clinical outcomes and toxicity profiles of both clinically approved and selected investigational immunotherapies. Either alone or in combination, these novel agents are encouraging for the future of mRCC therapy.
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Affiliation(s)
- David Gill
- a Department of Internal Medicine , University of Utah , Salt Lake City , UT , USA
| | - Andrew W Hahn
- a Department of Internal Medicine , University of Utah , Salt Lake City , UT , USA
| | - Guru Sonpavde
- b University of Alabama at Birmingham (UAB) , Birmingham , AL , USA
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Chao C, Zatarain JR, Ding Y, Coletta C, Mrazek AA, Druzhyna N, Johnson P, Chen H, Hellmich JL, Asimakopoulou A, Yanagi K, Olah G, Szoleczky P, Törö G, Bohanon FJ, Cheema M, Lewis R, Eckelbarger D, Ahmad A, Módis K, Untereiner A, Szczesny B, Papapetropoulos A, Zhou J, Hellmich MR, Szabo C. Cystathionine-beta-synthase inhibition for colon cancer: Enhancement of the efficacy of aminooxyacetic acid via the prodrug approach. Mol Med 2016; 22:361-379. [PMID: 27257787 DOI: 10.2119/molmed.2016.00102] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/17/2023] Open
Abstract
Colon cancer cells contain high levels of cystathionine-beta-synthase (CBS). Its product, hydrogen sulfide (H2S) promotes the growth and proliferation of colorectal tumor cells. In order to improve the antitumor efficacy of the prototypical CBS inhibitor aminooxyacetic acid (AOAA), we have designed and synthesized YD0171, a methyl ester derivative of AOAA. The antiproliferative effect of YD0171 exceeded the antiproliferative potency of AOAA in HCT116 human colon cancer cells. The esterase inhibitor paraoxon prevented the cellular inhibition of CBS activity by YD0171. YD0171 suppressed mitochondrial respiration and glycolytic function and induced G0/G1 arrest, but did not induce tumor cell apoptosis or necrosis. Metabolomic analysis in HCT116 cells showed that YD0171 affects multiple pathways of cell metabolism. The efficacy of YD0171 as an inhibitor of tumor growth was also tested in nude mice bearing subcutaneous HCT116 cancer cell xenografts. Animals were treated via subcutaneous injection of vehicle, AOAA (1, 3 or 9 mg/kg/day) or YD0171 (0.1, 0.5 or 1 mg/kg/day) for 3 weeks. Tumor growth was significantly reduced by 9 mg/kg/day AOAA, but not at the lower doses. YD0171 was more potent: tumor volume was significantly inhibited at 0.5 and 1 mg/kg/day. Thus, the in vivo efficacy of YD0171 is 9-times higher than that of AOAA. YD0171 (1 mg/kg/day) attenuated tumor growth and metastasis formation in the intracecal HCT116 tumor model. YD0171 (3 mg/kg/day) also reduced tumor growth in patient-derived tumor xenograft (PDTX) bearing athymic mice. YD0171 (3 mg/kg/day) induced the regression of established HCT116 tumors in vivo. A 5-day safety study in mice demonstrated that YD0171 at 20 mg/kg/day (given in two divided doses) does not increase plasma markers of organ injury, nor does it induce histological alterations in the liver or kidney. YD0171 caused a slight elevation in plasma homocysteine levels. In conclusion, the prodrug approach improves the pharmacological profile of AOAA; YD0171 represents a prototype for CBS inhibitory anticancer prodrugs. By targeting colorectal cancer bioenergetics, an emerging important hallmark of cancer, the approach exemplified herein may offer direct translational opportunities.
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Affiliation(s)
- Celia Chao
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - John R Zatarain
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Ye Ding
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Ciro Coletta
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Amy A Mrazek
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nadiya Druzhyna
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Paul Johnson
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Haiying Chen
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Judy L Hellmich
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Antonia Asimakopoulou
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kazunori Yanagi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Gabor Olah
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Petra Szoleczky
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Gabor Törö
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Fredrick J Bohanon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Minal Cheema
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Rachel Lewis
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - David Eckelbarger
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Akbar Ahmad
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Katalin Módis
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America,Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Ashley Untereiner
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Bartosz Szczesny
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Andreas Papapetropoulos
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jia Zhou
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Mark R Hellmich
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Csaba Szabo
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas, United States of America
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Tu SM, Bilen MA, Tannir NM. Personalised cancer care: promises and challenges of targeted therapy. J R Soc Med 2016; 109:98-105. [PMID: 26933155 PMCID: PMC4794967 DOI: 10.1177/0141076816631154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Shi-Ming Tu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
| | - Mehmet A Bilen
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
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Vrdoljak E, Torday L, Szczylik C, Kharkevich G, Bavbek S, Sella A. Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe. Expert Opin Pharmacother 2015; 17:93-104. [PMID: 26619144 DOI: 10.1517/14656566.2016.1107043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries. AREAS COVERED The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC. EXPERT OPINION This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available.
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Affiliation(s)
- E Vrdoljak
- a University Hospital Split , Department of Oncology , Split , Croatia
| | - L Torday
- b University of Szeged , Department of Oncotherapy , Szeged , Hungary
| | - C Szczylik
- c Central Clinical Hospital , Department of Oncology, Military Institute of Medicine , Warsaw , Poland
| | - G Kharkevich
- d NN Blokhin Russian Cancer Research Center , Biotherapy Department , Moscow , Russia
| | - S Bavbek
- e VKV American Hospital , Div. Medical Oncology , Istanbul , Turkey
| | - A Sella
- f Assaf Harofeh Centre Zerifin, Department of Oncology , Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Thiery-Vuillemin A, Theodore C, Jacobasch L, Schmitz J, Papandreou C, Guillot A, Emmanouilides C, Slimane K, Kelkouli N, Kim S, Nguyen Tan Hon T. Efficacy and Safety of Sequential Use of Everolimus in Patients With Metastatic Renal Cell Carcinoma Previously Treated With Bevacizumab With or Without Interferon Therapy: Results From the European AVATOR Study. Clin Genitourin Cancer 2015; 13:231-8. [DOI: 10.1016/j.clgc.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023]
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Survival with AGS-003, an autologous dendritic cell-based immunotherapy, in combination with sunitinib in unfavorable risk patients with advanced renal cell carcinoma (RCC): Phase 2 study results. J Immunother Cancer 2015; 3:14. [PMID: 25901286 PMCID: PMC4404644 DOI: 10.1186/s40425-015-0055-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AGS-003 is an autologous immunotherapy prepared from fully matured and optimized monocyte-derived dendritic cells, which are co-electroporated with amplified tumor RNA plus synthetic CD40L RNA. AGS-003 was evaluated in combination with sunitinib in an open label phase 2 study in intermediate and poor risk, treatment naïve patients with metastatic clear cell renal cell carcinoma (mRCC). METHODS Twenty-one intermediate and poor risk patients were treated continuously with sunitinib (4 weeks on, 2 weeks off per 6 week cycle). After completion of the first cycle of sunitinib, patients were treated with AGS-003 every 3 weeks for 5 doses, then every 12 weeks until progression or end of study. The primary endpoint was to determine the complete response rate. Secondary endpoints included clinical benefit, safety, progression free survival (PFS) and overall survival (OS). Immunologic response was also monitored. RESULTS Thirteen patients (62%) experienced clinical benefit (9 partial responses, 4 with stable disease); however there were no complete responses in this group of intermediate and poor risk mRCC patients and enrollment was terminated early. Median PFS from registration was 11.2 months (95% CI 6.0, 19.4) and the median OS from registration was 30.2 months (95% CI 9.4, 57.1) for all patients. Seven (33%) patients survived for at least 4.5 years, while five (24%) survived for more than 5 years, including 2 patients who remain progression-free with durable responses for more than 5 years at the time of this report. AGS-003 was well tolerated with only mild injection-site reactions. The most common adverse events were related to expected toxicity from sunitinib therapy. In patients who had sequential samples available for immune monitoring, the magnitude of the increase in the absolute number of CD8(+) CD28(+) CD45RA(-) effector/memory T cells (CTLs) after 5 doses of AGS-003 relative to baseline, correlated with overall survival. CONCLUSIONS AGS-003 in combination with sunitinib was well tolerated and yielded supportive immunologic responses coupled with extension of median and long-term survival in an unselected, intermediate and poor risk prognosis mRCC population. CLINICAL TRIAL REGISTRY #NCT00678119.
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Zhao Z, Liao G, Li Y, Zhou S, Zou H, Fernando S. Prognostic value of carbonic anhydrase IX immunohistochemical expression in renal cell carcinoma: a meta-analysis of the literature. PLoS One 2014; 9:e114096. [PMID: 25426861 PMCID: PMC4245260 DOI: 10.1371/journal.pone.0114096] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022] Open
Abstract
Background Carbonic anhydrase IX (CAIX) protein has been correlated with progression and survival in patients with renal cell carcinoma (RCC). The prognostic value of CAIX in RCC however, remains inconclusive according to published works. This study aimed to analyze CAIX as a biological marker to predict RCC patient prognosis. Methods A literature search of the PubMed and Web of Knowledge databases was performed to retrieve original studies from their inception to December of 2013. Fifteen studies, collectively including a total of 2611 patients with renal cell carcinoma, were carefully reviewed. Standard meta-analysis methods were applied to evaluate the prognostic impact of CAIX expression on patient prognosis. The hazard ratio (HR) and its 95% confidence interval (CI) were recorded for the relationship between CAIX expression and survival, and the data were analyzed using Review Manager 5.2 software and Stata software 11.0. Results In patients with RCC, low CAIX expression was associated with poor disease-specific survival (HR = 1.89, 95% CI: 1.20–2.98, P = 0.006), unfavorable progression-free survival (HR = 2.62, 95% CI: 1.14–6.05, P = 0.02) and worse overall survival (HR = 2.03, 95% CI: 1.28–3.21, P = 0.002). Furthermore, low CAIX expression was significantly associated with the presence of lymph node metastases (odds ratio (OR) = 0.31, 95% CI = 0.15–0.62, P = 0.0009) and distant metastases (OR = 0.66, 95% CI = 0.46–0.96, P = 0.03) and predicted a higher tumor grade (OR = 0.41, 95% CI = 0.31–0.54, P<0.00001). Conclusions Low CAIX expression most likely indicates poor prognosis in RCC patients. Moreover, low CAIX expression was significantly associated with unfavorable clinicopathological factors. To strengthen our findings, further well-designed prospective studies should be conducted to investigate the role of CAIX expression in RCC.
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Affiliation(s)
- Zhihong Zhao
- Institution of Urology and Nephrology, The third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Guixiang Liao
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongqiang Li
- Institution of Urology and Nephrology, The third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shulu Zhou
- Institution of Urology and Nephrology, The third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hequn Zou
- Institution of Urology and Nephrology, The third Affiliated Hospital of Southern Medical University, Guangzhou, China
- * E-mail:
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Abstract
The treatment of renal cell carcinoma (RCC) has changed greatly over the past 15 years. Progress in the surgical management of the primary tumor and increased understanding of the molecular biology and genomics of the disease have led to the development of new therapeutic agents. The management of the primary tumor has changed owing to the realization that clean margins around the primary lesion are sufficient to prevent local recurrence, as well as the development of more sophisticated tools and techniques that increase the safety of partial nephrectomy. The management of advanced disease has altered even more dramatically as a result of new agents that target the tumor vasculature or that attenuate the activation of intracellular oncogenic pathways. This review summarizes data from prospective randomized phase III studies on the surgical management and systemic treatment of RCC, and provides an up to date summary of the histology, genomics, staging, and prognosis of RCC. It describes the management of the primary tumor and offers an overview of systemic agents that form the mainstay of treatment for advanced disease. The review concludes with an introduction to the exciting new class of immunomodulatory agents that are currently in clinical trials and may form the basis of a new therapeutic approach for patients with advanced RCC.
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Affiliation(s)
- Eric Jonasch
- Department of GU Medical Oncology, MD Anderson Cancer Center, Houston, TX 77230-1439, USA
| | - Jianjun Gao
- Department of GU Medical Oncology, MD Anderson Cancer Center, Houston, TX 77230-1439, USA
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Nearchou A, Valachis A, Lind P, Akre O, Sandström P. Acquired Hypothyroidism as a Predictive Marker of Outcome in Patients With Metastatic Renal Cell Carcinoma Treated With Tyrosine Kinase Inhibitors: A Literature-Based Meta-Analysis. Clin Genitourin Cancer 2014; 13:280-286. [PMID: 25442773 DOI: 10.1016/j.clgc.2014.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/01/2014] [Accepted: 10/20/2014] [Indexed: 11/15/2022]
Abstract
Hypothyroidism in patients with metastatic renal cell carcinoma (mRCC) during treatment with the tyrosine kinase inhibitors (TKIs) sunitinib and sorafenib is a well-established side effect. Furthermore, the potential role of hypothyroidism as predictive marker of outcome has been studied but with conflicting results. The aim of the present meta-analysis was to assess the predictive value of hypothyroidism for progression-free (PFS) and overall survival (OS) in patients with mRCC during TKI therapy. We searched PubMed and the electronic abstract databases of the major international congresses' proceedings to identify all eligible studies that reported a correlation between the development of hypothyroidism during TKI treatment and outcome in patients with mRCC. Hazard ratios (HRs) with 95% confidence intervals (CIs) for PFS and OS were obtained from these publications and pooled in a meta-analysis. Eleven studies with a total of 500 patients fulfilled the inclusion criteria. We found no statistical significant difference in PFS between patients who developed hypothyroidism during sunitinib therapy and unaffected patients (HR, 0.82; 95% CI, 0.59-1.13; P = .22; 6 studies; 250 patients). The HR for OS was 0.52 (95% CI, 0.31-0.87; P = .01) for patients who developed hypothyroidism during sunitinib therapy compared with patients who did not (4 studies; 147 patients). The development of hypothyroidism during TKI therapy is not clearly shown to be predictive of efficacy in patients with mRCC. The observed advantage in OS for the patients with acquired hypothyroidism should be interpreted with caution.
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Affiliation(s)
- Andreas Nearchou
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
| | - Antonis Valachis
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden; Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden
| | - Pehr Lind
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Olof Akre
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Per Sandström
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Mileto A, Marin D, Alfaro-Cordoba M, Ramirez-Giraldo JC, Eusemann CD, Scribano E, Blandino A, Mazziotti S, Ascenti G. Iodine quantification to distinguish clear cell from papillary renal cell carcinoma at dual-energy multidetector CT: a multireader diagnostic performance study. Radiology 2014; 273:813-20. [PMID: 25162309 DOI: 10.1148/radiol.14140171] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether dual-energy multidetector row computed tomographic (CT) imaging with iodine quantification is able to distinguish between clear cell and papillary renal cell carcinoma ( RCC renal cell carcinoma ) subtypes. MATERIALS AND METHODS In this retrospective, HIPAA-compliant, institutional review board-approved study, 88 patients (57 men, 31 women) with diagnosis of either clear cell or papillary RCC renal cell carcinoma at pathologic analysis, who underwent contrast material-enhanced dual-energy nephrographic phase study between December 2007 and June 2013, were included. Five readers, blinded to pathologic diagnosis, independently evaluated all cases by determining the lesion iodine concentration on color-coded iodine maps. The receiving operating characteristic curve analysis was adopted to estimate the optimal threshold for discriminating between clear cell and papillary RCC renal cell carcinoma , and results were validated by using a leave-one-out cross-validation. Interobserver agreement was assessed by using an intraclass correlation coefficient. The correlation between tumor iodine concentration and tumor grade was investigated. RESULTS A tumor iodine concentration of 0.9 mg/mL represented the optimal threshold to discriminate between clear cell and papillary RCC renal cell carcinoma , and it yielded the following: sensitivity, 98.2% (987 of 1005 [95% confidence interval: 97.7%, 98.7%]); specificity, 86.3% (272 of 315 [95% confidence interval: 85.0%, 87.7%]); positive predictive value, 95.8% (987 of 1030 [95% confidence interval: 95.0%, 96.6%]); negative predictive value, 93.7% (272 of 290 [95% confidence interval: 92.8%, 94.7%]); overall accuracy of 95.3% (1259 of 1320 [95% confidence interval: 94.6%, 96.2%]), with an area under the curve of 0.923 (95% confidence interval: 0.913, 0.933). An excellent agreement was found among the five readers in measured tumor iodine concentration (intraclass correlation coefficient, 0.9990 [95% confidence interval: 0. 9987, 0.9993). A significant correlation was found between tumor iodine concentration and tumor grade for both clear cell (τ = 0.85; P < .001) and papillary RCC renal cell carcinoma (τ = 0.53; P < .001). CONCLUSION Dual-energy multidetector CT with iodine quantification can be used to distinguish between clear cell and papillary RCC renal cell carcinoma , and it provides insights regarding the tumor grade.
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Affiliation(s)
- Achille Mileto
- From the Department of Radiology, Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710 (A.M., D.M.); Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy (A.M., E.S., A.B., S.M., G.A.); Department of Statistics, North Carolina State University, Raleigh, NC (M.A.C.); and Siemens Medical Solutions USA, Malvern, Pa (J.C.R.G., C.D.E.)
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Lopez J, Banerjee S, Kaye SB. New developments in the treatment of ovarian cancer--future perspectives. Ann Oncol 2014; 24 Suppl 10:x69-x76. [PMID: 24265409 DOI: 10.1093/annonc/mdt475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Over the past 40 years, the treatment of ovarian cancer has undoubtedly improved as a result of better multi-modality care and platinum-based chemotherapy. More recently, the introduction of anti-angiogenic therapy, PARP inhibitors and a weekly regimen for paclitaxel indicate that results are likely to improve further. However, major challenges remain and these will be reviewed in this article. We assess key issues in anti-angiogenic treatment including potential ways for addressing resistance; we review the current studies of PARP inhibitor treatment, which shows most promise in patients with germline BRCA mutations; we describe the potential for folate-receptor-directed therapy, given the high level of FR expression in ovarian cancer and we highlight the potential for molecular targeted therapy, focusing on specific subgroups of the disease with targets such as the PI3 K/AKT and RAS/RAF/MEK pathways and the ErbB family of oncogenes. We anticipate that progress will accelerate with a better understanding of the molecular pathogenesis of the various subtypes of ovarian cancer, leading to an increasingly personalized approach to treating women with this disease.
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Affiliation(s)
- J Lopez
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Sutton
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Escudier B, Michaelson MD, Motzer RJ, Hutson TE, Clark JI, Lim HY, Porfiri E, Zalewski P, Kannourakis G, Staehler M, Tarazi J, Rosbrook B, Cisar L, Hariharan S, Kim S, Rini BI. Axitinib versus sorafenib in advanced renal cell carcinoma: subanalyses by prior therapy from a randomised phase III trial. Br J Cancer 2014; 110:2821-8. [PMID: 24823696 PMCID: PMC4056058 DOI: 10.1038/bjc.2014.244] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In the AXIS trial, axitinib prolonged progression-free survival (PFS) vs sorafenib in patients with advanced renal cell carcinoma (RCC) previously treated with sunitinib or cytokines. METHODS In post hoc analyses, patients were grouped by objective response to prior therapy (yes vs no), prior therapy duration (< vs ⩾median), and tumour burden (baseline sum of the longest diameter < vs ⩾median). PFS and overall survival (OS), and safety by type and duration of prior therapy were evaluated. RESULTS Response to prior therapy did not influence outcome with second-line axitinib or sorafenib. PFS was significantly longer in axitinib-treated patients who received longer prior cytokine treatment and sorafenib-treated patients with smaller tumour burden following sunitinib. Overall survival with the second-line therapy was longer in patients who received longer duration of prior therapy, although not significant in the sunitinib-to-axitinib sequence subgroup; OS was also longer in patients with smaller tumour burden, but not significant in the cytokine-to-axitinib sequence subgroup. Safety profiles differed modestly by type and duration of prior therapy. CONCLUSIONS AXIS data suggest that longer duration of the first-line therapy generally yields better outcome with the second-line therapy and that lack of response to first-line therapy does not preclude positive clinical outcomes with a second-line vascular endothelial growth factor-targeted agent in patients with advanced RCC.
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Affiliation(s)
- B Escudier
- Institut Gustave Roussy/Medical Oncology Department, Villejuif 94805, France
| | - M D Michaelson
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA
| | - R J Motzer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | - T E Hutson
- Baylor-Sammons/Texas Oncology Physician's Association, Sammons Cancer Center, Dallas, TX 75246, USA
| | - J I Clark
- Department of Medicine, Loyola University Chicago Cardinal Bernardin Cancer Center, Maywood, IL 60153, USA
| | - H Y Lim
- Department of Internal Medicine, Samsung Medical Center/Sungkyunkwan University, Seoul 135-710, Korea
| | - E Porfiri
- Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK
| | - P Zalewski
- Durham Regional Cancer Centre, Oshawa, Ontario L1G 2B9, Canada
| | - G Kannourakis
- Fiona Elsey Cancer Research Institute and Ballarat Oncology and Haematology Services, Ballarat, Victoria 3355, Australia
| | - M Staehler
- Ludwig-Maximilians University of Munich, Munich 80539, Germany
| | - J Tarazi
- Pfizer Oncology, San Diego, CA 92121, USA
| | - B Rosbrook
- Pfizer Oncology, San Diego, CA 92121, USA
| | - L Cisar
- Pfizer Oncology, New York, NY 10017, USA
| | | | - S Kim
- Pfizer Oncology, San Diego, CA 92121, USA
| | - B I Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA
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Abstract
Traditionally, scientific research has focused on studying individual events, such as single mutations, gene function, or the effect that mutating one protein has on a biological phenotype. A range of technologies is beginning to provide information that will enable a holistic view of how genomic and epigenetic aberrations in cancer cells can alter the homeostasis of signalling networks within these cells, between cancer cells and the local microenvironment, and at the organ and organism level. This process, termed Systems Biology, needs to be integrated with an iterative approach wherein hypotheses and predictions that arise from modelling are refined and constrained by experimental evaluation. Systems biology approaches will be vital for developing and implementing effective strategies to deliver personalized cancer therapy. Specifically, these approaches will be important to select those patients who are most likely to benefit from targeted therapies and for the development and implementation of rational combinatorial therapies. Systems biology can help to increase therapy efficacy or bypass the emergence of resistance, thus converting the current-often short term-effects of targeted therapies into durable responses, ultimately to improve patient quality of life and provide a cure.
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Felici A, Bria E, Tortora G, Cognetti F, Milella M. Sequential therapy in metastatic clear cell renal carcinoma: TKI–TKI vs TKI–mTOR. Expert Rev Anticancer Ther 2014; 12:1545-57. [DOI: 10.1586/era.12.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mitchell CC, Parikh OA. Factors involved in treatment preference in patients with renal cancer: pazopanib versus sunitinib. Patient Prefer Adherence 2014; 8:503-11. [PMID: 24790418 PMCID: PMC4003261 DOI: 10.2147/ppa.s38989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The last decade has seen a surge in the treatment options for metastatic renal cell carcinoma and life expectancies are now approaching 3 years from diagnosis. There is some suggestion that, for now at least, we may have reached a plateau in efficacy. Patients are often stable and on treatment for years rather than months. Attention has therefore shifted to a focus on patient preference rather than reported frequency of toxicities. The standard first-line treatment for metastatic clear-cell renal cancer is either sunitinib or pazopanib. The COMPARZ trial has shown that sunitinib and pazopanib have similar efficacy. The PISCES trial, with its unique design, has evaluated patient preference between pazopanib and sunitinib. This review explores the factors involved in treatment preference in patients with renal cancer and in particular the choice between pazopanib and sunitinib.
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Affiliation(s)
| | - Omi A Parikh
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Correspondence: Omi A Parikh, Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK, Tel +4417 7252 2089, Email
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A phase 1b clinical trial of the multi-targeted tyrosine kinase inhibitor lenvatinib (E7080) in combination with everolimus for treatment of metastatic renal cell carcinoma (RCC). Cancer Chemother Pharmacol 2013; 73:181-9. [PMID: 24190702 PMCID: PMC3889692 DOI: 10.1007/s00280-013-2339-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 10/23/2013] [Indexed: 01/05/2023]
Abstract
Purpose Lenvatinib is an oral multi-targeted tyrosine kinase inhibitor of VEGFR1-3, FGFR1-4, PDGFRβ, RET, and KIT. Everolimus is an oral mammalian target of rapamycin inhibitor approved for advanced renal cell carcinoma (RCC). This phase 1b study assessed safety, maximum tolerated dose (MTD), and preliminary antitumor activity of lenvatinib plus everolimus in metastatic RCC (mRCC) patients. Methods Patients with advanced unresectable or mRCC and Eastern Cooperative Oncology Group performance status 0–1 were eligible (number of prior treatments not restricted). Starting dose was lenvatinib 12 mg once daily with everolimus 5 mg once daily administered continuously in 28-day cycles using a conventional 3 + 3 dose-escalation design. At the MTD, additional patients were enrolled in an expansion cohort. Results Twenty patients (mean 58.4 years) received lenvatinib [12 mg (n = 7); 18 mg (n = 11); 24 mg (n = 2)] plus everolimus 5 mg. MTD was established as once daily lenvatinib 18 mg plus everolimus 5 mg. The most common treatment-related treatment-emergent adverse events (all dosing cohorts) were fatigue 60 % (Grade ≥3: 10 %), mucosal inflammation 50 %, proteinuria (Grade ≥3: 15 %), diarrhea (Grade ≥3: 10 %), vomiting (Grade ≥3: 5 %), hypertension, and nausea, each 40 %. In MTD and lowest-dose cohorts (n = 18), best responses of partial response and stable disease were achieved in 6 (33 %) and 9 (50 %) patients, respectively. Conclusions Lenvatinib 18 mg combined with everolimus 5 mg was associated with manageable toxicity consistent with individual agents and no new safety signals. Observed activity warrants further evaluation of the combination in advanced RCC patients.
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Simon JM, Hacker KE, Singh D, Brannon AR, Parker JS, Weiser M, Ho TH, Kuan PF, Jonasch E, Furey TS, Prins JF, Lieb JD, Rathmell WK, Davis IJ. Variation in chromatin accessibility in human kidney cancer links H3K36 methyltransferase loss with widespread RNA processing defects. Genome Res 2013; 24:241-50. [PMID: 24158655 PMCID: PMC3912414 DOI: 10.1101/gr.158253.113] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Comprehensive sequencing of human cancers has identified recurrent mutations in genes encoding chromatin regulatory proteins. For clear cell renal cell carcinoma (ccRCC), three of the five commonly mutated genes encode the chromatin regulators PBRM1, SETD2, and BAP1. How these mutations alter the chromatin landscape and transcriptional program in ccRCC or other cancers is not understood. Here, we identified alterations in chromatin organization and transcript profiles associated with mutations in chromatin regulators in a large cohort of primary human kidney tumors. By associating variation in chromatin organization with mutations in SETD2, which encodes the enzyme responsible for H3K36 trimethylation, we found that changes in chromatin accessibility occurred primarily within actively transcribed genes. This increase in chromatin accessibility was linked with widespread alterations in RNA processing, including intron retention and aberrant splicing, affecting ∼25% of all expressed genes. Furthermore, decreased nucleosome occupancy proximal to misspliced exons was observed in tumors lacking H3K36me3. These results directly link mutations in SETD2 to chromatin accessibility changes and RNA processing defects in cancer. Detecting the functional consequences of specific mutations in chromatin regulatory proteins in primary human samples could ultimately inform the therapeutic application of an emerging class of chromatin-targeted compounds.
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Affiliation(s)
- Jeremy M Simon
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina 27514, USA
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