1
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Zhang HH, Du XJ, Deng ML, Zheng L, Yao DC, Wang ZQ, Yang QY, Wu SX. Apatinib for recurrent/progressive glioblastoma multiforme: A salvage option. Front Pharmacol 2022; 13:969565. [PMID: 36060005 PMCID: PMC9432461 DOI: 10.3389/fphar.2022.969565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose: The recurrent/progressive glioblastoma multiforme (GBM) carries a dismal prognosis and the definitive treatment strategy has not yet been established. This study aimed to assess the efficacy and safety of apatinib in recurrent/progressive GBM patients. Materials and methods: The clinical data of 19 recurrent/progressive GBM patients who received apatinib treatment from November 2015 to December 2019 at Sun Yat-sen University Cancer Center were collected retrospectively in this study. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (AEs) were reviewed and assessed. Results: The overall ORR was 52.6%, and the DCR was 73.7%. Median PFS and OS were 5.1 and 10.4 months, respectively. The 6-month PFS and OS rates were 38.9% and 68.4%, respectively. The 12-month PFS and OS rates were 16.7% and 36.8%, respectively. The treatment-related toxicities were generally well-tolerated. The most common grade 3/4 AEs were hand-foot syndrome (36.8%) and hypertension (21.1%). Conclusion: Our study showed that apatinib therapy provided a better salvaging option for recurrent/progressive GBM patients and the toxicity was manageable.
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Affiliation(s)
- Hong-Hong Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Radiation Oncology, Xiang’an Hospital of Xiamen University, Cancer Research Center, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Jing Du
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Mei-Ling Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lie Zheng
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dun-Chen Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Qiang Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qun-Ying Yang
- Department of Neurosurgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shao-Xiong Wu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- *Correspondence: Shao-Xiong Wu,
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Zhang X, Zhang H, Dai J, Liu Z, Zhu X, Ni Y, Yin X, Sun G, Zhu S, Chen J, Zhao J, Wang J, Zeng H, Shen P. The influence of dynamic changes in lipid metabolism on survival outcomes in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors. Jpn J Clin Oncol 2021; 50:1454-1463. [PMID: 32719852 DOI: 10.1093/jjco/hyaa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of lipid metabolic status in tyrosine kinase inhibitors-treated patients with metastatic renal cell carcinoma is insufficient. OBJECTIVE To analyse the influence of dynamic changes of lipid metabolism on survival outcomes in tyrosine kinase inhibitors-treated metastatic renal cell carcinoma. PATIENTS AND METHODS Serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol were collected, both before tyrosine kinase inhibitors therapy and at different time points of tyrosine kinase inhibitors treatment duration. Other clinicopathological and survival data were retrospectively reviewed. The clinical outcomes, including tumour response, progression-free survival and overall survival, were analysed. Kaplan-Meier survival curves were plotted and the log-rank test was used to analyse statistical significance. RESULTS A total of 127 patients with metastatic renal cell carcinoma, initially treated with tyrosine kinase inhibitors as first-line systemic therapy, were included. In the whole cohort, the serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol fluctuated but gradually increased during tyrosine kinase inhibitors treatment. In survival analysis, the higher serum level of lipid metabolism, the longer progression-free survival was observed. In terms of overall survival, all post-treatment lipid metabolism, including the percentages of increasing change, were correlated with better survival. Further multivariate analysis showed that patients with five components of treatment-related dysfunction of lipid metabolism had superior survival to those with less than five components. However, lipid metabolism was not correlated with tumour response. CONCLUSION Increasing parameters of lipid metabolism indicated improvement of survival in tyrosine kinase inhibitors-treated metastatic renal cell carcinoma, especially the increasing percentages.
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Affiliation(s)
- Xingming Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Haoran Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Jindong Dai
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Zhenhua Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Xudong Zhu
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Yuchao Ni
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Xiaoxue Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Guangxi Sun
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Sha Zhu
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Junru Chen
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Jinge Zhao
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Jia Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Hao Zeng
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
| | - Pengfei Shen
- Department of Urology, West China Hospital, Sichuan University, Chengdu.,Institute of Urology, West China Hospital, Sichuan University, Chengdu
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Gadd M, Pranavan G, Malik L. Association between tyrosine-kinase inhibitor induced hypertension and treatment outcomes in metastatic renal cancer. Cancer Rep (Hoboken) 2020; 3:e1275. [PMID: 32767664 DOI: 10.1002/cnr2.1275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Tyrosine-kinase inhibitor (TKI) drugs have been considered first line treatment for metastatic renal cell cancer (RCC) for over a decade. TKI-induced hypertension is a common adverse-event in patients treated for metastatic RCC. AIM This study was aimed at investigating an association between TKI-induced hypertension and treatment outcomes for metastatic RCC patients. METHODS AND RESULTS Retrospective data pertaining to patients with histologically or radiologically confirmed metastatic RCC treated with sunitinib, pazopanib, sorafenib, axitinib or cabozantinib between June 2012 and May 2019 were evaluated. Clinical information and serial blood pressure measurements were extracted from medical records for each patient. We compared objective response rate, progression-free survival (PFS), and 12-month survival between TKI-induced hypertension (TIH) and non-TIH groups using χ2 and Mann-Whitney tests. Out of 72 patients screened, 52 met study eligibility criteria. The median age at diagnosis was 61 years (range: 42-85 years) with a clear male predominance. The majority of patients had a history of nephrectomy with clear cell pathology. Almost all patients were on first-line TKI therapy with sunitinib or pazopanib. Median follow-up was 11 months. About half of patients developed TKI-induced hypertension (grade 2-3). In the TIH group 82% were commenced on an antihypertensive agent. Median PFS measured 30.5 weeks for TIH group compared to 22.2 weeks for non-TIH (P = .05). The 6 month and 12 month survival rates for TIH were 82% and 56%, respectively, as compared to 76% and 44% for non-TIH. CONCLUSION The occurrence of TKI-induced hypertension was found to be a positive prognostic factor for progression in patients with metastatic RCC.
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Affiliation(s)
- Monique Gadd
- Australian National University Medical School, Australian National University, Acton, Australia
| | - Ganes Pranavan
- Australian National University Medical School, Australian National University, Acton, Australia.,Department of Medical Oncology, The Canberra Hospital, Garran, Australia
| | - Laeeq Malik
- Australian National University Medical School, Australian National University, Acton, Australia.,Department of Medical Oncology, The Canberra Hospital, Garran, Australia
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4
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Badran A, Elshenawy MA, Shahin A, Aljubran A, Alzahrani A, Eldali A, Bazarbashi S. Efficacy and Prognostic Factors of Sunitinib as First-Line Therapy for Patients With Metastatic Renal Cell Carcinoma in an Arab Population. JCO Glob Oncol 2020; 6:19-26. [PMID: 32031432 PMCID: PMC6998020 DOI: 10.1200/jgo.19.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Antiangiogenic tyrosine kinase inhibitors have been the mainstay first-line therapy for metastatic renal cell carcinoma (mRCC). We reviewed the efficacy of first-line therapy with sunitinib in patients with mRCC in an Arab population. METHODS Medical records of patients with mRCC treated at a tertiary care center in Saudi Arabia, during the period from 2007 to 2016, were reviewed. Demographic data, treatment received, response, and prognostic factors were analyzed. RESULTS Fifty-five patients who received sunitinib were identified. The median age was 60 years (range, 18 to 78 years), and 42 of the 55 patients were men (76.3%). International Metastatic RCC Diagnostic Consortium prognostic scores for favorable/intermediate/poor were 14.5%/43.6%/38.2%, respectively. The median performance status was 1, and the median Charlson comorbidity index score was 9. Thirty-seven patients (67.2%) had cytoreductive nephrectomy. Thirty-seven patients (67.2%) had clear cell histology. Twenty-two patients (40%) underwent dose reduction. Twenty-seven patients (49%) received second-line therapy, and seven patients (12.7%) received third-line therapy. Response rates were complete response in one patient (1.8%), partial response in 17 (30.9%), stable disease in 10 (18.1), and disease progression in 20 (36.3%). Progression-free survival (PFS) and overall survival (OS) were 6.0 and 24.7 months, respectively. Univariate analysis showed statistically improved PFS for dose reduction (P = .015) and the development of hypothyroidism (P = .03). It also showed statistically improved OS for dose reduction (P = .035), hypothyroidism (P = .0002), and cytoreductive nephrectomy (P = .0052). Multivariate analysis showed statistically improved PFS for dose reduction (P = .01) and OS for development of hypothyroidism (P = .007). CONCLUSION Our data for sunitinib in mRCC show significantly lower PFS than expected. The absence of prognostic value of the International Metastatic RCC Diagnostic Consortium scoring system and pathologic subtype warrant further investigation and possible inclusion of genetic scoring in this ethnic group of patients.
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Affiliation(s)
- Ahmed Badran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud A. Elshenawy
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Amgad Shahin
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ali Aljubran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific Computing, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Shouki Bazarbashi, MBBS, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; e-mail:
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5
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Parmar A, Bjarnason GA. Individualization of Dose and Schedule Based On Toxicity for Oral VEGF Drugs in Kidney Cancer. KIDNEY CANCER 2019. [DOI: 10.3233/kca-190077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ambika Parmar
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
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6
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Liu Y, Zhou L, Chen Y, Liao B, Ye D, Wang K, Li H. Hypertension as a prognostic factor in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: a systematic review and meta-analysis. BMC Urol 2019; 19:49. [PMID: 31174518 PMCID: PMC6555944 DOI: 10.1186/s12894-019-0481-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/28/2019] [Indexed: 02/05/2023] Open
Abstract
Background Conflicting evidence exists regarding the effect of hypertension on the prognosis of metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). This study aimed to assess the predictive value of TKIs-induced hypertension in patients with mRCC. Methods This study was registered in PROSPERO (CRD42019129593). PubMed, Embase, Web of Science and the Cochrane Library database were searched with terms: “renal cell carcinoma”, “hypertension”, “blood pressure”, “tyrosine kinase inhibitor”, “sunitinib”, “axitinib”, “sorafenib” and “pazopanib” until March 21, 2019. Hazard Ratios (HR) and 95% confidence intervals (CI) for progression-free survival (PFS) or overall survival (OS) were extracted and analyzed with Stata 15.0 software. Heterogeneity was assessed using the I2 value. Meta-regression, subgroup analysis and sensitivity analysis were also performed to explore heterogeneity. Publication bias was assessed with funnel plots and precisely assessed by Egger’s and Begg’s tests. The quality of evidence of outcomes was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results A total of 4661 patients from 22 studies were included in the study. The results showed that the increase of blood pressure was an effective predictor for longer PFS (HR = 0.59, 95% CI: 0.48–0.71, p < 0.001; I2 = 77.3%) and OS (HR = 0.57, 95% CI: 0.45–0.70, p < 0.001; I2 = 77.4%) of patients with mRCC. Subgroup analysis revealed that patients receiving sunitinib and pazopanib could have longer PFS and OS. Conclusions This study indicated that TKIs-induced hypertension may be a good predictor for better prognosis of patients with mRCC receiving TKIs treatment, especially using sunitinib or pazopanib. Electronic supplementary material The online version of this article (10.1186/s12894-019-0481-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuntian Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Banghua Liao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Donghui Ye
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
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7
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Kucharz J, Dumnicka P, Kusnierz-Cabala B, Demkow T, Wiechno P. The correlation between the incidence of adverse events and progression-free survival in patients treated with cabozantinib for metastatic renal cell carcinoma (mRCC). Med Oncol 2019; 36:19. [DOI: 10.1007/s12032-018-1239-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/17/2018] [Indexed: 12/30/2022]
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8
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Kucharz J, Budnik M, Dumnicka P, Pastuszczak M, Kuśnierz-Cabala B, Demkow T, Popko K, Wiechno P. Hand-Foot Syndrome and Progression-Free Survival in Patients Treated with Sunitinib for Metastatic Clear Cell Renal Cell Carcinoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1133:35-40. [DOI: 10.1007/5584_2018_328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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Lee HJ, Moon JY, Baek SW. Is Treatment-Emergent Toxicity a Biomarker of Efficacy of Apatinib in Gastric Cancer? J Clin Oncol 2018; 34:3823. [PMID: 27528729 PMCID: PMC5477921 DOI: 10.1200/jco.2016.68.8663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Hyo Jin Lee
- Hyo Jin Lee, Chungnam National University and Chungnam National University Hospital, Daejeon, Republic of Korea; Ji Young Moon and Seung Woo Baek, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ji Young Moon
- Hyo Jin Lee, Chungnam National University and Chungnam National University Hospital, Daejeon, Republic of Korea; Ji Young Moon and Seung Woo Baek, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seung Woo Baek
- Hyo Jin Lee, Chungnam National University and Chungnam National University Hospital, Daejeon, Republic of Korea; Ji Young Moon and Seung Woo Baek, Chungnam National University Hospital, Daejeon, Republic of Korea
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10
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Okubo K, Horiguchi A, Ito K, Asano T. Recurrent retroperitoneal soft tissue sarcoma showing drastic reduction after pazopanib administration accompanied by severe liver dysfunction. Urol Case Rep 2018; 20:22-24. [PMID: 30003043 PMCID: PMC6041368 DOI: 10.1016/j.eucr.2018.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 11/17/2022] Open
Abstract
Pazopanib is an orally bioavailable tyrosine kinase inhibitor anticancer drug approved worldwide for the treatment of metastatic renal cell carcinoma and advanced soft tissue sarcoma. Here we report the case of a patient whose recurrent retroperitoneal soft tissue sarcoma showed a drastic reduction immediately after pazopanib administration accompanied by severe liver dysfunction. His liver function was restored conservatively by giving him hepatoprotectors and having him stop taking pazopanib. The recurrent tumor disappeared but by 4 months later had regrown.
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Affiliation(s)
- Kazuki Okubo
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Tomohiko Asano
- Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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11
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Pinter M, Jain RK. Targeting the renin-angiotensin system to improve cancer treatment: Implications for immunotherapy. Sci Transl Med 2018; 9:9/410/eaan5616. [PMID: 28978752 PMCID: PMC5928511 DOI: 10.1126/scitranslmed.aan5616] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/25/2017] [Indexed: 12/25/2022]
Abstract
Renin-angiotensin system (RAS) inhibitors (RASi)-widely prescribed for the treatment of cardiovascular diseases-have considerable potential in oncology. The RAS plays a crucial role in cancer biology and affects tumor growth and dissemination directly and indirectly by remodeling the tumor microenvironment. We review clinical data on the benefit of RASi in primary and metastatic tumors and propose that, by activating immunostimulatory pathways, these inhibitors can enhance immunotherapy of cancer.
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Affiliation(s)
- Matthias Pinter
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114, USA.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, A-1090, Austria
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114, USA.
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12
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Qin SK, Jin J, Guo J, Wang JW, Zhou FJ, Huang YR, Ren XB, Ye DW, Pan S, Sajben P, Wang Q. Efficacy and safety of first-line sunitinib in Chinese patients with metastatic renal cell carcinoma. Future Oncol 2018; 14:1835-1845. [PMID: 29717651 DOI: 10.2217/fon-2017-0733] [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: 12/15/2022] Open
Abstract
AIM We report the first prospective study of sunitinib for metastatic renal cell carcinoma (mRCC) in China. METHODS Chinese mRCC patients received first-line sunitinib 50 mg daily (4/2 regimen). Overall survival (OS), progression-free survival (PFS), objective response rate and safety were assessed. Potential efficacy biomarkers were explored in post hoc analyses. RESULTS Median PFS was 61.7 weeks; median OS was 133.4 weeks; objective response rate was 31.1%. Most frequent adverse events (AEs) were: hand-foot syndrome (63.8%), decreased white blood cell count (52.4%), fatigue (51.4%) and decreased platelet count (51.4%). AEs were identified that predicted longer PFS and OS. CONCLUSION Sunitinib showed efficacy and manageable AE profile in treatment-naive Chinese mRCC patients. Larger prospective studies are required to confirm identified AEs as predictors of efficacy.
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Affiliation(s)
- Shu-Kui Qin
- Department of Medical Oncology, PLA Cancer Center of Nanjing Bayi Hospital, Nanjing, PR China
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Beijing, PR China
| | - Jun Guo
- Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Jin-Wan Wang
- Department of Medical Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Fang-Jian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Yi-Ran Huang
- Department of Urology, Shanghai Renji Hospital, Shanghai, PR China
| | - Xiu-Bao Ren
- Department of Biology Treatment, Tianjin Medical University Cancer Institute & Hospital, Tianjin, PR China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | | | | | - Qiao Wang
- Pfizer Global Research & Development, Shanghai, PR China
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13
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Pinter M, Kwanten WJ, Jain RK. Renin-Angiotensin System Inhibitors to Mitigate Cancer Treatment-Related Adverse Events. Clin Cancer Res 2018; 24:3803-3812. [PMID: 29610292 DOI: 10.1158/1078-0432.ccr-18-0236] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/01/2018] [Accepted: 03/29/2018] [Indexed: 12/13/2022]
Abstract
Treatment-related side effects are a major clinical problem in cancer treatment. They lead to reduced compliance to therapy as well as increased morbidity and mortality. Well-known are the sequelae of chemotherapy on the heart, especially in childhood cancer survivors. Therefore, measures to mitigate the adverse events of cancer therapy may improve health and quality of life in patients with cancer, both in the short and long term. The renin-angiotensin system (RAS) affects all hallmarks of cancer, and blockage of the RAS is associated with an improved outcome in several cancer types. There is also increasing evidence that inhibition of the RAS might be able to alleviate or even prevent certain types of cancer treatment-related adverse effects. In this review, we summarize the potential of RAS inhibitors to mitigate cancer treatment-related adverse events, with a special emphasis on chemotherapy-induced cardiotoxicity, radiation injury, and arterial hypertension. Clin Cancer Res; 24(16); 3803-12. ©2018 AACR.
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Affiliation(s)
- Matthias Pinter
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wilhelmus J Kwanten
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.,Laboratory of Experimental Medicine and Paediatrics (LEMP), University of Antwerp, Antwerp, Belgium
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
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Toxicity profile of approved anti-PD-1 monoclonal antibodies in solid tumors: a systematic review and meta-analysis of randomized clinical trials. Oncotarget 2018; 8:8910-8920. [PMID: 27852042 PMCID: PMC5352453 DOI: 10.18632/oncotarget.13315] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose Nivolumab and pembrolizumab are antibodies against the programmed-death-receptor- 1 (PD-1) which are associated with distinct immune related adverse effects (AEs). This meta-analysis of randomized clinical trials aims to summarize current knowledge regarding the toxicity profile of these agents. Methods PubMed search was conducted in February of 2016. The randomized trials needed to have at least one of the study arms consisting of nivolumab or pembrolizumab monotherapy and a control arm containing no anti-PD-1 therapy. Data were analyzed using random effects meta-analysis for risk ratios. Heterogeneity across studies was analyzed using Q and I2 statistics. Results Nine randomized trials and 5,353 patients were included in our meta-analysis. There was evidence of significant heterogeneity between studies. The pooled relative risk (RR) for treatment-related all grade AEs and grade 3/4 AEs was 0.88 (95% CI 0.81-0.95;P=0.002) and 0.39 (95% CI 0.29-0.53; P<0.001) respectively favoring anti-PD-1 therapy versus standard of care approach. The RR of treatment-related death was 0.45 (95% CI 0.19-1.09; P=0.076). Patients treated with PD-1 inhibitors had an increased risk of hyperthyroidism [RR of 3.44 (95% CI 1.98-5.99; P<0.001)] and hypothyroidism [RR of 6.79 (95% CI 3.10-14.84; P<0.001)]. All grade pruritus and vitiligo were also more common among these patients. The pooled absolute risks of pneumonitis and hypophysitis were 2.65% and 0.47% respectively. Conclusion Approved PD-1 inhibitors are well tolerated, associated with significant low risk of severe treatment-related AEs and increased risk of thyroid dysfunction, pruritus, and vitiligo.
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Prognostic role of the cumulative toxicity in patients affected by metastatic renal cells carcinoma and treated with first-line tyrosine kinase inhibitors. Anticancer Drugs 2017; 28:206-212. [PMID: 27754995 DOI: 10.1097/cad.0000000000000439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tyrosine kinase inhibitor-related toxicities have been reported to be predictive and/or prognostic factors in patients affected by metastatic renal cell carcinoma (mRCC). We aim to investigate the incidence of cumulative toxicity and its prognostic role in mRCC patients treated with sunitinib or pazopanib. mRCC patients treated with sunitinib or pazopanib at the European Institute of Oncology in Milan were reviewed for the incidence of adverse events. Cumulative toxicity was defined as the presence of more than one selected adverse event of any grade. Prognoses were evaluated by the International mRCC Database Consortium criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox analysis. A total of 104 patients were included in the final analysis. Only 18.3% did not experience any of the selected toxicities: 26.9% had one, 35.6% had two and 19.2% all three toxicities. Accordingly, 54.8% of patients experienced cumulative toxicity. In those with or without cumulative toxicity, the median PFS was 27.6 versus 7.2 months and the median OS was 61.2 versus 18.7 months, respectively. When cumulative toxicity was adjusted for International mRCC Database Consortium prognostic groups, it maintained its prognostic role for both PFS (hazard ratio: 0.31, 95% confidence interval, 0.20-0.49; P<0.001) and OS (hazard ratio: 0.27, 95% confidence interval, 0.15-0.48; P<0.001). A major limitation was the retrospective and monocentric nature of the analysis. We reported the prognostic role of cumulative toxicity because of hypertension, hypothyroidism and hand-foot syndrome in patients affected by mRCC and treated with sunitinib or pazopanib.
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Takahashi S, Kiyota N, Tahara M. Optimal use of lenvatinib in the treatment of advanced thyroid cancer. CANCERS OF THE HEAD & NECK 2017; 2:7. [PMID: 31093354 PMCID: PMC6460646 DOI: 10.1186/s41199-017-0026-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/18/2017] [Indexed: 01/13/2023]
Abstract
The development of orally active, multitargeted kinase inhibitors (MKIs) represents a significant advance in the treatment of progressive, metastatic thyroid cancer. Lenvatinib, an MKI targeting vascular endothelial growth factor receptor, fibroblast growth factor receptor, platelet-derived growth factor receptor, c-Kit, and RET, has shown efficacy in stabilizing previously progressive disease, with emerging evidence of a possible benefit in terms of overall survival. However, lenvatinib is associated with a side-effect profile similar to those of other MKIs that might affect the outcome of therapy. The aim of this review is to summarize the clinical efficacy and safety of MKIs in the treatment of advanced thyroid cancer in pivotal phase III trials. Common adverse events that may occur during lenvatinib therapy and their management are discussed, including conditions in which its administration should be temporarily withdrawn and resumed pending resolution of adverse events. We focus on data from a subanalysis of Japanese patients in the SELECT trial and in a post-marketing study in Japan. We suggest that lenvatinib is a valuable treatment option for advanced differentiated thyroid cancer. Monitoring and careful management of adverse events including supportive care are required to ensure continuation of therapy.
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Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Penttilä P, Donskov F, Rautiola J, Peltola K, Laukka M, Bono P. Everolimus-induced pneumonitis associates with favourable outcome in patients with metastatic renal cell carcinoma. Eur J Cancer 2017; 81:9-16. [DOI: 10.1016/j.ejca.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 01/13/2023]
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18
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Iacovelli R, Cossu Rocca M, Galli L, De Giorgi U, Sabbatini R, Santoni M, Mosca A, Fornarini G, Massari F, Masini C, Bersanelli M, Biasco E, Lolli C, Guida A, Berardi R, Terrone C, Pastorino A, Ardizzoni A, Pinto C, Buti S, Nolè F, Tortora G. Clinical outcome of patients who reduced sunitinib or pazopanib during first-line treatment for advanced kidney cancer. Urol Oncol 2017; 35:541.e7-541.e13. [PMID: 28572027 DOI: 10.1016/j.urolonc.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/25/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the different outcomes in patients with metastatic renal cell carcinoma (mRCC) who receive a reduced first-line dose of sunitinib or pazopanib compared to those who continue at the standard dose. PATIENTS AND METHODS All the patients treated in 11 oncological centers in Italy for mRCC who started first-line treatment with sunitinib or pazopanib at the standard dose. Descriptive statistical tests were used to highlight differences among groups. Survival was estimated by the Kaplan-Meier method and compared across the groups using log-rank tests, the Cox proportional hazards model adjusted for statistically significant variables was also done. RESULTS A total of 591 patients were included in the study. Of these, 45.7% received a reduced dose of sunitinib or pazopanib after a median treatment time of 3.6 months at the standard dose. The median overall survival in the patients who continued to receive the standard dose was 24.0 months compared to 49.4 months for those who received a reduced dose (hazard ratio = 1.80; 95% CI: 1.42-2.29; P<0.001). Only 45% of the patients received second-line therapy: 42.5% had an mTOR and 54.1% a tyrosine kinase inhibitor. Second-line overall survival was 19.8 and 11.8 months, respectively, in the patients who received, or did not, a reduced dose during first-line therapy (P = 0.007). CONCLUSIONS Toxicity-related dose reduction is a common event in mRCC patients who have started first-line therapy with either sunitinib or pazopanib. This is positively related to the outcomes of both first- and second-line therapy.
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Affiliation(s)
- Roberto Iacovelli
- Department of Medicine, Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy.
| | - Maria Cossu Rocca
- Medical Oncology Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Luca Galli
- Department of Medicine and Oncology, Medical Oncology 2, AOUP, Istituto Toscano Tumori, Pisa, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberto Sabbatini
- Departmet of Oncology and Haematology and Respiratory Disease, University Hospital, Modena, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, Ancona, Italy
| | - Alessandra Mosca
- Department of Translational Medicine, Medical Oncology, Maggiore della Carità Academic Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Fornarini
- Medical Oncology Department, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | - Cristina Masini
- Department of Oncology and Advanced Technology, Medical Oncology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Melissa Bersanelli
- Dipartimento di Emergenza-Urgenza e Area medica generale e Specialistica, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Elisa Biasco
- Department of Medicine and Oncology, Medical Oncology 2, AOUP, Istituto Toscano Tumori, Pisa, Italy
| | - Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Annalisa Guida
- Departmet of Oncology and Haematology and Respiratory Disease, University Hospital, Modena, Italy
| | - Rossana Berardi
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, Ancona, Italy
| | - Carlo Terrone
- Department of Translational Medicine, Urology, Maggiore della Carità Academic Hospital, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Pastorino
- Medical Oncology Department, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Andrea Ardizzoni
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Carmine Pinto
- Department of Oncology and Advanced Technology, Medical Oncology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Sebastiano Buti
- Department of Translational Medicine, Urology, Maggiore della Carità Academic Hospital, University of Eastern Piedmont, Novara, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Giampaolo Tortora
- Department of Medicine, Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
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Bilir C, Yıldız İ, Bilici A, Ucar M, Berk V, Yıldız Y, Yazıcı O, İmamoğlu Gİ, Karadurmuş N, Pilancı KN, Arpacı E, Tanrıverdi Ö, Karcı E, Temiz S, Nayır E, Oktay E, Dal P, Petekkaya İ, Varım C, Cinemre H. Is Change in Hemoglobin Level a Predictive Biomarker of Tyrosine Kinase Efficacy in Metastatic Renal Cell Carcinoma? A Turkish Oncology Group Study. Cancer Invest 2017; 35:248-255. [PMID: 28333566 DOI: 10.1080/07357907.2017.1292518] [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: 10/19/2022]
Abstract
BACKGROUND There are insufficient predictive markers for renal cell carcinoma (RCC). METHODS A total of 308 metastatic RCC patients were analyzed retrospectively. RESULTS The increased hemoglobin (Hb) group had significantly higher progression-free survival and overall survival (OS) compared with the decreased Hb group at 11.5 versus 6.35 months (p < .001) and 21.0 versus 11.36 months (p < .001) respectively. The 1- and 3-year OS rates were higher in the Hb increased group, i.e., 84% versus 64% and 52% versus 35% respectively. CONCLUSIONS The present study showed that increased Hb levels after tyrosine kinase inhibitor therapy could be a predictive marker of RCC.
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Affiliation(s)
- Cemil Bilir
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
| | | | - Ahmet Bilici
- c Department of Medical Oncology , Medipol University School of Medicine , Istanbul , Turkey
| | - Mahmut Ucar
- d Department of Medical Oncology , Erciyes University School of Medicine , Kayseri , Turkey
| | - Veli Berk
- d Department of Medical Oncology , Erciyes University School of Medicine , Kayseri , Turkey
| | - Yaşar Yıldız
- e Department of Medical Oncology , Izmir Katip Çelebi University School of Medicine , Izmir , Turkey
| | - Ozan Yazıcı
- f Department of Medical Oncology , Ankara Numune Teaching and Education Hospital , Ankara , Turkey
| | - Gökşen İnanç İmamoğlu
- g Department of Medical Oncology , Dışkapı Teaching and Education Hospital , Ankara , Turkey
| | - Nuri Karadurmuş
- h Department of Medical Oncology , Gulhane School of Medicine , Ankara , Turkey
| | - Kezban Nur Pilancı
- i Department of Medical Oncology , Haseki Teaching and Education Hospital , Istanbul , Turkey
| | - Erkan Arpacı
- j Department of Medical Oncology , Bülent Ecevit University School of Medicine , Zonguldak , Turkey
| | - Özgür Tanrıverdi
- k Department of Medical Oncology , Mugla Sıtkı Koçman University School of Medicine , Mugla , Turkey
| | - Ebru Karcı
- l Department of Medical Oncology , Ankara University School of Medicine , Ankara , Turkey
| | | | - Erdinc Nayır
- n Department of Medical Oncology , Kahramanmaras Necip Fazil City Hospital , Kahramanmaras , Turkey
| | - Esin Oktay
- o Department of Medical Oncology , Adnan Menderes University Faculty of Medicine , Aydin , Turkey
| | - Pınar Dal
- p Department of Medical Oncology , Eskisehir Osman Gazi University School of Medicine , Eskişehir , Turkey
| | | | - Ceyhun Varım
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
| | - Hakan Cinemre
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
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20
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Peltola KJ, Penttilä P, Rautiola J, Joensuu H, Hänninen E, Ristimäki A, Bono P. Correlation of c-Met Expression and Outcome in Patients With Renal Cell Carcinoma Treated With Sunitinib. Clin Genitourin Cancer 2017; 15:487-494. [PMID: 28237182 DOI: 10.1016/j.clgc.2017.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/11/2017] [Accepted: 01/23/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Treatment of patients with metastatic renal cell carcinoma (mRCC) has improved substantially since the introduction of targeted therapies, but no predictive biomarkers are available. The proto-oncogene c-Met is involved in tumor angiogenesis, development, and metastasis. The main objective was to evaluate c-Met expression in sunitinib-treated patients with mRCC, including patients with bone metastases. METHODS c-Met expression was analyzed from 137 formalin-fixed paraffin-embedded tumor samples using a validated immunostaining protocol. RESULTS Patients with low c-Met expression (n = 78) had longer progression-free survival (PFS) (median 14.3 vs. 6.5 months; P < .001) and overall survival (OS) (median 32.1 vs. 20.1 months; P = .049) than those with high expression. High c-Met expression was an independent predictor of unfavorable PFS in a Cox proportional hazards model adjusted for the Heng risk criteria (HR 1.60 [1.09-2.35]; P = .016). In a subgroup of patients with no bone metastases (n = 106), low c-Met expression was associated with a both longer OS (unadjusted HR 0.63 [95% CI, 0.42-0.95]; P = .034) and PFS (unadjusted HR 0.47 [95% CI, 0.31-0.71]; P < .001). CONCLUSIONS High c-Met expression was associated with poor survival in patients with mRCC treated with sunitinib. Interestingly, the prognostic role may vary based on the location of metastases.
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Affiliation(s)
| | - Patrick Penttilä
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Juhana Rautiola
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Erkki Hänninen
- Pathology, Research Programs Unit and HUSLAB, University of Helsinki, Helsinki, Finland
| | - Ari Ristimäki
- Pathology, Research Programs Unit and HUSLAB, University of Helsinki, Helsinki, Finland
| | - Petri Bono
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
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21
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Macrocytosis during sunitinib treatment predicts progression-free survival in patients with metastatic renal cell carcinoma. Med Oncol 2016; 33:109. [PMID: 27573381 PMCID: PMC5005381 DOI: 10.1007/s12032-016-0818-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 08/13/2016] [Indexed: 01/07/2023]
Abstract
Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, is a first-line treatment for metastatic renal cell carcinoma (mRCC) in patients in ‘low’ and ‘intermediate’ Memorial Sloan Kettering Cancer Center and Heng risk groups. Disruptions of hematopoiesis, such as anemia, neutropenia, and thrombocytopenia, are typically observed during sunitinib treatment. When it comes to RBC parameters, an increase in mean cell volume (MCV) tends to occur, meeting the criteria for macrocytosis in some patients (MCV > 100 fL). We examined changes in RBC parameters of 27 mRCC patients treated with sunitinib (initial dose of 50 mg/day, 6-week treatment: 4 weeks on, 2 weeks off) and correlated them with progression-free survival time (PFS). Patients who had macrocytosis after 3 treatment cycles had significantly longer PFS than those whose MCV stayed less than 100 fL (not reached vs. 11.2 months, p < 0.001). We also found a correlation between MCV values after the first and third treatment cycles and the risk of progression: HR of 0.9 (0.81–0.99) and 0.76 (0.65–0.90) per 1 fL increase in MCV, respectively. The mechanism of MCV elevation during sunitinib treatment has not yet been fully explained. One of the probable causes is sunitinib’s inhibitory influence on c-Kit kinase, as is the case with imatinib. For mRCC patients, this phenomenon could help predict PFS, but since our sample was small, further studies are essential.
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22
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Nagyiványi K, Budai B, Bíró K, Gyergyay F, Noszek L, Küronya Z, Németh H, Nagy P, Géczi L. Synergistic Survival: A New Phenomenon Connected to Adverse Events of First-Line Sunitinib Treatment in Advanced Renal Cell Carcinoma. Clin Genitourin Cancer 2016; 14:314-22. [DOI: 10.1016/j.clgc.2015.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/30/2015] [Indexed: 01/20/2023]
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Rautiola J, Lampinen A, Mirtti T, Ristimäki A, Joensuu H, Bono P, Saharinen P. Association of Angiopoietin-2 and Ki-67 Expression with Vascular Density and Sunitinib Response in Metastatic Renal Cell Carcinoma. PLoS One 2016; 11:e0153745. [PMID: 27100185 PMCID: PMC4839598 DOI: 10.1371/journal.pone.0153745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 04/04/2016] [Indexed: 12/12/2022] Open
Abstract
The Angiopoietin-2 (Ang2, Angpt2) growth factor is a context-dependent antagonist/agonist ligand of the endothelial Tie2 receptor tyrosine kinase and known to promote tumour angiogenesis and metastasis. Angiopoietin antagonists have been tested in clinical cancer trials in combination with VEGF-based anti-angiogenic therapy, including sunitinib, which is widely used as a first-line therapy for metastatic renal cell carcinoma (mRCC). However, little is known about Ang2 protein expression in human tumours and the correlation of tumour Ang2 expression with tumour vascularization, tumour cell proliferation and response to anti-angiogenic therapies. Here, we evaluated, using immunohistochemistry, the expression of Ang2, CD31 and the cell proliferation marker Ki-67 in the primary kidney cancer from 136 mRCC patients, who received first-line sunitinib after nephrectomy. Ang2 protein expression was restrained to RCC tumour vessels, and correlated with tumour vascularization and response to sunitinib. High pre-therapeutic Ang2 expression, and more strongly, combined high expression of both Ang2 and CD31, were associated with a high clinical benefit rate (CBR). Low cancer Ki-67 expression, but not Ang2 or CD31 expression, was associated with favourable progression-free (PFS) and overall survival (OS) as compared to patients with high Ki-67 expression (PFS 6.5 vs. 10.6 months, P = 0.009; OS, 15.7 vs. 28.5 months, P = 0.015). In summary, in this study to investigate endothelial Ang2 in mRCC patients treated with first-line sunitinib, high cancer Ang2 expression was associated with the CBR, but not PFS or OS, whereas low Ki-67 expression was significantly associated with long PFS and OS.
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Affiliation(s)
- Juhana Rautiola
- Comprehensive Cancer Center, Helsinki University Hospital, P.O.B. 180, 00029 HUS, Finland and University of Helsinki, Finland
| | - Anita Lampinen
- Translational Cancer Biology Program, Research Programs Unit, and Department of Virology, Haartman Institute, Biomedicum Helsinki, Haartmaninkatu 8, P.O.B. 63, FI-00014, University of Helsinki, Finland
| | - Tuomas Mirtti
- Institute for Molecular Medicine Finland, Haartmaninkatu 8, P.O.B. 63, FI-00014, University of Helsinki, Finland.,Pathology, Research Programs Unit and HUSLAB, University of Helsinki and Helsinki University Hospital, P.O.B. 400, FI-00029, HUS, Helsinki, Finland
| | - Ari Ristimäki
- Pathology, Research Programs Unit and HUSLAB, University of Helsinki and Helsinki University Hospital, P.O.B. 400, FI-00029, HUS, Helsinki, Finland
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital, P.O.B. 180, 00029 HUS, Finland and University of Helsinki, Finland
| | - Petri Bono
- Comprehensive Cancer Center, Helsinki University Hospital, P.O.B. 180, 00029 HUS, Finland and University of Helsinki, Finland
| | - Pipsa Saharinen
- Translational Cancer Biology Program, Research Programs Unit, and Department of Virology, Haartman Institute, Biomedicum Helsinki, Haartmaninkatu 8, P.O.B. 63, FI-00014, University of Helsinki, Finland.,Wihuri Research Institute, Biomedicum Helsinki, Haartmaninkatu 8, FI-00290, Helsinki, Finland
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Costa R, Carneiro BA, Chandra S, Pai SG, Chae YK, Kaplan JB, Garrett HB, Agulnik M, Kopp PA, Giles FJ. Spotlight on lenvatinib in the treatment of thyroid cancer: patient selection and perspectives. Drug Des Devel Ther 2016; 10:873-84. [PMID: 27013865 PMCID: PMC4778792 DOI: 10.2147/dddt.s93459] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Thyroid cancer is the most common endocrine malignancy, with over 60,000 cases reported per year in the US alone. The incidence of thyroid cancer has increased in the last several years. Patients with metastatic differentiated thyroid cancer (DTC) generally have a good prognosis. Metastatic DTC can often be treated in a targeted manner with radioactive iodine, but the ability to accumulate iodine is lost with decreasing differentiation. Until recently, chemotherapy was the only treatment in patients with advanced thyroid cancer, which is no longer amenable to therapy with radioactive iodine. The modest efficacy and significant toxicity of chemotherapy necessitated the need for urgent advances in the medical field. New insights in thyroid cancer biology propelled the development of targeted therapies for this disease, including the tyrosine kinase inhibitor sorafenib as salvage treatment for DTC. In 2015, the US Food and Drug Administration approved a second tyrosine kinase inhibitor, lenvatinib, for the treatment of radioiodine-refractory thyroid cancer. Although associated with a significant progression-free survival improvement as compared to placebo in a large Phase III study (median progression-free survival 18.2 vs 3.6 months; hazard ratio 0.21; 99% confidence interval 0.14-0.31; P<0.001), the benefit of lenvatinib needs to be proved in the context of associated moderate to severe toxicities that require frequent dose reduction and delays. This article reviews the evidence supporting the use of lenvatinib as salvage therapy for radioactive iodine-refractory thyroid cancer, with a focus on the toxicity profile of this new therapy.
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Affiliation(s)
- Ricardo Costa
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
| | - Benedito A Carneiro
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sunandana Chandra
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sachin G Pai
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
| | - Young Kwang Chae
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason B Kaplan
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hannah B Garrett
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
| | - Mark Agulnik
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Peter A Kopp
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francis J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Robert H Lurie Comprehensive Cancer Center of Northwestern University, IL, USA
- Division of Hematology and Oncology, Feinberg School of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sorich MJ, Kichenadasse G, Rowland A, Woodman RJ, Mangoni AA. Angiotensin system inhibitors and survival in patients with metastatic renal cell carcinoma treated with VEGF-targeted therapy: A pooled secondary analysis of clinical trials. Int J Cancer 2016; 138:2293-9. [PMID: 26685869 DOI: 10.1002/ijc.29972] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 12/25/2022]
Abstract
Use of angiotensin system inhibitors (ASIs; angiotensin receptor blockers or angiotensin-converting enzyme inhibitors) has been reported to be associated with improved survival in metastatic renal cell carcinoma (mRCC), particularly when used with vascular endothelial growth factor-targeted therapies. This study was a secondary pooled analysis of two Phase III randomized controlled trials (RCTs) of patients with mRCC: NCT00334282 comparing pazopanib to placebo and NCT00720941 comparing pazopanib to sunitinib. ASI users were defined as patients using an ASI at baseline. Association with overall survival (OS; primary outcome) and progression-free survival (PFS) was evaluated using Cox proportional hazards regression. The association was adjusted in multivariable analysis for baseline systolic blood pressure (SBP), use of other antihypertensive drugs and prognostic factors comprising the Heng risk criteria for mRCC. Of 1,545 patients pooled from the two RCTs, 649 (42%) were using one or more antihypertensive drugs at baseline, 385 (59%) of which were using an ASI. In the multivariable analysis of patients using pazopanib or sunitinib, no significant association was observed between baseline ASI use and OS (hazard ratio [HR] 0.97 [95% confidence interval (CI) 0.80-1.18], p = 0.80) or PFS (HR 0.88 [95% CI 0.73-1.06], p = 0.17). Exploratory subgroup analysis of NCT00720941 highlighted that the effect of baseline ASI use on OS may differ between patients treated with sunitinib and pazopanib. In conclusion, use of ASIs at baseline was not a significant independent prognostic factor for improved survival in a pooled analysis of mRCC patients treated with pazopanib or sunitinib.
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Affiliation(s)
- Michael J Sorich
- Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
| | - Ganessan Kichenadasse
- Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University, Adelaide, Australia
| | - Andrew Rowland
- Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University, Adelaide, Australia
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Lee HJ, Ryu H, Choi YS, Song IC, Yun HJ, Jo DY, Kim S. Just Toxicity, or Toxicity As a Biomarker of Efficacy of Ramucirumab in Breast Cancer? J Clin Oncol 2015. [PMID: 26195714 DOI: 10.1200/jco.2015.60.8992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hyo Jin Lee
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Hyewon Ryu
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Yoon Seok Choi
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Ik-Chan Song
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Hwan-Jung Yun
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Deog-Yeon Jo
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Samyong Kim
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
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Bracarda S, Iacovelli R, Boni L, Rizzo M, Derosa L, Rossi M, Galli L, Procopio G, Sisani M, Longo F, Santoni M, Morelli F, Di Lorenzo G, Altavilla A, Porta C, Camerini A, Escudier B, Ricotta R, Gasparro D, Sabbatini R, Ceresoli GL, Mosca A, Santini D, Caserta C, Cavanna L, Massari F, Sava T, Boni C, Verzoni E, Cartenì G, Hamzaj A. Sunitinib administered on 2/1 schedule in patients with metastatic renal cell carcinoma: the RAINBOW analysis. Ann Oncol 2015. [PMID: 26216384 DOI: 10.1093/annonc/mdv315] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND First-line sunitinib is recommended in metastatic renal cell carcinoma (mRCC), but it is frequently associated with relevant toxicities and subsequent dose reductions. Alternative schedules, such as 2-week-on treatment and 1-week-off (2/1 schedule), might improve tolerability. We evaluated the safety and outcomes of this schedule in a large multicenter analysis. PATIENTS AND METHODS Retrospective, multicenter analysis of mRCC patients treated with first-line sunitinib on a 2/1 schedule. Data of 249 patients were reviewed: 208 cases who started sunitinib on the 4/2 schedule (full dosage: 188/208, 90.4%) and thereafter switched to the 2/1 schedule for toxicity (group 4/2 → 2/1) and 41 patients who started first-line sunitinib with the 2/1 schedule because of suboptimal clinical conditions (group 2/1). A total of 211 consecutive patients treated with the 4/2 schedule in another institution served as external controls. Safety was the primary end point. Treatment duration (TD), progression-free survival (PFS) and overall survival (OS) were also analyzed. RESULTS In group 4/2 → 2/1, the overall incidence of grade ≥ 3 toxicities was significantly reduced (from 45.7% to 8.2%, P < 0.001) after the switch to 2/1 schedule. This advantage was maintained also in the 106/188 cases (56.4%) who maintained the full dosage. Fatigue, hypertension, hand-foot syndrome and thrombocytopenia were less frequent. The incidence of grade ≥ 3 adverse events in the negatively selected group 2/1 (only 73.2% starting at full dose) was 26.8%, similar to what observed in the external control group (29.4%). Median TD was 28.2 months in the 4/2 → 2/1 group (total time spent with both schedules), 7.8 months in the 2/1 group and 9.7 months in external controls. Median PFS was 30.2, 10.4 and 9.7 months, respectively. Median OS was not reached, 23.2 and 27.8 months, respectively. CONCLUSIONS mRCC patients who moved to a modified 2/1 schedule of sunitinib experience an improved safety profile compared with that observed during the initial 4/2 schedule.
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Affiliation(s)
- S Bracarda
- Ospedale San Donato USL8, Istituto Toscano Tumori (ITT), Arezzo
| | | | - L Boni
- Clinical Trials Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Florence
| | - M Rizzo
- Medical Oncology; AORN Cardarelli, Napoli, Italy
| | - L Derosa
- Institut Gustave Roussy/Medical Oncology Department, Paris, France
| | - M Rossi
- Medical Oncology, Ospedale Santa Maria della Misericordia, Perugia
| | - L Galli
- Polo Oncologico AOU Pisana, Pisa
| | | | - M Sisani
- Ospedale San Donato USL8, Istituto Toscano Tumori (ITT), Arezzo
| | - F Longo
- Medical Oncology A, Policlinico Umberto I°, Roma
| | - M Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Ancona
| | - F Morelli
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - G Di Lorenzo
- Genitourinary Cancers Section, AOU Federico II, Napoli
| | - A Altavilla
- Medical Oncology B, Policlinico Umberto I°, Roma
| | | | - A Camerini
- U.O. Oncologia Medica, Ospedale Versilia, Az. USL12, Lido Di Camaiore, Italy
| | - B Escudier
- Institut Gustave Roussy/Medical Oncology Department, Paris, France
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Anand D, Escalante CP. Ongoing Screening and Treatment to Potentially Reduce Tyrosine Kinase Inhibitor-Related Fatigue in Renal Cell Carcinoma. J Pain Symptom Manage 2015; 50:108-17. [PMID: 25701692 DOI: 10.1016/j.jpainsymman.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 01/03/2023]
Abstract
CONTEXT Renal cell carcinoma (RCC) represents 1% to 4% of adult malignancies, and approximately 33% of patients with RCC present with metastatic disease and have a poor prognosis. Better understanding of RCC tumor biology has led to the development of several molecularly targeted agents, such as tyrosine kinase inhibitors (TKIs), to manage advanced disease. Although evolving data suggest these drugs may be beneficial in RCC, they are associated with significant toxicities. Cancer-related fatigue (CRF) is one of the most common toxicities associated with the TKIs used in RCC. OBJECTIVES To review the incidence, pathophysiology, and management of CRF in patients with RCC who are undergoing targeted therapy with TKIs. METHODS A comprehensive database search was performed using PubMed, Ovid, Embase, and MEDLINE. References of all cited articles also were reviewed. Data from articles published between 1975 and June 2014 were considered. A narrative review regarding the incidence, pathophysiology, and management of CRF in patients with RCC undergoing targeted therapy with TKIs was performed. RESULTS CRF is one of the most common TKI toxicities in patients with metastatic RCC and often is the dose-limiting toxicity. Management of TKI-related CRF can be difficult and may necessitate various nonpharmacologic and pharmacologic interventions. CONCLUSION TKI-related CRF in patients with RCC is a highly distressing complication of cancer therapy. CRF can substantially influence drug compliance, the ability to maximally treat, and quality of life. It is important to recognize this common, yet frequently underdiagnosed complication and initiate appropriate management strategies, to increase the likelihood for optimal outcomes.
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Affiliation(s)
- Deepa Anand
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Carmen P Escalante
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Precision medicine in oncology needs to integrate pharmacogenetic profiling. Eur Urol 2015; 68:630-1. [PMID: 26044803 DOI: 10.1016/j.eururo.2015.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
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Co-occurring adverse events enable early prediction of progression-free survival in metastatic renal cell carcinoma patients treated with sunitinib: a hypothesis-generating study. TUMORI JOURNAL 2015; 101:555-9. [PMID: 26045121 DOI: 10.5301/tj.5000342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 01/24/2023]
Abstract
AIMS AND BACKGROUND Clinical practice shows significant differences in treatment outcomes and toxicity of sunitinib across patients. This retrospective study assessed early predictive markers for progression-free survival (PFS) in patients with metastatic clear cell renal cell carcinoma (RCC) treated with sunitinib in the first-line setting. METHODS We evaluated 28 patients with stage IV clear cell RCC (with good or intermediate MSKCC risk prognosis) treated at the Department of Oncology, University Hospital, Cracow between 2008 and 2013. Data included demographic profiles, adverse events during first cycle of therapy, treatment delays, and treatment outcomes. Sunitinib was administered on a standard schedule (50 mg/day, 4 weeks on, 2 weeks off). PFS values were estimated with the Kaplan-Meier method and compared using the log-rank test; we identified independent PFS predictors using multiple Cox regression models. RESULTS PFS was significantly longer in patients who experienced at least 1 adverse event after the first cycle of sunitinib (median 17.6 months vs. 5.6; p = 0.006). Hypertension and hand-foot syndrome were significantly correlated with longer PFS (29.3 vs. 6.0 months; p = 0.002, and not reached vs. 9.8 months; p = 0.002, respectively). We observed a similar (though not significant) tendency for neutropenia (17.5 vs. 8.4 months; p = 0.055). In multiple Cox regression, hypertension was the only individual independent predictor of PFS, but the co-occurrence of any 2 or 3 sunitinib-induced adverse events also predicted longer survival. CONCLUSIONS Although small, our study suggests that hypertension and hand-foot syndrome predict longer PFS in patients with clear cell RCC treated with sunitinib. The co-occurrence of 2 or more side effects seems also a significant predictor of longer survival. Larger studies are warranted to confirm the correlation between co-occurring side effects and PFS.
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Rautiola J, Donskov F, Peltola K, Joensuu H, Bono P. Sunitinib-induced hypertension, neutropaenia and thrombocytopaenia as predictors of good prognosis in patients with metastatic renal cell carcinoma. BJU Int 2015; 117:110-7. [DOI: 10.1111/bju.12940] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Juhana Rautiola
- Department of Oncology; Helsinki University Central Hospital; Helsinki Finland
- Laboratory of Molecular Oncology; Molecular Cancer Biology Research Program; Biomedicum Helsinki; University of Helsinki; Helsinki Finland
| | - Frede Donskov
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Katriina Peltola
- Department of Oncology; Helsinki University Central Hospital; Helsinki Finland
| | - Heikki Joensuu
- Department of Oncology; Helsinki University Central Hospital; Helsinki Finland
- Laboratory of Molecular Oncology; Molecular Cancer Biology Research Program; Biomedicum Helsinki; University of Helsinki; Helsinki Finland
| | - Petri Bono
- Department of Oncology; Helsinki University Central Hospital; Helsinki Finland
- Laboratory of Molecular Oncology; Molecular Cancer Biology Research Program; Biomedicum Helsinki; University of Helsinki; Helsinki Finland
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Iacovelli R, Verri E, Cossu Rocca M, Aurilio G, Cullurà D, Nolé F. Sunitinib 2 weeks on, 1 off: strengths and weaknesses. Ann Oncol 2015; 26:1511-2. [PMID: 25846552 DOI: 10.1093/annonc/mdv167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Iacovelli
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan PhD Program, Sapienza University of Rome, Rome, Italy
| | - E Verri
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan
| | - M Cossu Rocca
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan
| | - G Aurilio
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan
| | - D Cullurà
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan
| | - F Nolé
- Medical Oncology Unit of Urogenital and Head & Neck Tumors, European Institute of Oncology, Milan
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Chan JY, Choudhury Y, Tan MH. Predictive molecular biomarkers to guide clinical decision making in kidney cancer: current progress and future challenges. Expert Rev Mol Diagn 2015; 15:631-46. [PMID: 25837857 DOI: 10.1586/14737159.2015.1032261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although the past decade has seen a surfeit of new targeted therapies for renal cell carcinoma (RCC), no predictive molecular biomarker is currently used in routine clinical practice to guide personalized therapy as a companion diagnostic. Many putative biomarkers have been suggested, but none have undergone rigorous validation. There have been considerable advances in the biological understanding of RCC in recent years, with the development of accompanying molecular diagnostics that with additional validation, may be helpful for routine clinical decision making. In this review, we summarize the current understanding of predictive biomarkers in RCC management and also highlight upcoming developments of interest in biomarker research for personalizing RCC diagnostics and therapeutics.
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Affiliation(s)
- Jason Yongsheng Chan
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, Singapore
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Merchan JR, Qin R, Pitot H, Picus J, Liu G, Fitch T, Maples WJ, Flynn PJ, Fruth BF, Erlichman C. Safety and activity of temsirolimus and bevacizumab in patients with advanced renal cell carcinoma previously treated with tyrosine kinase inhibitors: a phase 2 consortium study. Cancer Chemother Pharmacol 2015; 75:485-93. [PMID: 25556030 PMCID: PMC4348698 DOI: 10.1007/s00280-014-2668-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Bevacizumab or temsirolimus regimens have clinical activity in the first-line treatment of advanced renal cell carcinoma (RCC). This phase I/II trial was conducted to determine the safety of combining both agents and its efficacy in RCC patients who progressed on at least one prior anti-VEGF receptor tyrosine kinase inhibitor (RTKI) agent. METHODS In the phase I portion, eligible patients were treated with temsirolimus (25 mg IV weekly) and escalating doses of IV bevacizumab (level 1 = 5 mg/kg; level 2 = 10 mg/kg) every other week. The primary endpoint for the phase II portion (RTKI resistant patients) was the 6-month progression-free rate. Secondary endpoints were response rate, toxicity evaluation, and PFS and OS. RESULTS Maximum tolerated dose was not reached at the maximum dose administered in 12 phase I patients. Forty evaluable patients were treated with the phase II recommended dose (temsirolimus 25 mg IV weekly and bevacizumab 10 mg/kg IV every 2 weeks). The 6-month progression-free rate was 40 % (16/40 pts). Median PFS was 5.9 (4-7.8) months, and median OS was 20.6 (11.5-23.7) months. Partial response, stable disease, and progressive disease were seen in 23, 63, and 14 % of patients, respectively. Most common grade 3-4 AEs included fatigue (17.8 %), hypertriglyceridemia (11.1 %), stomatitis (8.9 %), proteinuria (8.9 %), abdominal pain (6.7 %), and anemia (6.7 %). Baseline levels of serum sFLT-1 and VEGF-A were inversely correlated with PFS and OS, respectively. CONCLUSIONS Temsirolimus and bevacizumab is a feasible combination in patients with advanced RCC previously exposed to oral anti-VEGF agents. The safety and efficacy results warrant further confirmatory studies in this patient population.
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Affiliation(s)
- Jaime R Merchan
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW. 12 Avenue. Suite 3400, Miami, FL, 33136, USA,
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Affiliation(s)
- Hyo Jin Lee
- Cancer Research Institute, Chungnam National University, Daejeon, 301-721, South Korea; Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea.
| | - Hyewon Ryu
- Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yoon Seok Choi
- Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Ik-Chan Song
- Cancer Research Institute, Chungnam National University, Daejeon, 301-721, South Korea; Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Hwan-Jung Yun
- Cancer Research Institute, Chungnam National University, Daejeon, 301-721, South Korea; Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Deog-Yeon Jo
- Cancer Research Institute, Chungnam National University, Daejeon, 301-721, South Korea; Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Samyong Kim
- Cancer Research Institute, Chungnam National University, Daejeon, 301-721, South Korea; Division of Hematology/Oncology, Department of Internal Medicine, School of Medicine, Chungnam National University Hospital, Daejeon, South Korea
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Iacovelli R, Pietrantonio F, Palazzo A, Maggi C, Ricchini F, de Braud F, Di Bartolomeo M. Incidence and relative risk of grade 3 and 4 diarrhoea in patients treated with capecitabine or 5-fluorouracil: a meta-analysis of published trials. Br J Clin Pharmacol 2014; 78:1228-37. [PMID: 24962653 PMCID: PMC4256612 DOI: 10.1111/bcp.12449] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/17/2014] [Indexed: 01/05/2023] Open
Abstract
AIM Capecitabine is an oral fluoropyrimidine that can effectively replace infusional 5-fluorouracil (5-FU) for treatment of colorectal, gastric and breast cancer. This study aims to analyze the incidence and the relative risk of grade 3 and 4 diarrhoea in patients treated with capecitabine or 5-FU in randomized clinical trials (RCTs). METHODS MEDLINE and Cochrane Library were reviewed for RCTs that compared capecitabine with 5-FU for treatment of solid malignancies. The incidence and relative risk (RR) of grade 3/4 diarrhoea were estimated for each arm in the overall population and in colorectal cancer (CRC) patients RESULTS Twenty-three studies and 15,761 patients were included. Among these 8303 and 7458 patients received capecitabine or 5-FU based therapies, respectively. In the overall populations severe diarrhoea was reported in 16.6% (95% CI 15.8, 17.4) and in 12.7% (95% CI 11.9, 13.4) of patients treated with capecitabine or 5-FU-based therapies, respectively. The RR was 1.39 (95% CI 1.14, 1.69, P = 0.0010). In 14,899 CRC patients, the incidence of severe diarrhoea was 17.0% (95% CI 16.2, 17.9) and 12.9% (95% CI 12.1, 13.7), respectively, with a RR of 1.46 (95% CI 1.18, 1.81, P < 0.0001). In CRC patients treated with combined chemotherapy, the RR was 1.40 (95% CI 1.07, 1.82; P = 0.01) for patients receiving oxaliplatin and 2.35 (95% CI 1.76, 3.13; P < 0.0001) for patients receiving irinotecan. CONCLUSIONS Treatment with capecitabine is characterized by an increased risk of severe diarrhoea, mainly in patients affected by CRC and treated with polichemotherapy. Combination treatment with irinotecan doubles the risk over 5-FU.
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Affiliation(s)
- Roberto Iacovelli
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
- PhD Program, Department of Radiology Oncology and Human Pathology, Sapienza University of RomeRome, Italy
| | - Filippo Pietrantonio
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
| | - Antonella Palazzo
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
- PhD Program, Department of Radiology Oncology and Human Pathology, Sapienza University of RomeRome, Italy
| | - Claudia Maggi
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
- PhD Program, Department of Radiology Oncology and Human Pathology, Sapienza University of RomeRome, Italy
| | - Francesca Ricchini
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
| | - Filippo de Braud
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
| | - Maria Di Bartolomeo
- Department of Meical Oncology, Fondazione IRCCS, Istituto Nazionale TumoriMilan, Italy
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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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van der Mijn JC, Mier JW, Broxterman HJ, Verheul HM. Predictive biomarkers in renal cell cancer: insights in drug resistance mechanisms. Drug Resist Updat 2014; 17:77-88. [PMID: 25457974 DOI: 10.1016/j.drup.2014.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION VEGF-targeted therapy is currently the first line treatment for patients with metastatic clear cell renal cell carcinoma (ccRCC), but most patients either display primary (intrinsic) resistance or acquire drug resistance. In recent years multiple mechanisms of resistance to VEGF-targeted therapy emerged from preclinical research, but it is currently unknown to what extent these drug resistance modalities play a role in the clinic. Here we reviewed the current literature on biomarkers that predict treatment outcome in patients with ccRCC to gain insight in clinical drug resistance mechanisms. METHODS A search syntax was compiled by combining different synonyms of "biomarker" AND "renal" AND "cancer". MEDLINE was accessed through PubMed, where this syntax was entered and used to search titles and abstracts of publications. Articles were selected based on three criteria: (1) description of patients with clear cell RCC, (2) treatment with VEGF targeted therapy and (3) discussion of biomarkers that were studied for potential association with treatment response. RESULTS The literature search was performed on March 4th 2014 and yielded 1882 articles. After carefully reading the titles and abstracts based on the three previously mentioned criteria, 103 publications were evaluated. Backward citation screening was performed on all eligible studies and revealed another 24 articles. This search revealed that (1) High glucose uptake and low contrast enhancement on PET- and CT-imaging before start of treatment may correlate with poor response to therapy, (2) Low dose intensity due to treatment intolerance is related to shorter progression free survival. (3) Acquired resistance appears to be associated with rebound vascularization based on both longitudinal monitoring of contrast enhancement by CT and blood vessel counts in tumor tissue, and (4) Based on plasma cytokine and single nucleotide polymorphism (SNP) studies, interleukin-8, VEGFR-3, FGFR2 and HGF/MET emerged as potential clinical markers for chemoresistance. CONCLUSION Low dose intensity, specific tumor-imaging techniques and potential biological biomarkers may be predictive for response to VEGF-targeted therapy in ccRCC. Some of these plausible biomarkers may also provide more insight into the underlying mechanisms of resistance such as altered glucose metabolism and rapid rebound vascularization.
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Affiliation(s)
- Johannes C van der Mijn
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Hematology/Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - James W Mier
- Department of Hematology/Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Henk J Broxterman
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk M Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Koyama N, Saito K, Nishioka Y, Yusa W, Yamamoto N, Yamada Y, Nokihara H, Koizumi F, Nishio K, Tamura T. Pharmacodynamic change in plasma angiogenic proteins: a dose-escalation phase 1 study of the multi-kinase inhibitor lenvatinib. BMC Cancer 2014; 14:530. [PMID: 25047123 PMCID: PMC4223557 DOI: 10.1186/1471-2407-14-530] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/03/2014] [Indexed: 12/13/2022] Open
Abstract
Background Lenvatinib (E7080), an oral multi-kinase inhibitor, has inhibitory action on tumor cell proliferation and tumor angiogenesis in preclinical models. We evaluated correlations between pharmacodynamic (PD) biomarkers with patient clinical outcomes in a lenvatinib phase 1 dose-escalation study. Methods Plasma angiogenic proteins were evaluated as potential PD biomarkers of response to lenvatinib in a dose-escalation phase 1 study. Lenvatinib was administered to 27 patients by twice-daily dosing in 3-week cycles; 2 weeks of treatment followed by 1 week of rest until discontinuation. Blood samples for plasma proteins were collected on days 1 (baseline), 8, and 15 of cycle 1, and days 1, 8, and 15 of cycle 2. Selected clinical outcomes, including tumor shrinkage and adverse events (AEs), were used for correlative analyses of pharmacokinetic parameters and PD biomarkers. Results Tumor shrinkage and changes in PD biomarkers (increased vascular endothelial growth factor [VEGF] and stromal cell-derived factor 1 alpha [SDF1α] levels and decreased soluble VEGF receptor 2 [sVEGFR2] levels) significantly correlated with increasing lenvatinib exposure. Observed changes in levels of VEGF, SDF1α, and sVEGFR2 were maintained on day 15 of cycle 1, but returned to baseline during the 1-week rest period, and similar changes were induced by reinstitution of treatment in cycle 2. The worst grades of hypertension, proteinuria, and fatigue were associated with changes in VEGF and HGF at day 8 of cycle 1. Maximum tumor shrinkage was correlated with increased SDF1α levels. Decreased sVEGFR2 level was also correlated with tumor shrinkage and frequency of hypertension, proteinuria, and fatigue. Tumor shrinkage significantly correlated with the worst grade of proteinuria, but not with hypertension or fatigue. Conclusion PD biomarker changes observed in plasma angiogenic proteins are correlated with lenvatinib-induced tumor shrinkage and AEs. Our findings warrant further assessment of plasma proteins associated with angiogenesis as potential biomarkers of lenvatinib activity. Trial registration ClinicalTrial.gov: NCT00280397 (January 20, 2006).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tomohide Tamura
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Vano YA, Tartour E, Fournier LS, Beuselinck B, Mejean A, Oudard S. Prognostic factors in patients with advanced renal cell carcinoma treated with VEGF-targeted agents. Expert Rev Anticancer Ther 2014; 14:523-42. [DOI: 10.1586/14737140.2014.882773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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