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Roy S, Biswas B, Dabkara D, Ganguly S, Ghosh J, Bhattacharjee A, Ray K, Mandal S, Patel YS, Pal S, Karmakar J, Mitra A, Bakshi R, Mukhopadhyay S, Gupta S. Demographic Characteristics and Treatment Outcomes of Advanced Renal Cell Carcinoma With Clear Cell Histology: A Single-Center Experience From India. Cureus 2024; 16:e61978. [PMID: 38855498 PMCID: PMC11162510 DOI: 10.7759/cureus.61978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background Treatment of metastatic renal cell cancer (mRCC) has revolutionized with the introduction of anti-VEGF tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). There is limited data in the literature on the outcomes of Indian patients treated with TKI. Here, we report the outcome of mRCC treated with first-line TKI in a resource-poor setting. Material and methods This is a single-center retrospective study of clear cell mRCC treated with first-line TKI from June 2012 to December 2022. Demographic characteristics and treatment details, including outcome data, were captured from electronic medical records. Patients who received at least one week of therapy were eligible for survival analysis. Results A total of 345 patients with metastatic clear cell histology were analyzed, with a median age of 61 years (range: 20-84 years). One hundred and eighty patients (52%) underwent nephrectomy before systemic therapy. The majority received pazopanib (257 patients, 75%), followed by sunitinib (36 patients, 10%) and cabozantinib (21 patients, 6%); 145 (45%) patients required dose interruption, and 143 (43%) required dose modification of TKI for adverse events. After a median follow-up of 44 months, the median progression-free survival (PFS) was 20.3 months (95% CI: 17.8-24.8), and the median overall survival (OS) was 22.7 months (95% CI: 18.8-28.3). In the poor-risk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) group, no prior nephrectomy emerged as an independent poor-risk factor for both PFS and OS in multivariate analysis. Conclusion This is the largest single-center cohort of clear cell mRCC from Asia. Median PFS was 20.3 months with predominantly TKI monotherapy. In the poor-risk IMDC group, no prior nephrectomy emerged as an independent poor-risk factor for both PFS and OS.
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Affiliation(s)
- Somnath Roy
- Medical Oncology, Tata Medical Center, Kolkata, IND
| | - Bivas Biswas
- Medical Oncology, Tata Medical Center, Kolkata, IND
| | | | | | | | | | - Kuntal Ray
- Medical Oncology, Tata Medical Center, Kolkata, IND
| | - Sayan Mandal
- Medical Oncology, Tata Medical Center, Kolkata, IND
| | | | - Souhita Pal
- Medical Oncology, Tata Medical Center, Kolkata, IND
| | | | | | - Rupsa Bakshi
- Medical Oncology, Tata Medical Center, Kolkata, IND
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Wang X, Qian L, Qian Z, Wu Q, Cheng D, Wei J, Song L, Huang S, Chen X, Wang P, Weng G. Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review. Medicine (Baltimore) 2024; 103:e38268. [PMID: 38788027 PMCID: PMC11124732 DOI: 10.1097/md.0000000000038268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Renal cell carcinoma (RCC) stands among the top 10 malignant neoplasms with the highest fatality rates. It exhibits pronounced heterogeneity and robust metastatic behavior. Patients with RCC may present with solitary or multiple metastatic lesions at various anatomical sites, and their prognoses are contingent upon the site of metastasis. When deliberating the optimal therapeutic approach for a patient, thorough evaluation of significant risk factors such as the feasibility of complete resection, the presence of oligometastases, and the patient's functional and physical condition is imperative. Recognizing the nuanced differences in RCC metastasis to distinct organs proves advantageous in contemplating potential treatment modalities aimed at optimizing survival outcomes. Moreover, discerning the metastatic site holds promise for enhancing risk stratification in individuals with metastatic RCC. This review summarizes the recent data pertaining to the current status of different RCC metastatic sites and elucidates their role in informing clinical management strategies across diverse metastatic locales of RCC.
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Affiliation(s)
- Xue Wang
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Lin Qian
- Department of Urologic Surgery, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Zengxing Qian
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Qihang Wu
- Department of Clinical Laboratory, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Dongying Cheng
- Department of community, Ningbo Yinzhou No. 3 Hospital, Ningbo, China
| | - Junjun Wei
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Lingmin Song
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Shuaihuai Huang
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Xiaodong Chen
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Ping Wang
- Department of Clinical Laboratory, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Guobin Weng
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
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Barthélémy P, Dutailly P, Qvick B, Perrot V, Verzoni E. CaboCombo: a prospective, phase IV study of first-line cabozantinib + nivolumab for advanced renal cell carcinoma. Future Oncol 2024; 20:811-819. [PMID: 37403652 DOI: 10.2217/fon-2023-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Cabozantinib plus nivolumab was approved as a first-line (1L) treatment for advanced renal cell carcinoma (aRCC) following the CheckMate 9ER trial. CaboCombo (ClinicalTrials.gov identifier: NCT05361434) is a non-interventional study designed to evaluate the effectiveness and tolerability of cabozantinib plus nivolumab in a real-world setting. Overall, 311 patients with clear-cell aRCC receiving 1L cabozantinib plus nivolumab will be recruited from at least 70 centers in seven countries worldwide. The primary end point is overall survival at 18 months. Secondary end points include progression-free survival, objective response rate, safety, patterns of treatment, subsequent anticancer therapies and quality of life. CaboCombo will provide real-world evidence on the characteristics, treatment sequences, and outcomes of patients with aRCC receiving 1L cabozantinib plus nivolumab.
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Affiliation(s)
- Philippe Barthélémy
- Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, Strasbourg, 67200, France
| | - Pascale Dutailly
- Ipsen, 65 Quai Georges Gorse, Boulogne-Billancourt, 92100, France
| | - Bryan Qvick
- Ipsen, Einsteinstraße 174, München, 81677, Germany
| | - Valerie Perrot
- Ipsen, 65 Quai Georges Gorse, Boulogne-Billancourt, 92100, France
| | - Elena Verzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milano, 20133, Italy
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Minami K, Osawa T, Kojima T, Hara T, Eto M, Takeuchi A, Nakai Y, Ueda K, Ozawa M, Uemura M, Ohba K, Tamura K, Shindo T, Nakagomi H, Takahashi A, Anai S, Yokomizo A, Morizane S, Kimura T, Shimazui T, Miyauchi Y, Mitsuzuka K, Hara H, Yoshimura K, Shiina H, Ito YM, Murai S, Nishiyama H, Shinohara N, Kitamura H. Efficacy and safety of axitinib for metastatic renal cell carcinoma: Real-world data on patients with renal impairment. Urol Oncol 2023; 41:458.e9-458.e19. [PMID: 37798145 DOI: 10.1016/j.urolonc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Limited information is currently available on the efficacy and safety of axitinib for metastatic renal cell carcinoma (mRCC) patients with renal impairment. Therefore, the present study investigated the efficacy and toxicity of axitinib in patients with chronic kidney disease. METHODS Post-hoc analyses were performed on a Japanese multicenter cohort study of 477 mRCC patients who received axitinib followed by 1 or 2 regimens of systemic antiangiogenic therapy between January 2012 and December 2016. Differences in clinical characteristics and the efficacy and safety of axitinib were assessed based on pretreatment renal function. RESULTS Patients were categorized into the following 5 renal function groups according to baseline renal function: estimated glomerular filtration rate (eGFR) ≥60 ml/min (n = 133), 45 ml/min ≤eGFR <60 ml/min (n = 153), 30 ml/min ≤eGFR< 45 ml/min (n = 130), eGFR <30 ml/min (n = 45), and dialysis (n = 16). Median progression-free survival (PFS) (95% confidence interval [CI]) in the 5 groups was 11 (8-16), 14 (11-19), 14 (10-19), 12 (8-24), and 6 (3-NR) months, respectively (p = 0.781). After adjustments for treatment-related confounders, the renal function group was not a significant prognostic factor for PFS. Objective response rates in the 5 groups were 22%, 23%, 23%, 18%, 20%, and 38%, respectively (p = 0.468). Regarding adverse events of all grades, hypertension (p = 0.0006) and renal and urinary disorders (p < 0.0001) were more frequently observed in the eGFR <30 ml/min group than in the other groups. CONCLUSIONS Since renal function at the initiation of treatment with axitinib does not adversely affect the efficacy of VEGF-TKI therapy, clinicians do not need to avoid its administration to mRCC patients with impaired renal function in consideration of the risk of progression to end-stage renal disease.
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Affiliation(s)
- Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takahiro Kimura
- Department of Urology, The Jikei University, School of Medicine, Tokyo, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | | | | | - Hiroaki Hara
- Department of Urology, Shinshu University Hospital, Matsumoto, Japan
| | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Youichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Toyama University Hospital, Toyama, Japan
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Semenescu LE, Kamel A, Ciubotaru V, Baez-Rodriguez SM, Furtos M, Costachi A, Dricu A, Tătăranu LG. An Overview of Systemic Targeted Therapy in Renal Cell Carcinoma, with a Focus on Metastatic Renal Cell Carcinoma and Brain Metastases. Curr Issues Mol Biol 2023; 45:7680-7704. [PMID: 37754269 PMCID: PMC10528141 DOI: 10.3390/cimb45090485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
The most commonly diagnosed malignancy of the urinary system is represented by renal cell carcinoma. Various subvariants of RCC were described, with a clear-cell type prevailing in about 85% of all RCC tumors. Patients with metastases from renal cell carcinoma did not have many effective therapies until the end of the 1980s, as long as hormonal therapy and chemotherapy were the only options available. The outcomes were unsatisfactory due to the poor effectiveness of the available therapeutic options, but then interferon-alpha and interleukin-2 showed treatment effectiveness, providing benefits but only for less than half of the patients. However, it was not until 2004 that targeted therapies emerged, prolonging the survival rate. Currently, new technologies and strategies are being developed to improve the actual efficacy of available treatments and their prognostic aspects. This article summarizes the mechanisms of action, importance, benefits, adverse events of special interest, and efficacy of immunotherapy in metastatic renal cell carcinoma, with a focus on brain metastases.
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Affiliation(s)
- Liliana Eleonora Semenescu
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania; (L.E.S.); (A.C.)
| | - Amira Kamel
- Neurosurgical Department, Clinical Emergency Hospital “Bagdasar-Arseni”, Soseaua Berceni 12, 041915 Bucharest, Romania; (A.K.); (V.C.); (S.M.B.-R.); (L.G.T.)
| | - Vasile Ciubotaru
- Neurosurgical Department, Clinical Emergency Hospital “Bagdasar-Arseni”, Soseaua Berceni 12, 041915 Bucharest, Romania; (A.K.); (V.C.); (S.M.B.-R.); (L.G.T.)
| | - Silvia Mara Baez-Rodriguez
- Neurosurgical Department, Clinical Emergency Hospital “Bagdasar-Arseni”, Soseaua Berceni 12, 041915 Bucharest, Romania; (A.K.); (V.C.); (S.M.B.-R.); (L.G.T.)
| | - Mircea Furtos
- Neurosurgical Department, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania;
| | - Alexandra Costachi
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania; (L.E.S.); (A.C.)
| | - Anica Dricu
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Str. Petru Rares nr. 2-4, 710204 Craiova, Romania; (L.E.S.); (A.C.)
| | - Ligia Gabriela Tătăranu
- Neurosurgical Department, Clinical Emergency Hospital “Bagdasar-Arseni”, Soseaua Berceni 12, 041915 Bucharest, Romania; (A.K.); (V.C.); (S.M.B.-R.); (L.G.T.)
- Department of Neurosurgery, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania
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Harada KI, Sato R, Bando Y, Sano A, Matsushita Y, Tamura K, Terakawa T, Furukawa J, Fujimoto N, Fujisawa M, Miyake H. Efficacy and safety of pembrolizumab and axitinib as first-line treatment for patients with advanced renal cell carcinoma: Real-world experience in Japan. Int J Urol 2023; 30:772-777. [PMID: 37345413 DOI: 10.1111/iju.15230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES The objective of this study was to assess the clinical outcomes following combined treatment with pembrolizumab and axitinib as first-line therapy for patients with advanced RCC. METHODS This study retrospectively included 47 consecutive Japanese patients who were diagnosed with advanced RCC and subsequently received pembrolizumab and axitinib between February 2020 and January 2022. Efficacy and safety of this combined therapy in these patients were comprehensively investigated. RESULTS The 47 included patients were classified into the following 3 groups by the IMDC system: favorable, 7 (14.9%); intermediate, 24 (51.1%) and poor, 16 (34.0%). Responses to this combined therapy in the 47 patients were as follows: CR, 8 (17.0%); PR, 20 (42.6%); SD, 16 (34.0%) and PD, 3 (6.4%); thus, the ORR was 59.6%. During the observation period, disease progression and death occurred in 19 (40.4%) and 9 (19.1%) patients, respectively, and the median PFS and OS were 18 months and not reached, respectively. Univariate analyses identified the following significant predictors for poor prognostic outcomes: lack of nephrectomy, liver metastasis, bone metastasis, elevated CRP and IMDC poor risk for PFS; and lack of nephrectomy, non-CCC and elevated CRP for OS. AEs and those corresponding to grade ≥ 3 occurred in all (100%) and 30 (63.8%) patients, respectively. CONCLUSIONS To our knowledge, this is the first study focusing on real-world outcomes following pembrolizumab and axitinib for treatment-naïve advanced Japanese RCC patients, which showed the efficacy and safety of this combined therapy being similar or even superior to those in clinical trial.
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Affiliation(s)
- Ken-Ichi Harada
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukari Bando
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Asuka Sano
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Ishihara H, Nemoto Y, Nakamura K, Tachibana H, Ikeda T, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Shimmura H, Hashimoto Y, Kondo T, Takagi T. Comparison of Outcomes Between Therapeutic Combinations Based on Immune Checkpoint Inhibitors or Tyrosine Kinase Inhibitor Monotherapy for First-Line Therapy of Patients with Advanced Renal Cell Carcinoma Outside of Clinical Trials: A Real-World Retrospective Multi-Institutional Study. Target Oncol 2023; 18:209-220. [PMID: 36941516 DOI: 10.1007/s11523-023-00956-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Clinical trials have demonstrated the superior efficacy of immune checkpoint inhibitor (ICI)-based combination therapy over sunitinib, a multi-target tyrosine kinase inhibitor (TKI), in patients with advanced renal cell carcinoma. However, such benefits have not been elucidated in populations outside of clinical trials. METHODS We retrospectively evaluated data from 467 patients with advanced renal cell carcinoma who received ICI-based combination therapy or TKIs, as first-line therapy. Clinical outcome was compared between ICI-based combination therapy and TKIs in each population divided according to trial eligibility. RESULTS Among 152 patients treated with ICI-based combination therapy and 315 patients treated with TKIs, 76 (50.0%) and 156 (49.5%) were trial ineligible, respectively. Overall survival (p = 0.0072) and objective response rate (p < 0.0001) were significantly higher in ICI-based combination therapy than in TKIs, but progression-free survival was comparable (p = 0.681). In the trial-eligible population, overall survival was longer (p = 0.0906) and the objective response rate was significantly higher (p = 0.0124) in ICI-based combination therapy than in TKIs. In the trial-ineligible population, overall survival (p = 0.0208) and objective response rate (p = 0.0006) were significantly higher with ICI-based combination therapy than with TKIs. A multivariate analysis also showed that ICI-based combination therapy was independently associated with prolonged overall survival (hazard ratio, 0.47; p = 0.0016). Regardless of trial eligibility, progression-free survival did not differ between ICI-based combination therapy and TKIs (trial eligible: p = 0.287; trial ineligible: p = 0.0708). CONCLUSIONS The present study, using real-world data, provides evidence indicating the therapeutic benefit of ICI-based combination therapy over TKIs for advanced renal cell carcinoma was more statistically significant in the trial-ineligible population than in the trial-eligible population.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, Japan.
| | - Yuki Nemoto
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, Japan
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazutaka Nakamura
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
- Department of Urology, Jyoban Hospital, Uenodai 57, Joban Kamiyunagayamachi, Iwaki, Fukushima, Japan
| | - Hidekazu Tachibana
- Department of Urology, Saiseikai Kazo Hospital, 1680 Kamitakayanagi, Kazo, Saitama, Japan
| | - Takashi Ikeda
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital, Uenodai 57, Joban Kamiyunagayamachi, Iwaki, Fukushima, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kouhoku, Adachi-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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Outcomes from treatment of metastatic renal-cell carcinoma following failure of first-line anti-VEGF/VEGFR therapy: real-life evidence on the change of the treatment paradigm. Anticancer Drugs 2023; 34:413-421. [PMID: 36730619 DOI: 10.1097/cad.0000000000001420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recently approved agents for post-vascular endothelial growth factor/post-vascular endothelial growth factor receptor (VEGF/VEGFR) inhibitors treatment of metastatic renal-cell carcinomas (mRCC), such as axitinib, nivolumab, and cabozantinib were shown to improve prognosis and substituted everolimus in this setting. We studied practice patterns, efficacy, and tolerability of these agents in a real-world series of Greek patients. We included patients with mRCC who received everolimus, axitinib, or nivolumab after progression on first-line anti-VEGF/VEGFRs therapy. Patients were stratified into three groups. Group A received nivolumab with or without cabozantinib at some point in their disease. Group B received axitinib but without nivolumab or cabozantinib. Group C received only everolimus among the four approved agents. Overall, 131 patients were included in the analysis. Everolimus and nivolumab were mainly used in the second line, while axitinib and cabozantinib were mostly used in the third and fourth lines. Median overall survival (OS) from first-line initiation was 8.7 [95% confidence interval (CI), 4-not reached], 3.6 (95% CI, 2-6), and 2.1 years (95% CI, 1.4-2.6) for Group A, B, and C, respectively ( P < 0.001). Median OS from the initiation of second-line therapy was 3.5, 2.7, and 1.3 years, respectively ( P < 0.001). There was no impact of first-line agent or treatment timing on survival. International Metastatic Renal Cell Carcinoma Database Consortium risk stratification was associated with OS. Toxicities observed were within expected frequencies. Grade ≥3 events were rare. Adoption of modern standards in everyday treatment of mRCC results in prolongation of survival. Real-world datasets are the new landmarks of survival for future research.
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9
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Baseline and Dynamic Changes in Hemoglobin Levels Predict Treatment Response and Prognosis in Metastatic Renal Cell Carcinoma: A Multicenter Retrospective Study. Clin Genitourin Cancer 2023:S1558-7673(23)00035-6. [PMID: 36922286 DOI: 10.1016/j.clgc.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Clinical markers of response in metastatic renal cell carcinoma (mRCC) are lacking. Low hemoglobin (Hb) is associated with poor outcomes in the IMDC risk score. This study evaluates the role of Hb as a marker of treatment outcomes in mRCC. PATIENTS AND METHODS This multicenter retrospective study evaluated 276 patients with mRCC treated with frontline immune checkpoint inhibitor (ICI) therapy, ICI and vascular endothelial growth factor (VEGF) inhibitor (VEGFI) combinations (ICI/VEGFI), or VEGFI monotherapy between 2014 and 2021. Hb levels at baseline, week 6 and 12 and at disease progression or death were recorded. Patients were categorized as responders (CR+PR) or nonresponders (SD+PD) using cross-sectional imaging at week 12. The association between baseline and dynamic changes in Hb and oncological outcomes was assessed. RESULTS Thirty-seven percent, 40% and 22% of patients received ICIs, ICI/VEGFI and VEGFI respectively. In patients receiving ICIs, there was a significant increase in Hb amongst responders from baseline to week 12 (P= .02). Amongst patients receiving ICI/VEGFI, there was an increase in Hb from baseline to week 12 which was greater in responders (P< .001). In patients receiving VEGFI monotherapy, responders had a higher Hb at baseline (P= .01), week 6 (P= .04), and week 12 (P= .003). An increase in Hb was a significant independent predictor of progression-free survival amongst patients receiving ICIs (HR 0.40, 95%CI, 0.19-0.83, P= .009). CONCLUSION Baseline and dynamic changes in Hb are associated with first-line treatment outcomes in patients with mRCC and represent a pragmatic early serological marker.
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Boys E, Gao B, Hui R, da Silva I, Hau E, Gee H, Nagrial A. Use of durvalumab in stage III non-small-cell lung cancer based on eligibility for the PACIFIC study. Thorac Cancer 2023; 14:563-572. [PMID: 36627112 PMCID: PMC9968599 DOI: 10.1111/1759-7714.14780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Durvalumab following concurrent chemoradiotherapy is standard treatment for unresectable stage III non-small-cell lung cancer based on the results of the PACIFIC trial. Based on trial criteria, not all patients are eligible for durvalumab in routine clinical practice. METHODS We evaluated eligibility for durvalumab in a real-world clinical setting and the impact of eligibility on outcomes. Consecutive patients treated with concurrent chemoradiotherapy at two tertiary centers between January 2015 and June 2022 were assessed. Clinical characteristics and outcomes were evaluated based on eligibility criteria for the PACIFIC trial. RESULTS A total of 126 patients were included. Seventy patients (56%) were eligible for durvalumab. Ineligibility was associated with shorter progression-free survival of 9.7 months versus 18.4 months (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39-0.95, p = 0.029) and overall survival of 26.4 months versus 58.7 months (HR 0.47, 95% CI 0.28-0.80, p = 0.005). Common reasons for ineligibility were history of previous malignancy (32%) and progressive disease or death during chemoradiotherapy (25%). Ineligible patients who received durvalumab had similar outcomes to eligible patients who received durvalumab. CONCLUSIONS In a real-world cohort, adjuvant durvalumab is safe and beneficial in a substantial proportion of patients who would not have been eligible for the PACIFIC trial.
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Affiliation(s)
- Emma Boys
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bo Gao
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rina Hui
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Inês da Silva
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Eric Hau
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Harriet Gee
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Adnan Nagrial
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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11
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Noda R, Akabane A, Kawashima M, Uchino K, Tsunoda S, Segawa M, Inoue T. VEGFR-TKI treatment for radiation-induced brain injury after gamma knife radiosurgery for brain metastases from renal cell carcinomas. Jpn J Clin Oncol 2022; 53:355-364. [PMID: 36579769 DOI: 10.1093/jjco/hyac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Antiangiogenic vascular endothelial growth factor receptor tyrosine kinase inhibitors play an essential role in systemic therapy for renal cell carcinoma. Given the anti-edematous effect of bevacizumab, an antiangiogenic antibody targeting vascular endothelial growth factor, vascular endothelial growth factor receptor tyrosine kinase inhibitors should exert therapeutic effects on radiation-induced brain injury after stereotactic radiosurgery. This preliminary study aimed to investigate the therapeutic effect of vascular endothelial growth factor receptor tyrosine kinase inhibitor against radiation-induced brain injury. METHODS Magnetic resonance images for six patients treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors who were diagnosed with radiation-induced brain injury following gamma knife radiosurgery were retrospectively reviewed. RESULTS The median brain edema volume and tumour mass volume in the pre-tyrosine kinase inhibitor period were 57.6 mL (range: 39.4-188.2) and 3.2 mL (range: 1.0-4.6), respectively. Axitinib, pazopanib (followed by cabozantinib) and sunitinib were administered in four, one and one cases, respectively. The median brain edema volume and tumour mass volume in the post-tyrosine kinase inhibitor period were 4.8 mL (range: 1.5-27.8) and 1.6 mL (range: 0.4-3.6), respectively. The median rates of reduction in brain edema volume and tumour mass volume were 90.8% (range: 51.9-97.6%) and 57.2% (range: 20.0-68.6%), respectively. The post-tyrosine kinase inhibitor values for brain edema volume (P = 0.027) and tumour mass volume (P = 0.008) were significantly lower than the pre-tyrosine kinase inhibitor values. Changes in volume were correlated with tyrosine kinase inhibitor use. CONCLUSION This study is the first to demonstrate the therapeutic effects of vascular endothelial growth factor receptor tyrosine kinase inhibitors on radiation-induced brain injury in patients with brain metastases from renal cell carcinoma treated via gamma knife radiosurgery.
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Affiliation(s)
- Ryuichi Noda
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan.,Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Atsuya Akabane
- Gamma Knife Center, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Keita Uchino
- Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Masafumi Segawa
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan
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12
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Eggers H, Schünemann C, Grünwald V, Rudolph L, Tiemann ML, Reuter C, Anders-Meyn MF, Ganser A, Ivanyi P. Improving survival in metastatic renal cell carcinoma (mRCC) patients: do elderly patients benefit from expanded targeted therapeutic options? World J Urol 2022; 40:2489-2497. [PMID: 35916904 PMCID: PMC9512722 DOI: 10.1007/s00345-022-04110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Treatment advances in metastatic renal cell carcinoma (mRCC) have improved overall survival (OS) in mRCC patients over the last two decades. This single center retrospective analysis assesses if the purported survival benefits are also applicable in elderly mRCC patients. METHODS 401 patients with mRCC treated at Hannover Medical School from 01/2003-05/2016 were identified and evaluated by chart review. Treatment periods were defined as 01.01.2003-31.12.2009 (P1) and 01.01.2010-31.05.2016 (P2). Age groups were defined according to WHO classes (≤ 60 years: younger, > 60-75 years: elderly and > 75 years: old). Descriptive statistics, Kaplan-Meier analysis and logistic regression were performed. RESULTS Median OS improved from 35.1 months in P1 to 59.1 months in P2. Sub-division into the respective age groups revealed median survival of 38.1 (95%-CI: 28.6-47.6) months in younger patients, 42.9 (95%-CI: 29.5-56.3) months among elderly patients and 27.3 (95%-CI: 12.8-41.8) months among old patients. Risk reduction for death between periods was most evident among old patients (young: HR 0.71 (95%-CI: 0.45-1.13, p = 0.2); elderly: HR 0.62 (95%-CI: 0.40-0.97, p = 0.04); old: HR 0.43 (95%-CI: 0.18-1.05, p = 0.06)). Age ≥ 75 years was an independent risk factor for death in P1 but not in P2. CONCLUSION Improved OS in the targeted treatment period was confirmed. Surprisingly elderly and old patients seem to profit the most form expansion of therapeutic armamentarium, within the TKI-dominated observation period.
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Affiliation(s)
- Hendrik Eggers
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Christoph Schünemann
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Viktor Grünwald
- Interdisciplinary Working Group Renal Cell Cancer of German Cancer Society (IAG-N), Berlin, Germany
- Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Essen University Hospital, Essen, Germany
| | - Linda Rudolph
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Maria-Luisa Tiemann
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Christoph Reuter
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Merle Freya Anders-Meyn
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
| | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany.
- Interdisciplinary Working Group Renal Cell Cancer of German Cancer Society (IAG-N), Berlin, Germany.
- Department for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School, OE 6860, Carl-Neuberg Str. 1, Hannover, Germany.
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13
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Stühler V, Herrmann L, Rausch S, Stenzl A, Bedke J. Real world data on IO-based therapy for metastatic renal cell carcinoma. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04173-0. [PMID: 35907009 DOI: 10.1007/s00432-022-04173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/25/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Immune-based (IO)-combinations are the backbone in the systemic therapy of metastatic renal cell carcinoma (mRCC). Despite phase III clinical trial data, real world data are of special importance to reflect clinical practice. METHODS This retrospective study included 201 mRCC patients receiving first-line systemic therapy from January 2006. Clinicopathological and treatment-related data were recorded. Progression-free (PFS) and overall survival (OS) were analyzed using descriptive statistics and Kaplan-Meier analysis. RESULTS Over the years, IO-based therapies have increased significantly. The collective comprises 76 patients with first-line IO-based therapy (IO-IO:55, TKI-IO:21) and 125 patients with TKI-monotherapy. PFS was significantly improved with TKI-IO combinations if compared to both TKI-monotherapy (23.9 vs. 10.3 months, HR 0.48, p = 0.034) and IO-IO combination (23.9 vs. 6.1 months, HR 0.37, p = 0.012). OS for TKI-IO treated patients was longer compared to TKI-monotherapy (HR 0.37, p = 0.050) at median follow-up of 24.1 versus 29.9 months. In a subanalysis of nivolumab treated patients, starting from second-line (n = 40), PFS was 5.5 months. The addition of nivolumab either in second-or later lines improved OS compared to repeated TKI- or mTOR-therapies alone (6.13 vs. 2.61 years, HR 0.46, p = 0.003). CONCLUSION Both first-line IO-based combinations and nivolumab after first-line TKI-monotherapy prolong OS in a real-world setting.
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Affiliation(s)
- Viktoria Stühler
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Lisa Herrmann
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany
| | - Jens Bedke
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Hoppe-Seyler Street 3, 72076, Tuebingen, Germany.
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14
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Efficacy and Safety of Immunotherapy-Based Combinations as First-Line Therapy for Metastatic Renal Cell Carcinoma in Patients Who Do Not Meet Trial Eligibility Criteria. Target Oncol 2022; 17:475-482. [PMID: 35789472 DOI: 10.1007/s11523-022-00896-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Data regarding the efficacy and safety profiles of immune checkpoint inhibitors (ICIs) for metastatic renal cell carcinoma (mRCC) trial-ineligible patients in the real world remain unclear. OBJECTIVES The aim of this study was to clarify the impact of trial eligibility on ICI-based combination therapy for mRCC. PATIENTS AND METHODS We collected clinical data of mRCC patients receiving ICIs since 2016, and 222 patients were registered. Among these patients, we evaluated 93 patients treated with ICI-based combination therapy, including nivolumab plus ipilimumab, pembrolizumab plus axitinib, or avelumab plus axitinib, as first-line therapy. Patients were classified into the trial-ineligible group when they had at least one of the following factors at the time of treatment initiation: Karnofsky performance status (KPS) < 70%, hemoglobin level < 9.0 g/dL, estimated glomerular filtration rate (eGFR) < 40 mL/min/1.73 m2, platelet count < 100,000/µL, neutrophil count < 1500/µL, non-clear cell histology, or brain metastasis. The remaining patients were classified into the trial-eligible group. RESULTS Forty-eight patients (52%) were classified into the trial-ineligible group. The frequency of patients with trial-ineligible factors was highest for low eGFR (n = 20, 45%), followed by non-clear cell histology (n = 17, 36%) and low KPS score (n = 12, 25%). There was no significant difference in progression-free survival (median: 24.0 vs. 11.0 months, p = 0.416), overall survival (1-year rate: 87.0% vs. 85.3%, p = 0.634), or objective response rate (52% vs. 42%, p = 0.308) between the trial-eligible and -ineligible patients. The incidence rate of adverse events was higher in the trial-eligible patients than in the trial-ineligible patients (91% vs. 75%, p = 0.0397); however, the rate of grade 3 or higher adverse events was comparable between the two groups (42% vs. 40%, p = 0.796). CONCLUSIONS There are many trial-ineligible patients in the real world. Nevertheless, the efficacy and safety of ICI-based combination therapy in trial-ineligible patients were non-inferior compared with those of trial-eligible patients.
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15
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Rathmell WK, Rumble RB, Van Veldhuizen PJ, Al-Ahmadie H, Emamekhoo H, Hauke RJ, Louie AV, Milowsky MI, Molina AM, Rose TL, Siva S, Zaorsky NG, Zhang T, Qamar R, Kungel TM, Lewis B, Singer EA. Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline. J Clin Oncol 2022; 40:2957-2995. [PMID: 35728020 DOI: 10.1200/jco.22.00868] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC). METHODS An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations. RESULTS The panel considered peer-reviewed reports published in English. RECOMMENDATIONS The diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.,American Society for Therapeutic Radiology and Oncology Representative, Toronto, ON
| | | | | | - Tracy L Rose
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH.,American Society for Therapeutic Radiology and Oncology Representative, Cleveland, OH
| | - Tian Zhang
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Bryan Lewis
- KidneyCan, Philadelphia, PA.,Patient Representative, Philadelphia, PA
| | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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16
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van Veelen A, Abtahi S, Souverein P, Driessen JH, Klungel OH, Dingemans AMC, van Geel R, de Vries F, Croes S. Characteristics of patients with lung cancer in clinical practice and their potential eligibility for clinical trials evaluating tyrosine kinase inhibitors or immune checkpoint inhibitors. Cancer Epidemiol 2022; 78:102149. [DOI: 10.1016/j.canep.2022.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022]
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17
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Zakharia Y, Thomaidou D, Li B, Siu G, Levin R, Vlahiotis A, Rao D, Zanotti G. Real-World Therapy Management and Outcomes of First-Line Axitinib Plus Pembrolizumab in Patients With Advanced Renal Cell Carcinoma in the United States. Front Oncol 2022; 12:861189. [PMID: 35664758 PMCID: PMC9161634 DOI: 10.3389/fonc.2022.861189] [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: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCombination axitinib plus pembrolizumab is a standard of care in the first-line treatment of patients with advanced clear cell renal cell carcinoma (RCC). This analysis describes the clinical characteristics, treatment management and outcomes of patients receiving first-line (1L) axitinib plus pembrolizumab in a real-world US setting.MethodsElectronic health record (EHR)-derived data from the Flatiron Health Database, which includes ~280 cancer clinics across 800 sites in the US, were used. Patients had confirmed Stage IV or metastatic RCC and initiated 1L axitinib plus pembrolizumab on or after 1/1/2018 to 3/31/2021. Outcomes were best overall response rate; real-world progression-free survival (rwPFS) and overall survival (OS) at landmark time periods (3, 6, 9, and 12 months). Therapy management (TM) included dose hold, dose change and discontinuation. Data are reported as medians (IQR) unless otherwise noted.Results355 patients received 1L axitinib plus pembrolizumab, with median follow-up of 9.7 (0.1–24.3) months. IMDC Risk Score was favorable, intermediate, and poor in 27 (7.6%), 126 (35.5%), and 76 (21.4%) patients, respectively (23.4% intermediate/poor, 12.1% unknown). 270 patients (76.1%) received only 1L axitinib plus pembrolizumab and 85 patients (24.3%) received ≥1 subsequent line of treatment; cabozantinib was the most frequent subsequent line of treatment (47.9%). rwPFS at 3 months and 1 year was 77.2% and 39.3%, respectively. OS ranged from 90.8% at 3 months to 73.5% at 1 year. Best overall response rate was 47.9%. Toxicity was the most common reason for first TM events of dose hold, change and discontinuation at, 58.6%, 58.5%, and 45.8%, respectively. Over 80% of patients with TM were able to continue with 1L axitinib plus pembrolizumab.ConclusionsIn a real-world setting, axitinib plus pembrolizumab was effective as a 1L treatment for patients with advanced RCC. Dose holds, changes and discontinuation were driven by treatment-related toxicity. Dose holds may represent an effective TM strategy to toxicity.
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Affiliation(s)
- Yousef Zakharia
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- *Correspondence: Yousef Zakharia,
| | | | | | - Gordon Siu
- Pfizer Inc., New York, NY, United States
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18
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Ishihara H, Nemoto Y, Nakamura K, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Shimmura H, Hashimoto Y, Tanabe K, Kondo T, Takagi T. Changes in Real-World Outcomes in Patients with Metastatic Renal Cell Carcinoma from the Molecular-Targeted Therapy Era to the Immune Checkpoint Inhibitor Era. Target Oncol 2022; 17:307-319. [PMID: 35460475 DOI: 10.1007/s11523-022-00879-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge of changes in the outcome in patients with metastatic renal cell carcinoma from the molecular-targeted therapy era to the immune checkpoint inhibitor (ICI) era remains limited in the real-world setting. OBJECTIVES We aimed to clarify outcome changes from the previous molecular-targeted therapy era to the current ICI era in patients with metastatic renal cell carcinoma using multi-institution real-world data. METHODS We retrospectively evaluated 415 patients with metastatic renal cell carcinoma who received first-line systemic therapy at five Japanese institutions between January 2008 and August 2021. We divided the patients into two groups based on the treatment era: molecular-targeted therapy era (January 2008-August 2018) and ICI era (September 2018-August 2021). According to the era, progression-free survival, overall survival, and objective response rate from first-line systemic therapy were compared. RESULTS Overall, 304 (73.3%) and 111 (26.7%) patients were categorized into the molecular-targeted therapy and ICI eras, respectively. The proportion of patients without prior nephrectomy (p = 0.0030) or those with low Karnofsky Performance Status scores [≤ 70] (p = 0.0258) were significantly higher in the ICI era group. The patients in the ICI era group had significantly longer overall survival (median: not reached vs 23.2 months, p = 0.0001) and a higher objective response rate (47.8% vs 24.7%, p < 0.0001) than those in the molecular-targeted therapy era group, and progression-free survival tended to be longer in the ICI era group (median: 13.3 vs 8.75 months, p = 0.0579). Multivariate analysis further showed that the treatment era (ICI vs molecular-targeted therapy) was an independent factor for overall survival and objective response (both, p < 0.0001). CONCLUSIONS The present multi-institution real-world data showed the improved outcome of previously untreated patients with metastatic renal cell carcinoma in the ICI era group compared with that in the molecular-targeted therapy era group. These findings strongly encourage the use of ICI-based treatment for patients with metastatic renal cell carcinoma in the real-world setting. Further studies with extended follow-up periods are needed to confirm our findings.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
| | - Yuki Nemoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
| | | | - Hidekazu Tachibana
- Department of Urology, Saiseikai Kurihashi Hospital, Kuki, Saitama, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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19
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Ishihara H, Nemoto Y, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Hashimoto Y, Takagi T, Ishida H, Kondo T, Tanabe K. Outcomes of nivolumab monotherapy for previously treated metastatic renal cell carcinoma: a real-world multi-institution data with a minimum of 2 years of follow-up. Jpn J Clin Oncol 2022; 52:785-790. [PMID: 35373823 DOI: 10.1093/jjco/hyac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate the long-term follow-up outcomes of nivolumab monotherapy for previously treated metastatic renal cell carcinoma, using real-world data. METHODS A total of 121 patients were treated with nivolumab monotherapy as subsequent therapy after the failure of prior tyrosine kinase inhibitor therapy between January 2013 and December 2021 at four affiliated institutions. To evaluate the outcome after 2 years or more, we selected patients in whom nivolumab therapy was started in December 2019 or earlier because data collection was performed until the end of December 2021. RESULTS Seventy-four patients were evaluated. During the median follow-up period of 25.8 months, 62 (84%) and 40 (54%) patients had disease progression and died, respectively. Nivolumab was administered as second-line therapy in 43 patients (58%). The median progression-free survival and overall survival were 5.52 and 31.1 months, respectively, and objective response rate was 36%. There was no difference in progression-free survival or overall survival based on the treatment line of nivolumab (P = 0.915, P = 0.559). The magnitude of tumor response and development of immune-related adverse events were significantly associated with progression-free survival (P < 0.0001, P < 0.0001, respectively) and overall survival (P < 0.0001, P = 0.0002, respectively). Treatment-related adverse events developed in 38 patients (51%), including 33 (45%) who had immune-related adverse events. Steroid administration was needed in nine patients (12%). CONCLUSIONS The present real-world multi-institution study with long-term follow-up data demonstrates that nivolumab monotherapy is effective for previously treated metastatic renal cell carcinoma, prolonging survival, improving tumor response and has a manageable safety profile.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Yuki Nemoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi-city, Saitama, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi-city, Saitama, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Arakawa-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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20
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Abdel-Rahman O, North S. Socioeconomic disparities in the prevalence of comorbid chronic conditions among Canadian adults with cancer. Acta Oncol 2022; 61:294-301. [PMID: 34726566 DOI: 10.1080/0284186x.2021.1995892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the prevalence of comorbid chronic conditions among Canadian adults with cancer and the impact of socioeconomic background on the distribution of these conditions. METHODS Canadian Community Health Survey (CCHS) 2017-2018 dataset was accessed and individuals with complete information about cancer history were reviewed. The prevalence of the following 10 chronic conditions was reviewed: asthma, chronic obstructive pulmonary disease, arthritis, hypertension, hypercholesterolemia/hyperlipidemia, heart disease, stroke, diabetes, mood disorder, and anxiety disorder. Stratification of the prevalence was done according to age, sex, and racial subgroups. Multivariable logistic regression analysis was done to evaluate the association between sociodemographic characteristics and having multiple comorbid conditions. RESULTS A total of 104,362 participants were included in the current study (including 10,782 participants with a history of cancer; and 93,580 participants without a history of cancer). Among all age, sex, and race strata, participants with a history of cancer were more likely to have multiple chronic conditions (p < 0.05 for all comparisons). The most common three individual comorbid conditions among participants with cancer were arthritis (40.2%), hypertension (36.1%), and hypercholesterolemia (25.2%); while the most common cancer-comorbidity triad among participants with cancer was cancer/arthritis/hypertension (17.7%). In a multivariable logistic regression analysis among participants with cancer, the following sociodemographic factors were associated with having multiple comorbid conditions: older age (OR for age 80+ versus age 18-20 years: 8.32; 95% CI: 5.17-13.39), indigenous racial group (OR: 1.94; 95% CI: 1.43-2.63) and lower income (OR for income ≥80,000 Canadian dollars (CAD) versus income: ≤20,000 CAD: 0.29; 95% CI: 0.23-0.37). CONCLUSION History of cancer is associated with a higher probability of many comorbid conditions. This excess comorbidity burden seems to be unequally shouldered by individuals in the lower socioeconomic stratum as well as minority populations.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Scott North
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
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21
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Han HS, Lee KE, Suh YJ, Jee HJ, Kim BJ, Kim HS, Lee KW, Ryu MH, Baek SK, Park IH, Ahn HK, Jeong JH, Kim MH, Lee DH, Kim S, Moon H, Son S, Byun JH, Kim DS, An H, Park YH, Zang DY. Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group. Ther Adv Med Oncol 2022; 14:17588359221132628. [PMID: 36339930 PMCID: PMC9634188 DOI: 10.1177/17588359221132628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Electronic medical records (EMRs) have the highest value among real-world
data (RWD). The aim of the present study was to propose a data collection
framework of EMR-based RWD to evaluate the effectiveness and safety of
cancer drugs by conducting a nationwide real-world study based on the Korean
Cancer Study Group. Methods: We considered all patients who received ramucirumab plus paclitaxel (RAM/PTX)
for gastric cancer and trastuzumab emtansine (T-DM1) for breast cancer at
relevant institutions in South Korea. Standard operating procedures for
systematic data collection were prospectively developed. Investigator
reliability was evaluated using the concordance rate between the recommended
input value for representative fictional cases and the input value of each
investigator. Reliability of collected data was evaluated twice during the
study period at three institutions randomly selected using the concordance
rate between the previously collected data and data collected by an
independent investigator. The reliability results of the investigators and
collected data were used for revision of the electronic data capture system
and site training. Results: Between the starting date of medical insurance coverage and December 2018, a
total of 1063 patients at 56 institutions in the RAM/PTX cohort and 824
patients at 60 institutions in the T-DM1 cohort were included. Mean
investigator reliability in the RAM/PTX and T-DM1 cohorts was 73.5% and
71.9%, respectively. Mean reliability of collected data in the RAM/PTX and
T-DM1 cohort was 90.0% for both cohorts in the first analysis and 89.0% and
84.0% in the second analysis, respectively. Mean missing values of the
RAM/PTX and T-DM1 cohorts at the time of simulation of fictional cases and
final data analysis decreased from 20.7% to 0.46% and from 18.5% to 0.76%,
respectively. Conclusion: This real-world study provides a framework that ensures relevance and
reliability of EMR-based RWD for evaluating the effectiveness and safety of
cancer drugs.
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Affiliation(s)
- Hye Sook Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea
| | - Hyeong Su Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - In Hae Park
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Hwan Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul
| | - Dae Hyung Lee
- Inha University Hospital, Incheon, Republic of Korea
| | - Siheon Kim
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyemi Moon
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Serim Son
- Department of Biostatistics, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji-Hye Byun
- Innovation Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong Sook Kim
- Review & Assessment Research Department, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, College of Medicine, Korea University, Anam-dong 5-ga, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yeon Hee Park
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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22
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Demasure S, Spriet I, Debruyne PR, Laenen A, Wynendaele W, Baldewijns M, Dumez H, Clement PM, Wildiers H, Schöffski P, Roussel E, Kinget L, Albersen M, Beuselinck B. Overall survival improvement in patients with metastatic clear-cell renal cell carcinoma between 2000 and 2020: a retrospective cohort study. Acta Oncol 2022; 61:22-29. [PMID: 34711121 DOI: 10.1080/0284186x.2021.1989720] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Only a few recent phase III trials with targeted therapies or immune checkpoint inhibitors (ICIs) in metastatic clear-cell renal cell carcinoma (m-ccRCC) demonstrated an overall survival (OS) benefit compared to standard of care. We aimed to study the evolution of OS since the start of systemic therapy from 2000 to 2020. PATIENTS AND METHODS Retrospective study on all consecutively treated m-ccRCC patients in three Belgian hospitals starting with systemic therapy. The study outcome was OS since the start of systemic therapy. We used a univariable Cox model for OS with year of the start of therapy as a predictor, and a multivariable analysis including known prognostic factors. Linear and non-linear trends of time were tested. RESULTS Five hundred patients were included. In a linear model, the HR for OS depending on the year of the start of therapy was 0.95 (95%CI 0.93-0.97; p < 0.0001), estimated for an increase with 1 year in time. In a non-linear model, OS started to improve from 2006 on, when vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) replaced interferon alfa (IFNa) as a standard of care and continued to increase steadily during the following years. On multivariable analysis, the year of the start of therapy remained an independent prognostic factor for OS. Two-year OS after the start of systemic therapy was 23%, 34%, 50% and 59% for patients who started treatment in 2000-2005, 2006-2011, 2012-2017, and 2018-2020, respectively. The five-year OS of the first three groups was 7%, 14% and 24%. The mean number of administered lines of therapy increased over time, with an incidence rate ratio of 1.07 (95%CI 1.05-1.08; p < 0.0001) per year increase for the period 2000-2016. CONCLUSION OS of m-ccRCC patients has been improving significantly over the last 15 years since the introduction of VEGFR-TKIs and ICIs.
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Affiliation(s)
- Sofie Demasure
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Philip R. Debruyne
- Department of General Medical Oncology, AZ Groeninge, Kortrijk, School of Life Sciences, Anglia Ruskin University, Cambridge, UK
| | - Annouschka Laenen
- Biostatistics and Statistical Bioinformatics Center, Leuven, Belgium
| | - Wim Wynendaele
- Department of Medical Oncology, Imelda Ziekenhuis, Bonheiden, Belgium
| | | | - Herlinde Dumez
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Paul M. Clement
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Kinget
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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23
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Emamekhoo H, Olsen MR, Carthon BC, Drakaki A, Percent IJ, Molina AM, Cho DC, Bendell JC, Gordan LN, Rezazadeh Kalebasty A, George DJ, Hutson TE, Arrowsmith ER, Zhang J, Zoco J, Johansen JL, Leung DK, Tykodi SS. Safety and efficacy of nivolumab plus ipilimumab in patients with advanced renal cell carcinoma with brain metastases: CheckMate 920. Cancer 2021; 128:966-974. [PMID: 34784056 PMCID: PMC9298991 DOI: 10.1002/cncr.34016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
Background Nivolumab plus ipilimumab (NIVO + IPI) has demonstrated long‐term efficacy and safety in patients with previously untreated, advanced renal cell carcinoma (aRCC). Although most phase 3 clinical trials exclude patients with brain metastases, the ongoing, multicohort phase 3b/4 CheckMate 920 trial (ClincalTrials.gov identifier NCT02982954) evaluated the safety and efficacy of NIVO + IPI in a cohort that included patients with aRCC and brain metastases, as reported here. Methods Patients with previously untreated aRCC and asymptomatic brain metastases received NIVO 3 mg/kg plus IPI 1 mg/kg every 3 weeks × 4 followed by NIVO 480 mg every 4 weeks. The primary end point was the incidence of grade ≥3 immune‐mediated adverse events (imAEs) within 100 days of the last dose of study drug. Key secondary end points were progression‐free survival and the objective response rate according to Response Evaluation Criteria in Solid Tumors, version 1.1 (both determined by the investigator). Exploratory end points included overall survival, among others. Results After a minimum follow‐up of 24.5 months (N = 28), no grade 5 imAEs occurred. The most common grade 3 and 4 imAEs were diarrhea/colitis (n = 2; 7%) and hypophysitis, rash, hepatitis, and diabetes mellitus (n = 1 each; 4%). The objective response rate was 32% (95% CI, 14.9%‐53.5%) with a median duration of response of 24.0 months; 4 of 8 responders remained without reported progression. Seven patients (25%) had intracranial progression. The median progression‐free survival was 9.0 months (95% CI, 2.9‐12.0 months), and the median overall survival was not reached (95% CI, 14.1 months to not estimable). Conclusions In patients who had previously untreated aRCC and brain metastases—a population with a high unmet medical need that often is underrepresented in clinical trials—the approved regimen of NIVO + IPI followed by NIVO showed encouraging antitumor activity and no new safety signals. CheckMate 920 is the first prospective, multicohort study of nivolumab plus ipilimumab as first‐line therapy for advanced renal cell carcinoma in patients who have a poor prognosis and a high unmet medical need. In cohort 3 (advanced renal cell carcinoma and brain metastases), nivolumab plus ipilimumab has a safety profile consistent with previous reports of this dosing regimen with encouraging antitumor activity.
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Affiliation(s)
- Hamid Emamekhoo
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark R Olsen
- Oklahoma Cancer Specialists and Research Institute, Tulsa, Oklahoma
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University Hospital Midtown, Atlanta, Georgia
| | - Alexandra Drakaki
- Division of Hematology/Oncology, Institute of Urologic Oncology, UCLA Health, Los Angeles, California
| | | | | | - Daniel C Cho
- Perlmutter Cancer Center at New York University Langone Medical Center, New York, New York
| | - Johanna C Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Lucio N Gordan
- Florida Cancer Specialists North/Sarah Cannon Research Institute, Gainesville, Florida
| | | | | | | | | | | | | | | | | | - Scott S Tykodi
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
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24
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Evolving Patterns of Metastasis in Renal Cell Carcinoma: Do We Need to Perform Routine Bone Imaging? J Kidney Cancer VHL 2021; 8:13-19. [PMID: 34722126 PMCID: PMC8523177 DOI: 10.15586/jkcvhl.v8i4.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Advance diagnostic and treatment modalities have improved outcomes for renal cell carcinoma (RCC) patients, but the prognosis for those with metastatic disease (mRCC) remains poor. As given metastatic distribution is critical in guiding treatment decisions for mRCC patients, we evaluated evolving metastatic patterns to assess if our current practice standards effectively address patient needs. A systematic literature review was performed to identify all publicly available prospective clinical trials in metastatic renal cell carcinoma (mRCC) from 1990 to 2018. A total of 16,899 mRCC patients from 127 qualified phase I–III clinical trials with metastatic site documentations were included for analysis for incidence of metastases to lung, liver, bone, and lymph nodes (LNs) over time. Studies were categorized into three treatment eras based on the timing of regulatory approval: Cytokine Era (1990-2004), vascular endothelial growth factor/tyrosine kinase inhibitor (TKI) Era (2005-2016), and immune checkpoint inhibitor/TKI Era (ICI-TKI, 2017-2018) and also classified as first-line only (FLO) or second-line and beyond (SLB). Overall, an increase in the incidence of bone and LNs metastases in FLO and SLB, and lung metastases in FLO, was seen over the three treatment eras. Generally, the burden of disease is higher in SLB when compared with FLO. Importantly, in the ICI-TKI era, the incidences of bone metastasis are 28% in FLO and 29% in SLB settings. The disease burden in patients with mRCC has increased steadily over the past three decades. Given the unexpectedly high rate of bone metastasis, routine dedicated bone imaging should be considered in all patients with mRCC.
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25
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Abdel-Rahman O. Association between PD-L1 inhibitor, tumor site and adverse events of potential immune etiology within the US FDA adverse event reporting system. Immunotherapy 2021; 13:1407-1417. [PMID: 34709083 DOI: 10.2217/imt-2021-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: To analyze tumor- and treatment-related factors that might impact the development of certain adverse events (AEs) of potential immune etiology among patients receiving PD-L1 inhibitors. Methods: The FDA Adverse Event Reporting System (FAERS) was accessed, and AE reports related to the use of PD-L1 inhibitors were reviewed. Associations between treatment, tumor type and occurrence of AEs of special interest were analyzed through multivariable logistic regression analysis. Results: A total of 80,304 AE reports were included in the current analysis. Diagnosis with lung cancer was associated with a higher probability of pneumonitis; diagnosis with melanoma was associated with a higher probability of hepatitis, hypophysitis/hypopituitarism and uveitis; and diagnosis with genitourinary cancers was associated with a higher probability of nephritis, adrenal insufficiency and myocarditis. Conclusion: Within this cohort limited to AEs reported to the FAERS, there is an association between different AEs of special interest, agent(s) used and tumor(s) treated.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
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26
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Ishihara H, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Takagi T, Iizuka J, Ishida H, Kondo T, Tanabe K. Prognostic Impact of Trial-Eligibility Criteria in Patients with Metastatic Renal Cell Carcinoma. Urol Int 2021; 106:368-375. [PMID: 34515259 DOI: 10.1159/000518162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the prognostic impact of trial-eligibility criteria on outcome in real-world metastatic renal cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors (TKIs). PATIENTS AND METHODS mRCC patients treated with TKIs as first-line systemic therapy were retrospectively evaluated. The patients were determined as trial-ineligible when they met at least 1 following trial-ineligible criteria; Karnofsky performance status score <70, hemoglobin <9.0 g/dL, creatinine >2.4 mg/dL (male) or >2.0 mg/dL (female), calcium >12.0 mg/dL, platelet <100,000 /μL, neutrophil <1,500 /μL, nonclear-cell histology, and brain metastasis. RESULTS Of 238 patients, 101 patients (42%) were determined as trial-ineligible. Progression-free survival (PFS) and overall survival (OS) after the TKI initiation were significantly shorter in the trial-ineligible patients than in the trial-eligible patients (median PFS: 5.53 vs. 15.8 months, p < 0.0001; OS: 13.8 vs. 43.4 months, p < 0.0001). Objective response rate was also significantly lower in the trial-ineligible patients (15% vs. 37%, p = 0.0003). Multivariate analysis further showed that the trial-eligibility was an independent factor for PFS (hazard ratio [HR]: 2.46, p < 0.0001) and OS (HR: 2.39, p < 0.0001). In addition, the number of trial-ineligible factors were negatively correlated with PFS and OS. CONCLUSIONS In real-word, the substantial number of mRCC patients did not meet the trial-eligibility criteria, and their outcome was worse than that in the trial-eligible patients. Further studies focusing on the outcome in real-world trial-ineligible patients in the immune checkpoint inhibitor era are warranted.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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27
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Costello BA, Bhavsar NA, Zakharia Y, Pal SK, Vaishampayan U, Jim H, Fishman MN, Molina AM, Kyriakopoulos CE, Tsao CK, Appleman LJ, Gartrell BA, Hussain A, Stadler WM, Agarwal N, Pachynski RK, Hutson TE, Hammers HJ, Ryan CW, Mardekian J, Borham A, George DJ, Harrison MR. A Prospective Multicenter Evaluation of Initial Treatment Choice in Metastatic Renal Cell Carcinoma Prior to the Immunotherapy Era: The MaRCC Registry Experience. Clin Genitourin Cancer 2021; 20:1-10. [PMID: 34364796 PMCID: PMC10186183 DOI: 10.1016/j.clgc.2021.07.002] [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: 12/17/2020] [Revised: 05/07/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Metastatic Renal Cell Carcinoma (MaRCC) Registry provides prospective data on real-world treatment patterns and outcomes in patients with metastatic renal cell carcinoma (mRCC). METHODS AND MATERIALS Patients with mRCC and no prior systemic therapy were enrolled at academic and community sites. End of study data collection was in March 2019. Outcomes included overall survival (OS). A survey of treating physicians assessed reasons for treatment initiations and discontinuations. RESULTS Overall, 376 patients with mRCC initiated first-line therapy; 171 (45.5%) received pazopanib, 75 (19.9%) sunitinib, and 74 (19.7%) participated in a clinical trial. Median (95% confidence interval) OS was longest in the clinical trial group (50.3 [35.8-not reached] months) versus pazopanib (39.0 [29.7-50.9] months) and sunitinib 26.2 [19.9-61.5] months). Non-clear cell RCC (21.5% of patients) was associated with worse median OS than clear cell RCC (18.0 vs. 47.3 months). Differences in baseline characteristics, treatment starting dose, and relative dose exposure among treatment groups suggest selection bias. Survey results revealed a de-emphasis on quality of life, toxicity, and patient preference compared with efficacy in treatment selection. CONCLUSION The MaRCC Registry gives insights into real-world first-line treatment selection, outcomes, and physician rationale regarding initial treatment selection prior to the immunotherapy era. Differences in outcomes between clinical trial and off-study patients reflect the difficulty in translating trial results to real-world patients, and emphasize the need to broaden clinical trial eligibility. Physician emphasis on efficacy over quality of life and toxicity suggests more data and education are needed regarding these endpoints.
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Affiliation(s)
| | | | | | | | | | | | | | - Ana M Molina
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | | | - Che-Kai Tsao
- Tisch Cancer Institute, Mount Sinai Medical Center, New York, NY
| | | | - Benjamin A Gartrell
- Departments of Medical Oncology and Urology, Montefiore Medical Center, Bronx, NY
| | - Arif Hussain
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Walter M Stadler
- University of Chicago, Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, Chicago, IL
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Russell K Pachynski
- Siteman Cancer Center, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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28
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Harrison MR, Costello BA, Bhavsar NA, Vaishampayan U, Pal SK, Zakharia Y, Jim HSL, Fishman MN, Molina AM, Kyriakopoulos CE, Tsao C, Appleman LJ, Gartrell BA, Hussain A, Stadler WM, Agarwal N, Pachynski RK, Hutson TE, Hammers HJ, Ryan CW, Inman BA, Mardekian J, Borham A, George DJ. Active surveillance of metastatic renal cell carcinoma: Results from a prospective observational study (MaRCC). Cancer 2021; 127:2204-2212. [PMID: 33765337 PMCID: PMC8251950 DOI: 10.1002/cncr.33494] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Systemic therapy (ST) can be deferred in patients who have metastatic renal cell carcinoma (mRCC) and slow-growing metastases. Currently, this subset of patients managed with active surveillance (AS) is not well described in the literature. METHODS This was a prospective observational study of patients with mRCC across 46 US community and academic centers. The objective was to describe baseline characteristics and demographics of patients with mRCC initially managed by AS, reasons for AS, and patient outcomes. Descriptive statistics were used to characterize demographics, baseline characteristics, and patient-related outcomes. Wilcoxon 2-sample rank-sum tests and χ2 tests were used to assess differences between ST and AS cohorts in continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to assess survival. RESULTS Of 504 patients, mRCC was initially managed by AS (n = 143) or ST (n = 305); 56 patients were excluded from the analysis. Disease was present in 69% of patients who received AS, whereas the remaining 31% had no evidence of disease. At data cutoff, 72 of 143 patients (50%) in the AS cohort had not received ST. The median overall survival was not reached (95% CI, 122 months to not estimable) in patients who received AS versus 30 months (95% CI, 25-44 months) in those who received ST. Quality of life at baseline was significantly better in patients who were managed with AS versus ST. CONCLUSIONS AS occurs frequently (32%) in real-world clinical practice and appears to be a safe and appropriate alternative to immediate ST in selected patients.
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Affiliation(s)
| | | | - Nrupen A. Bhavsar
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
| | | | - Sumanta K. Pal
- Medical Oncology and Experimental TherapeuticsCity of Hope Comprehensive Cancer CenterDuarteCalifornia
| | - Yousef Zakharia
- Department of MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowa
| | | | | | - Ana M. Molina
- Division of Hematology and Medical OncologyDepartment of MedicineWeill Cornell MedicineNew YorkNew York
| | | | - Che‐Kai Tsao
- Tisch Cancer Institute, Mount Sinai Medical CenterNew YorkNew York
| | - Leonard J. Appleman
- The University of Pittsburgh Medical Center (UPMC) Cancer PavilionPittsburghPennsylvania
| | - Benjamin A. Gartrell
- Department of Medical OncologyMontefiore Medical CenterBronxNew York,Department of UrologyMontefiore Medical CenterBronxNew York
| | - Arif Hussain
- Department of MedicineUniversity of MarylandBaltimoreMaryland
| | - Walter M. Stadler
- Section of Hematology/OncologyDepartment of MedicineComprehensive Cancer CenterUniversity of ChicagoChicagoIllinois
| | - Neeraj Agarwal
- Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtah
| | - Russell K. Pachynski
- Siteman Cancer Center, Department of MedicineWashington University School of MedicineSt LouisMissouri
| | | | - Hans J. Hammers
- Division of Hematology‐OncologyUniversity of Texas SouthwesternDallasTexas
| | - Christopher W. Ryan
- Department of Medicine, Division of Hematology and Medical OncologyOregon Health and Science UniversityPortlandOregon
| | - Brant A. Inman
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
| | | | | | - Daniel J. George
- Duke Cancer InstituteDuke University Medical CenterDurhamNorth Carolina
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Prognostic Impact of Early Treatment Interruption of Nivolumab Plus Ipilimumab Due to Immune-Related Adverse Events as First-Line Therapy for Metastatic Renal Cell Carcinoma: A Multi-Institution Retrospective Study. Target Oncol 2021; 16:493-502. [PMID: 34173936 DOI: 10.1007/s11523-021-00825-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND It remains unclear how early treatment interruption of nivolumab plus ipilimumab due to immune-related adverse events affects the outcome of previously untreated metastatic renal cell carcinoma (mRCC). OBJECTIVE To investigate the prognostic impact of the early interruption of nivolumab plus ipilimumab, used as first-line therapy for mRCC. PATIENTS AND METHODS We retrospectively evaluated 59 intermediate- or poor-risk mRCC patients who received nivolumab plus ipilimumab as first-line therapy. Based on whether early treatment interruption was implemented within the initial four treatment cycles (i.e., 3 months) or not, progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were compared. The prognostic association was further compared with that of 186 patients treated with tyrosine kinase inhibitors (TKIs) as first-line therapy. RESULTS Twenty-three of the 59 patients (39%) experienced interruption of nivolumab plus ipilimumab therapy. The patients with interruption had longer PFS (p = 0.0055), similar OS (p = 0.366), and likely higher ORR (p = 0.0660) than those without interruption. Of the patients treated with TKIs, 60 of 186 (32%) experienced interruption, with shorter PFS (p = 0.0121), similar OS (p = 0.378), and similar ORR (p = 0.738) than those without interruption. In the 23 patients with nivolumab plus ipilimumab interruption, high-dose corticosteroids were administered in seven patients (30%). PFS (p = 0.638), OS (p = 0.968), or ORR (p = 0.760) did not differ based on corticosteroid administration. CONCLUSIONS Early treatment interruption, which exerted a negative effect for TKIs, was a preferable event for nivolumab plus ipilimumab when considering PFS. Furthermore, early administration of high-dose corticosteroids did not diminish the anti-tumor effect of nivolumab plus ipilimumab.
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30
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Ishihara H, Takagi T, Kondo T, Fukuda H, Tachibana H, Yoshida K, Iizuka J, Kobayashi H, Okumi M, Ishida H, Tanabe K. Assessing improvements in metastatic renal cell carcinoma systemic treatments from the pre-cytokine to the immune checkpoint inhibitor eras: a retrospective analysis of real-world data. Jpn J Clin Oncol 2021; 51:793-801. [PMID: 33324983 DOI: 10.1093/jjco/hyaa232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Studies assessing outcome improvements over a long period according to systemic therapy strategies for metastatic renal cell carcinoma using real-world data, including the results of the recent era of immune checkpoint inhibitors, are limited. Herein, we retrospectively evaluated patients who were diagnosed with metastatic renal cell carcinoma over a 40-year span. METHODS Patients were classified into four groups based on when their metastases were diagnosed as follows: (i) the pre-cytokine era (1980-1986), (ii) the cytokine era (1987-2007), (iii) the molecular-targeted therapy (mTT) era (2008 to August 2016) and (iv) the immune checkpoint inhibitor era (September 2016 to 2018). The immune checkpoint inhibitor era consisted of second- or later-line nivolumab. Overall survival from the diagnoses of metastases was evaluated. RESULTS In total, 576 patients were evaluated, including 22 (3.82%), 231 (40.1%), 253 (43.9%) and 70 (12.2%) patients from the pre-cytokine, cytokine, molecular-targeted therapy and immune checkpoint inhibitor eras, respectively. The overall survival significantly improved with each successive era (median: 13.1 vs. 24.5 vs. 44.4 months vs. not reached in pre-cytokine vs. cytokine vs. molecular-targeted therapy vs. immune checkpoint inhibitor eras, P < 0.0001). The implementation of molecular-targeted therapy improved overall survival compared with that of cytokine (cytokine vs. molecular-targeted therapy eras, P < 0.0001). Multivariate analysis demonstrated that the era was an independent factor for overall survival (P < 0.0001), together with histopathological type; metastasis status (i.e. synchronous or metachronous); systemic therapy status (i.e. absence or presence) and bone, liver or lymph node metastasis status (all, P < 0.05). CONCLUSION This retrospective study of real-world data indicated that metastatic renal cell carcinoma outcomes improved with successive systemic therapy paradigms.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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31
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Gan CL, Stukalin I, Meyers DE, Dudani S, Grosjean HAI, Dolter S, Ewanchuk BW, Goutam S, Sander M, Wells C, Pabani A, Cheng T, Monzon J, Morris D, Basappa NS, Pal SK, Wood LA, Donskov F, Choueiri TK, Heng DYC. Outcomes of patients with solid tumour malignancies treated with first-line immuno-oncology agents who do not meet eligibility criteria for clinical trials. Eur J Cancer 2021; 151:115-125. [PMID: 33975059 DOI: 10.1016/j.ejca.2021.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immuno-oncology (IO)-based therapies have been approved based on randomised clinical trials, yet a significant proportion of real-world patients are not represented in these trials. We sought to compare the outcomes of trial-ineligible vs. -eligible patients with advanced solid tumours treated with first-line (1L) IO therapy. PATIENTS AND METHODS Using the International Metastatic Renal Cell Carcinoma (RCC) Database Consortium and the Alberta Immunotherapy Database, patients with advanced RCC, non-small-cell lung cancer (NSCLC) or melanoma treated with 1L PD-(L)1 inhibition-based therapy were included. Trial eligibility was retrospectively determined as per commonly used exclusion criteria. The outcomes of interest were overall survival (OS), overall response rate (ORR), treatment duration (TD) and time to next treatment (TTNT). RESULTS A total of 395 of 1241 (32%) patients were deemed trial-ineligible. The main reasons for ineligibility based on preselected exclusion criteria were Karnofsky performance status <70%/Eastern Cooperative Oncology Group performance status >1 (40%, 158 of 395), brain metastases (32%, 126 of 395), haemoglobin < 9 g/dL (16%, 63 of 395) and estimated glomerular filtration rate <40 mL/min (15%, 61 of 395). Between the ineligible vs. eligible groups, the median OS, ORR, median TD and median TTNT were 10.2 vs. 39.7 months (p < 0.01), 36% vs. 47% (p < 0.01), 2.7 vs. 6.9 months (p < 0.01) and 6.0 vs. 16.8 months (p < 0.01), respectively. Subgroup analyses showed statistically significant inferior OS, TD and TTNT for trial-ineligible vs. -eligible patients across all tumour types. Adjusted hazard ratios for death in RCC, NSCLC and melanoma were 1.84 (95% confidence interval [CI] 1.22-2.77), 2.21 (95% CI 1.58-3.11) and 1.82 (95% CI 1.21-2.74), respectively.. CONCLUSIONS Thirty-two percent of real-world patients treated with contemporary 1L IO-based therapies were ineligible for clinical trials. Although one-third of the trial-ineligible patients responded to treatment, the overall trial-ineligible population had inferior outcomes than trial-eligible patients. These data may guide patient counselling and temper expectations of benefit.
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Affiliation(s)
- Chun L Gan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Igor Stukalin
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Daniel E Meyers
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Samantha Dolter
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | | | | | - Michael Sander
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Jose Monzon
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Don Morris
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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32
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Mosca A, De Giorgi U, Procopio G, Basso U, Cartenì G, Bersanelli M, Naglieri E, Galli L, Caffo O, Fornarini G, Boccardo F, Porta C. An Italian, multicenter, real-world, retrospective study of first-line pazopanib in unselected metastatic renal-cell carcinoma patients: the 'Pamerit' study. Jpn J Clin Oncol 2021; 51:484-491. [PMID: 33212499 DOI: 10.1093/jjco/hyaa193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Despite the current immunotherapy era, VEGFR inhibitors maintain effectiveness in metastatic renal cell cancer. Real-world data concerning pazopanib are limited. The aim of this study is to add information about efficacy and safety of pazopanib as first-line treatment in metastatic renal cell cancer patients not enrolled into clinical trials. METHODS Retrospective analysis (the PAMERIT study) of first-line pazopanib in real-world metastatic renal cell cancer patients among 39 Centers in Italy. Outcomes were progression-free survival, overall survival, objective response rate and treatment-related adverse events. Kaplan-Meier curves, log-rank test and multivariable Cox's models were used and adjusted for age, histology, previous renal surgery, International Metastatic RCC Database Consortium score and pazopanib initial dose. RESULTS Among 474 patients, 87.3% had clear cell metastatic renal cell cancer histology. Most of them (84.6%) had upfront renal surgery. Median progression-free survival and overall survival were 15.8 and 34.4 months, respectively, significantly correlating with International Metastatic RCC Database Consortium's good prognosis (P < 0.001), ECOG PS 0 (P < 0.001), age (<75 years, P = 0.005), surgery (P < 0.001) and response to pazopanib (P < 0.001). After 3 months of pazopanib, overall disease control rate have been observed in 76.6% patients. Among International Metastatic RCC Database Consortium's favorable group patients, 57/121 (47%) showed complete/partial response. No unexpected AEs emerged. CONCLUSIONS In this real-world study, metastatic renal cell cancer patients treated with first-line pazopanib reached greater progression-free survival and overall survival than in pivotal studies and had high response rates when belonging to International Metastatic RCC Database Consortium's favorable group, without new toxicities. Pazopanib has been confirmed a valid first-line option for International Metastatic RCC Database Consortium's good prognosis metastatic renal cell cancer patients who cannot be submitted to immunotherapy.
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Affiliation(s)
- Alessandra Mosca
- Medical Oncology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giacomo Cartenì
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli, Italy
| | | | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Luca Galli
- Oncology Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Camillo Porta
- Department of Internal Medicine and Therapeutics, University of Pavia, and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
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Wells JC, Dudani S, Gan CL, Stukalin I, Azad AA, Liow E, Donskov F, Yuasa T, Pal SK, De Velasco G, Hansen AR, Beuselinck B, Kollmannsberger CK, Powles T, McGregor BA, Duh MS, Huynh L, Heng DYC. Clinical Effectiveness of Second-line Sunitinib Following Immuno-oncology Therapy in Patients with Metastatic Renal Cell Carcinoma: A Real-world Study. Clin Genitourin Cancer 2021; 19:354-361. [PMID: 33863648 DOI: 10.1016/j.clgc.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist on the clinical effectiveness of second-line (2L) vascular endothelial growth factor (receptor) targeted inhibitor (VEGF(R)i) sunitinib after first-line (1L) immuno-oncology (IO) therapy for patients with metastatic renal cell carcinoma (mRCC) in real-world settings. METHODS A retrospective cohort study among adult patients with mRCC treated with 2L sunitinib following 1L IO was conducted from select International mRCC Database Consortium (IMDC) centers. All analyses were performed overall and by 1L ipilimumab + nivolumab (IPI+NIVO) or 1L IO+VEGF(R)i. Median overall survival (mOS) and time-to-treatment discontinuation (mTTD) in 2L were estimated using Kaplan-Meier analysis. The 2L objective response rate (ORR) (complete/partial response) was reported. RESULTS Among 102 patients on 2L sunitinib, mean age was 61.3 years. IMDC risk scores at 2L initiation was available for 83 patients: 8 (9.6%) were favorable, 45 (54.2%) were intermediate, and 30 (36.1%) were poor risk. The 1L consisted of IPI+NIVO in 62 (60.8%), IO+VEGF(R)i therapy in 27 (26.5%), and IO monotherapy in 13 (12.7%) patients. Among all patients, mOS was 15.6 months (95% confidence interval [CI], 9.8-21.7), with a 1-year OS rate of 57.5% (95% CI, 45.2-68.0). mTTD was 5.4 months (95% CI, 4.2-7.2) and ORR was 22.5%. CONCLUSION Despite availability of effective 1L therapies in recent years, 2L sunitinib continues to have clinical activity after failure of 1L IO. Further studies on optimal treatment sequencing after 1L IO progression are needed.
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Affiliation(s)
- J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada
| | - Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada
| | - Chun Loo Gan
- Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada
| | - Igor Stukalin
- Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada
| | - Arun A Azad
- Peter MacCallum Cancer Centre, Department of Medical Oncology, University of Melbourne, Melbourne, Australia
| | - Elizabeth Liow
- Walter and Eliza Hall Institute of Medical Research, Division of Systems Biology and Personalized Medicine, Melbourne, Australia
| | - Frede Donskov
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Takeshi Yuasa
- Japanese Foundation for Cancer Research, Department of Urology, Tokyo, Japan
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Department of Medical Oncology & Therapeutics Research, Duarte, CA, USA
| | - Guillermo De Velasco
- University Hospital 12 de Octubre, Department of Medical Oncology, Madrid, Spain
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University of Toronto, Division of Medical Oncology & Hematology, Toronto, Canada
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Department of Oncology, Leuven, Belgium
| | | | - Thomas Powles
- Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Department of Genitourinary Oncology, London, United Kingdom
| | - Bradley A McGregor
- Dana Farber Cancer Institute, Harvard Medical School, Lank Center for Genitourinary Oncology, Boston, MA, USA
| | - Mei S Duh
- Analysis Group, Inc., Boston, MA, USA
| | | | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Department of Oncology, Calgary, Canada.
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Rossi SH, Klatte T, Usher-Smith JA, Fife K, Welsh SJ, Dabestani S, Bex A, Nicol D, Nathan P, Stewart GD, Wilson ECF. A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound. Eur Urol Focus 2021; 7:407-419. [PMID: 31530498 DOI: 10.1016/j.euf.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Screening for renal cell carcinoma (RCC) has been identified as a key research priority; however, no randomised control trials have been performed. Value of information analysis can determine whether further research on this topic is of value. OBJECTIVE To determine (1) whether current evidence suggests that screening is potentially cost-effective and, if so, (2) in which age/sex groups, (3) identify evidence gaps, and (4) estimate the value of further research to close those gaps. DESIGN, SETTING, AND PARTICIPANTS A decision model was developed evaluating screening in asymptomatic individuals in the UK. A National Health Service perspective was adopted. INTERVENTION A single focused renal ultrasound scan compared with standard of care (no screening). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Expected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), discounted at 3.5% per annum. RESULTS AND LIMITATIONS Given a prevalence of RCC of 0.34% (0.18-0.54%), screening 60-yr-old men resulted in an ICER of £18 092/QALY (€22 843/QALY). Given a prevalence of RCC of 0.16% (0.08-0.25%), screening 60-yr-old women resulted in an ICER of £37327/QALY (€47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30000/QALY as long as the prevalence of RCC was ≥0.25% for men and ≥0.2% for women at age 60yr. Given the willingness to pay a threshold of £30000/QALY (€37 878/QALY), the population-expected values of perfect information were £194 million (€244 million) and £97 million (€123 million) for 60-yr-old men and women, respectively. The expected value of perfect parameter information suggests that the prevalence of RCC and stage shift associated with screening are key research priorities. CONCLUSIONS Current evidence suggests that one-off screening of 60-yr-old men is potentially cost-effective and that further research into this topic would be of value to society. PATIENT SUMMARY Economic modelling suggests that screening 60-yr-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed.
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Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kate Fife
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Saeed Dabestani
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Lund, Sweden
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, Specialist Centre for Kidney Cancer, UK; Netherlands Cancer Institute, Division of Surgical Oncology, Department of Urology, Amsterdam, The Netherlands
| | - David Nicol
- Department of Urology, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Paul Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Edward C F Wilson
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
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35
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Ishihara H, Takagi T, Kondo T, Fukuda H, Tachibana H, Yoshida K, Iizuka J, Okumi M, Ishida H, Tanabe K. Efficacy of Axitinib After Nivolumab Failure in Metastatic Renal Cell Carcinoma. In Vivo 2021; 34:1541-1546. [PMID: 32354960 DOI: 10.21873/invivo.11943] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Whether molecular-targeted therapy, particularly axitinib, is effective after failure of immune checkpoint inhibitors in metastatic renal cell carcinoma (mRCC) remains unclear. Here, we evaluated the therapeutic effect of axitinib as a third-line therapy following second-line nivolumab monotherapy for mRCC. PATIENTS AND METHODS Data from patients treated with axitinib as a third-line therapy after failure of first-line tyrosine kinase inhibitor (TKI) and second-line nivolumab monotherapy were reviewed. The progression-free survival (PFS), overall survival (OS), and objective response rate during axitinib therapy were retrospectively evaluated. Tumor responses were assessed according to the Response Evaluation Criteria in Solid Tumors version 1.1. RESULTS Seventeen patients were treated with third-line axitinib after failure of prior TKI and nivolumab. During a median follow-up of 8.15 months, eight (47.1%) and three (17.6%) patients showed disease progression and died, respectively. The median PFS was 12.8 months [95% confidence interval=(CI)4.08-21.7], the 1-year PFS rate was 51.3%, and the 1-year OS rate was 71.6%. The median magnitude of maximum changes of targeted lesions from baseline was -11.9% (95%CI=-36.1-0.44%). The objective response rate and disease control rates were 29.4% (n=5) and 94.1% (n=16), respectively. Univariate analysis for PFS showed a shorter PFS in patients with non-clear cell histopathological types or those with liver metastases (p-Value<0.0001 for both). CONCLUSION Axitinib as a third-line therapy showed reasonable therapeutic efficacy after the failure of first-line TKI and second-line nivolumab monotherapy for mRCC. Further studies are needed to confirm our findings.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Aeppli S, Schmaus M, Eisen T, Escudier B, Grünwald V, Larkin J, McDermott D, Oldenburg J, Porta C, Rini BI, Schmidinger M, Sternberg CN, Rothermundt C, Putora PM. First-line treatment of metastatic clear cell renal cell carcinoma: a decision-making analysis among experts. ESMO Open 2021; 6:100030. [PMID: 33460963 PMCID: PMC7815472 DOI: 10.1016/j.esmoop.2020.100030] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The treatment landscape of metastatic clear cell renal cell carcinoma (mccRCC) has been transformed by targeted therapies with tyrosine kinase inhibitors (TKI) and more recently by the incorporation of immune checkpoint inhibitors (ICI). Today, a spectrum of single agent TKI to TKI/ICI and ICI/ICI combinations can be considered and the choice of the best regimen is complex. MATERIALS AND METHODS We performed an updated decision-making analysis among 11 international kidney cancer experts. Each expert provided their treatment strategy and relevant decision criteria in the first line treatment of mccRCC. After the collection of all input a list of unified decision criteria was determined and compatible decision trees were created. We used a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees, to determine the most common treatment recommendations as well as deviations. RESULTS Diverse parameters were considered relevant for treatment selection, various drugs and drug combinations were recommended by the experts. The parameters, chosen by the experts, were performance status, International Metastatic renal cell carcinoma Database Consortium (IMDC) risk group, PD-L1 status, zugzwang and contraindication to immunotherapy. The systemic therapies selected for first line treatment were sunitinib, pazopanib, tivozanib, cabozantinib, ipilimumab/nivolumab or pembrolizumab/axitinib. CONCLUSION A wide spectrum of treatment recommendations based on multiple decision criteria was demonstrated. Significant inter-expert variations were observed. This demonstrates how data from randomized trials are implemented differently when transferred into daily practice.
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Affiliation(s)
- S Aeppli
- Division of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - M Schmaus
- Department of Radiotherapy and Radiation Oncology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - T Eisen
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, UK
| | | | - V Grünwald
- Interdisciplinary GU Oncology, Clinic for Urology and Clinic for Tumour Research, University Hospital Essen, Essen, Germany
| | - J Larkin
- The Royal Marsden Hospital, London, UK
| | - D McDermott
- Beth Israel Deaconess Medical Centre, Boston, USA
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway
| | - C Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
| | - B I Rini
- Division of Hematology and Oncology, Vanderbilt University Medical Centre, Nashville, USA
| | - M Schmidinger
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Centre, Medical University of Vienna, Austria
| | - C N Sternberg
- Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, USA
| | - C Rothermundt
- Division of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - P M Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Bazarbashi S, Alsharm A, Azam F, El Ashry H, Zekri J. The clinical significance of routine risk categorization in metastatic renal cell carcinoma and its impact on treatment decision-making: a systematic review. Future Oncol 2020; 16:2879-2896. [PMID: 32869660 DOI: 10.2217/fon-2020-0500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To analyze responses to first-line metastatic renal cell carcinoma (mRCC) treatment stratified by risk criteria. Patients & methods: Clinical trials and observational studies of patients aged ≥18 years, published January 2005-May 2019, were identified via Ovid from MEDLINE, EMBASE, the Cochrane Central Trials Register and the Cochrane Database of Systematic Reviews. Data extracted included progression-free survival (PFS), overall survival (OS) and objective response rate (ORR). Results: 47/1269 articles met eligibility criteria. Most studies stratified patients by International Metastatic RCC Database Consortium (n = 19) or Memorial Sloan Kettering Cancer Center (n = 21). PFS, OS and ORR varied according to risk group. Conclusion: Pembrolizumab + axitinib, ipilimumab + nivolumab and avelumab + axitinib were most effective across all risk groups. Favorable-risk patients benefit from sunitinib treatment.
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Affiliation(s)
- Shouki Bazarbashi
- Department of Medical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Faculty of Medicine, Alfaisal University, Riyadh, 12713, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Faisal Azam
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, 32253, Saudi Arabia
| | - Hazem El Ashry
- Department of Medical Affairs, Pfizer Ltd, Jeddah, 21391, Saudi Arabia
| | - Jamal Zekri
- Department of Medical Oncology, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, 11533, Saudi Arabia
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Ishihara H, Fukuda H, Takagi T, Kondo T, Tachibana H, Yoshida K, Iizuka J, Kobayashi H, Ishida H, Tanabe K. Efficacy of nivolumab versus molecular-targeted therapy as second-line therapy for metastatic renal cell carcinoma: Real-world data from two Japanese institutions. Int J Urol 2020; 28:99-106. [PMID: 33159426 DOI: 10.1111/iju.14412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the efficacy of nivolumab with that of molecular-targeted therapy as a second-line therapy for metastatic renal cell carcinoma using real-world data. METHODS We retrospectively evaluated patients who received nivolumab or molecular-targeted therapy after the failure of first-line molecular-targeted therapy between January 2008 and December 2019 at two Japanese institutions. Progression-free survival and overall survival after the initiation of second-line therapy were calculated using the Kaplan-Meier method and compared using the log-rank test. Objective response rate was assessed based on the Response Evaluation Criteria in Solid Tumors version 1.1. RESULTS Among 159 patients, 43 (27%) and 116 (73%) patients received nivolumab and molecular-targeted therapy as second-line therapy, respectively. During follow up (median 11.1 months), 129 (81%) and 98 (62%) patients had disease progression and died, respectively. Progression-free survival was comparable between the two treatments (median 5.06 vs 5.95 months, P = 0.881), whereas overall survival was significantly longer with nivolumab than with molecular-targeted therapy (not reached vs 13.0 months, P = 0.0008). Multivariate analysis further showed that nivolumab therapy was an independent favorable factor for overall survival (hazard ratio 0.33, P = 0.0007). In 151 patients with eligible radiographic data, the objective response rate was significantly higher in nivolumab than in molecular-targeted therapy (n = 14/41 [34%] vs n = 20/110 [18%], P = 0.0485). CONCLUSIONS Real-world data analysis suggests superior efficacy of nivolumab over molecular-targeted therapy as second-line therapy for metastatic renal cell carcinoma.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Ali Z, Zafar MU, Wolfe Z, Akbar F, Lash B. Thrombotic Thrombocytopenic Purpura Induced by Immune Checkpoint Inhibitiors: A Case Report and Review of the Literature. Cureus 2020; 12:e11246. [PMID: 33274128 PMCID: PMC7707147 DOI: 10.7759/cureus.11246] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In recent years, the role of immune checkpoint inhibitors (ICI) in cancer treatment has rapidly expanded. In randomized clinical trials, these agents have demonstrated clinical efficacy in extending survival and increasing response rates. Immune-related adverse effects (irAEs) involving various organs have been frequently narrated. Herein, we present a case report of thrombotic thrombocytopenic purpura (TTP) as a rare side effect of nivolumab, plus ipilimumab, in the treatment of metastatic renal cell carcinoma (RCC). A review of the literature for other case reports of TTP during treatment with ICIs was also performed. Our aim is to elucidate the significance of early recognition of this rare adverse effect in patients being treated with this relatively newer class of medications.
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Affiliation(s)
- Zeeshan Ali
- Hematology and Oncology, Lehigh Valley Health Network, Allentown, USA
| | | | - Zachary Wolfe
- Hematology and Medical Oncology, Lehigh Valley Health Network, Allentown, USA
| | - Faisal Akbar
- Hematology and Medical Oncology, Lehigh Valley Health Network, Allentown, USA
| | - Bradley Lash
- Hematology and Medical Oncology, Lehigh Valley Health Network, Allentown, USA
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40
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Current Multimodality Treatments Against Brain Metastases from Renal Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102875. [PMID: 33036276 PMCID: PMC7600559 DOI: 10.3390/cancers12102875] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 01/05/2023] Open
Abstract
Simple Summary Brain metastasis (BM) is generally one of poor prognostic factors in patients with advanced renal cell carcinoma. However, because of longer control of extra-cranial disease by the recent introduction of molecular target therapy and immune checkpoint inhibitor, the incidence of BM has been recently increasing and to progress the treatment of BM is one of urgent medical unmet needs. Although the pivotal clinical trials usually excluded patients with BM, BM subgroup data from the prospective and retrospective series have been gradually accumulated. To select the appropriate strategy, individual patient and tumor characteristics (e.g., Karnofsky Performance Status (KPS), systemic cancer burden, the number/size/location of BM) are important information. Among the local treatments, the technology of stereotactic radiosurgery (SRT) has been especially advanced and its adaptation has been expanded. The combination of SRT with molecular target therapy and/or immune checkpoint inhibitor would be promising to further enhance the efficacy without increased toxicity. Abstract In patients with renal cell carcinoma, brain metastasis is generally one of the poor prognostic factors. However, the recent introduction of molecular target therapy and immune checkpoint inhibitor has remarkably advanced the systemic treatment of metastatic renal cell carcinoma and prolonged the patients’ survival. The pivotal clinical trials of those agents usually excluded patients with brain metastasis. The incidence of brain metastasis has been increasing in the actual clinical setting because of longer control of extra-cranial disease. Brain metastasis subgroup data from the prospective and retrospective series have been gradually accumulated about the risk classification of brain metastasis and the efficacy and safety of those new agents for brain metastasis. While the local treatment against brain metastasis includes neurosurgery, stereotactic radiosurgery, and conventional whole brain radiation therapy, the technology of stereotactic radiosurgery has been especially advanced, and the combination with systemic therapy such as molecular target therapy and immune checkpoint inhibitor is considered promising. This review summarizes recent progression of multimodality treatment of brain metastasis of renal cell carcinoma from literature data and explores the future direction of the treatment.
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Prognostic and Predictive Factors in Metastatic Renal Cell Carcinoma: Current Perspective and a Look Into the Future. ACTA ACUST UNITED AC 2020; 26:365-375. [PMID: 32947304 DOI: 10.1097/ppo.0000000000000468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Metastatic renal cell carcinoma (mRCC) comprises a highly heterogeneous group of diseases with varied clinical outcomes. As a result, models to estimate prognosis were developed in an attempt to aid patient counseling, treatment selection, and clinical trial design. Contemporary prognostic models have been mostly generated based on clinical factors because of their ease of use. Recent advances in molecular techniques have allowed unprecedented molecular profiling of RCC and the discovery of genomic and proteotranscriptomic factors that may contribute to disease trajectory. With the advent of multiple systemic therapies in mRCC in recent years, predictive biomarkers have become increasingly relevant in treatment selection. In this review, we discuss the existing staging systems and prognostic models in mRCC. We also highlight various promising molecular biomarkers according to the subtypes of RCC and explore their integration into the traditional prognostic models. In addition, we discuss emerging predictive biomarkers in the era of immuno-oncology. Lastly, we explore future directions with a focus on liquid biopsies and composite biomarkers.
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42
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Wong SE, Quinn DI, Bjarnason GA, North SA, Sridhar SS. Eligibility Criteria and Endpoints in Metastatic Renal Cell Carcinoma Trials. Am J Clin Oncol 2020; 43:559-566. [PMID: 32398404 PMCID: PMC7515769 DOI: 10.1097/coc.0000000000000705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatments for metastatic renal cell carcinoma (mRCC) are often compared across trials, but trial eligibility criteria and endpoints differ. In an effort to better align trials, the Definition for the Assessment of Time to event Endpoints in CANcer trials (DATECAN) project published recommendations in 2015 to be used in mRCC clinical trial design. We analyzed mRCC trial criteria to determine if DATECAN's recommendations were followed. MATERIALS AND METHODS We compared eligibility criteria across 29 phase 3 mRCC trials conducted between 2003 and 2019. We then evaluated endpoints used in 10 phase 3 trials activated between 2015 and 2019 to determine their compliance with DATECAN's recommendations. RESULTS Among the 29 trials, performance status, renal function, and disease characteristics differed in terms of requirements and measures used. In terms of endpoints, the 10 trials did not entirely follow DATECAN's recommendations. In total, 7/10 trials' primary endpoint was progression-free survival (PFS) as recommended; 4/9 trials used PFS as an endpoint but did not publish their definition of PFS, and the 5 that did, included "death from any cause" instead of DATECAN's recommendation of "death from kidney cancer." CONCLUSIONS Key eligibility criteria were somewhat inconsistent across the phase 3 mRCC trials studied. Endpoints in the newer trials did not align with DATECAN's recommendations. Not only is greater standardization needed to facilitate meta-analyses and cross-trial comparisons, but as evident from lack of adherence to DATECAN's recommendations, greater promotion and adoption of recommendations are needed to better harmonize trial design.
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Affiliation(s)
- Sarah E. Wong
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre
| | - David I. Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Georg A. Bjarnason
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - Scott A. North
- Department of Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Srikala S. Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre
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Inamoto T, Azuma H, Tatsugami K, Oya M, Adachi M, Okayama Y, Sunaya T, Akaza H. Real-world use of sorafenib for advanced renal cell carcinoma patients with cardiovascular disease: nationwide survey in Japan. Expert Rev Anticancer Ther 2020; 20:615-623. [PMID: 32441582 DOI: 10.1080/14737140.2020.1773805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess whether the clinical outcome of advanced/metastatic renal cell carcinoma (mRCC) treated with sorafenib, in real-world conditions, differs in patients with cardiovascular disease (CVD). METHODS mRCC patients (n = 2256 before matching) were matched by propensity score into CVD (n = 560) and non-CVD groups (n = 560), followed by safety and effectiveness analyzes. RESULTS After matching, patients' features used for matching were balanced between the CVD and non-CVD groups, except for age (p = 0.0049). Renal comorbidity occurred more frequently in the CVD group. Exposure to sorafenib and objective response rate (25.4% [CVD], 28.5% [non-CVD]) were comparable in both groups. Median progression-free survival (PFS; 7.1 months, 95% CI: 6.4-8.6 [CVD]; 6.7 months, 6.3-8.3 [non-CVD]), and hazard ratios for PFS (0.954, 0.821-1.108) and overall survival (0.889, 0.683-1.156), were similar in the matched population. The incidences of adverse drug reactions (ADR, ≥10%) were generally similar between groups, although hypertension (42.1% vs 34.5%), diarrhea (26.3% vs 19.6%), decreased appetite (11.3% vs 7.5%), and non-serious and serious renal failure/dysfunction (3.6% vs 1.4% and 1.8% vs 0.4%), occurred more frequently in the CVD group. CONCLUSION This analyzes suggests that sorafenib has clinical benefit for mRCC patients regardless of baseline CVD. Serious ADRs increased for renal dysfunction. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT01411423.
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Affiliation(s)
- Teruo Inamoto
- Department of Urology, Osaka Medical College , Takatsuki, Osaka, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College , Takatsuki, Osaka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Science, Kyushu University , Fukuoka, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine , Tokyo, Japan
| | - Masatoshi Adachi
- Medical Affairs, Oncology & Hematology, Bayer Yakuhin Ltd , Osaka, Japan
| | - Yutaka Okayama
- PMS, Pharmacovigilance & Medical Governance, Bayer Yakuhin Ltd , Osaka, Japan
| | - Toshiyuki Sunaya
- Statistics & Data Insights, Research & Development Japan, Bayer Yakuhin Ltd , Osaka, Japan
| | - Hideyuki Akaza
- Research Centre for Advanced Science and Technology, The University of Tokyo , Tokyo, Japan
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Templeton AJ, Booth CM, Tannock IF. Informing Patients About Expected Outcomes: The Efficacy-Effectiveness Gap. J Clin Oncol 2020; 38:1651-1654. [DOI: 10.1200/jco.19.02035] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Arnoud J. Templeton
- Department of Medical Oncology, St Claraspital Basel, and Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christopher M. Booth
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
| | - Ian F. Tannock
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Leslie I, Boos LA, Larkin J, Pickering L. Avelumab and axitinib in the treatment of renal cell carcinoma: safety and efficacy. Expert Rev Anticancer Ther 2020; 20:343-354. [PMID: 32293937 DOI: 10.1080/14737140.2020.1756780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: The incidence of advanced renal cell carcinoma (RCC) is increasing. Over the last 10 years targeted therapies have led to improved efficacy outcomes for renal carcinoma, including longer survival. However, the majority of patients develop disease progression within a year of initiation of first-line therapy. Recently a number of new regimens have been investigated including the combination of immune checkpoint inhibitors with VEGF inhibitors.Areas covered: In this review, we assess the efficacy and safety of avelumab/axitinib in treatment-naïve patients with metastatic RCC and compare this combination to other current and emerging treatment regimens. In the Javelin 101 phase III registration trial, avelumab/axitinib demonstrated superior response rates and progression-free survival compared to sunitinib. However, after follow-up of 11.6 months, there was no significant difference in overall survival (OS). Avelumab/axitinib showed a tolerable safety profile. Adverse events were manageable and were in line with expected toxicities from the single agents.Expert Opinion: Avelumab/axitinib has shown impressive efficacy and a tolerable safety profile in metastatic RCC. The future role of this treatment combination in the rapidly evolving landscape of novel combinations in this disease will have to be defined.
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Affiliation(s)
- Isla Leslie
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Laura Amanda Boos
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - James Larkin
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Lisa Pickering
- Department of Medical Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Baillie K, Mueller T, Pan J, Laskey J, Bennie M, Crearie C, Kavanagh K, Alvarez-Madrazo S, Morrison D, Clarke J, Keel A, Cameron D, Wu O, Kurdi A, Jones RJ. Use of record linkage to evaluate treatment outcomes and trial eligibility in a real-world metastatic prostate cancer population in Scotland. Pharmacoepidemiol Drug Saf 2020; 29:653-663. [PMID: 32316077 PMCID: PMC8246935 DOI: 10.1002/pds.4998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/31/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
Purpose New treatments are introduced into standard care based on clinical trial results. However, it is not clear if these benefits are reflected in the broader population. This study analysed the clinical outcomes of patients with metastatic castration‐resistant prostate cancer, treated with abiraterone and enzalutamide, within the Scottish National Health Service. Methods Retrospective cohort study using record linkage of routinely collected healthcare data (study period: February 2012 to February 2017). Overall survival (OS) was analysed using Kaplan‐Meier methods and Cox Proportional Hazard models; a subgroup analysis comprised potentially trial‐eligible patients. Results Overall, 271 patients were included and 73.8% died during the study period. Median OS was poorer than in the pivotal trials, regardless of medication and indication: 10.8 months (95% confidence interval [CI] 8.6‐15.1) and 20.9 months (95% CI 14.9‐29.0) for abiraterone, and 12.6 months (95% CI 10.5‐18.2) and 16.0 months (95% CI 9.8—not reached) for enzalutamide, post and pre chemotherapy, respectively. Only 46% of patients were potentially “trial eligible” and in this subgroup OS improved. Factors influencing survival included baseline performance status, and baseline prostate‐specific antigen, alkaline phosphatase, and albumin levels. Conclusions Poorer prognostic features of non‐trial eligible patients impact real‐world outcomes of cancer medicines. Electronic record linkage of routinely collected healthcare data offers an opportunity to report outcomes on cancer medicines at scale and describe population demographics. The availability of such observational data to supplement clinical trial results enables patients and clinicians to make more informed treatment decisions, and policymakers to contextualise trial findings.
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Affiliation(s)
- Kelly Baillie
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jennifer Laskey
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health Intelligence, NHS National Services Scotland, Edinburgh, UK
| | - Christine Crearie
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Samantha Alvarez-Madrazo
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - David Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Julie Clarke
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Aileen Keel
- Innovative Healthcare Delivery Programme (IHDP), University of Edinburgh, Edinburgh, UK
| | - David Cameron
- Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Robert J Jones
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, UK.,Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Moran M, Nickens D, Adcock K, Bennetts M, Desscan A, Charnley N, Fife K. Sunitinib for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis of Real-World and Clinical Trials Data. Target Oncol 2020; 14:405-416. [PMID: 31301015 PMCID: PMC6684538 DOI: 10.1007/s11523-019-00653-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Randomized controlled trials (RCTs) have stringent inclusion criteria and may not fully represent patients seen in everyday clinical practice. Real-world data (RWD) can provide supportive evidence for the effectiveness of medical interventions in more heterogeneous populations than RCTs. Sunitinib is a widely used first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Objective This is the first comprehensive meta-analysis to evaluate the efficacy of sunitinib using the novel approach of combining RCTs and RWD. Methods RCTs and RWD studies published between 2000 and 2017 were identified from PubMed, Ovid, MEDLINE, and EMBASE. Eligible studies contained a cohort of ≥ 50 adult patients with mRCC receiving first-line sunitinib treatment. The meta-analysis combined RWD and RCT treatment groups, adjusting for data type (RCT or RWD). Recorded outcomes were median progression-free survival (mPFS), median overall survival (mOS), and objective response rate (ORR). Publication bias was assessed via review of funnel plots for each outcome measure. A random effects model to account for study heterogeneity was applied to each endpoint. Sensitivity analyses evaluated the robustness of the overall estimates. Results Of the 3611 studies identified through medical database searches, 22 (15 RWD studies, 7 RCTs) met eligibility criteria and were analyzed. mPFS (18 studies), mOS (19 studies), and ORR (15 studies) were reported for aggregate measures based on 4815, 5321, and 4183 patients, respectively. Reported mPFS (RWD, 7.5–11.0 months; RCTs, 5.6–15.1 months) and ORR data (RWD, 14.0–34.6%; RCTs, 18.8–46.9%) were consistent with the overall confidence estimates (95% confidence interval [CI]) of 9.3 (8.6–10.2) months and 27.9% (24.2–32.0), respectively. Reported mOS showed greater variation in RWD (6.8–33.2 months) compared with RCTs (21.8–31.5 months), with an overall confidence estimate (95% CI) of 23.0 (19.2–27.6) months. Inspection of funnel plots and sensitivity analyses indicated that there was no publication bias for any efficacy endpoint. Sensitivity analyses showed no evidence of lack of robustness for mPFS, mOS, or ORR. Interpretation of these results is limited by differences in trial design, cohort characteristics, and missing data. Conclusions This novel, comprehensive meta-analysis validates sunitinib as an effective first-line treatment for patients with mRCC in both RCTs and everyday clinical practice. The methodology provides a framework for future analyses combining data from RCTs and RWD. Electronic supplementary material The online version of this article (10.1007/s11523-019-00653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Kate Fife
- Cambridge University Hospital, Cambridge, UK
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Serth J, Peters I, Dubrowinskaja N, Reese C, Albrecht K, Klintschar M, Lafos M, Grote A, Becker A, Hennenlotter J, Stenzl A, Tezval H, Kuczyk MA. Age-, tumor-, and metastatic tissue-associated DNA hypermethylation of a T-box brain 1 locus in human kidney tissue. Clin Epigenetics 2020; 12:33. [PMID: 32070431 PMCID: PMC7029553 DOI: 10.1186/s13148-020-0823-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/03/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND While a considerable number of tumor-specific hypermethylated loci have been identified in renal cell cancer (RCC), DNA methylation of loci showing successive increases in normal, tumoral, and metastatic tissues could point to genes with high relevance both for the process of tumor development and progression. Here, we report that DNA methylation of a locus in a genomic region corresponding to the 3'UTR of the transcription factor T-box brain 1 (TBR1) mRNA accumulates in normal renal tissues with age and possibly increased body mass index. Moreover, a further tissue-specific increase of methylation was observed for tumor and metastatic tissue samples. RESULTS Biometric analyses of the TCGA KIRC methylation data revealed candidate loci for age-dependent and tumor-specific DNA methylation within the last exon and in a genomic region corresponding to the 3'UTR TBR1 mRNA. To evaluate whether methylation of TBR1 shows association with RCC carcinogenesis, we measured 15 tumor cell lines and 907 renal tissue samples including 355 normal tissues, 175 tissue pairs of normal tumor adjacent and corresponding tumor tissue as well 202 metastatic tissues samples of lung, bone, and brain metastases by the use of pyrosequencing. Statistical evaluation demonstrated age-dependent methylation in normal tissue (R = 0.72, p < 2 × 10-16), association with adiposity (P = 0.019) and tumor-specific hypermethylation (P = 6.1 × 10-19) for RCC tissues. Comparison of tumor and metastatic tissues revealed higher methylation in renal cancer metastases (P = 2.65 × 10-6). CONCLUSIONS Our analyses provide statistical evidence of association between methylation of TBR1 and RCC development and disease progression.
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Affiliation(s)
- Jürgen Serth
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany.
| | - Inga Peters
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Natalia Dubrowinskaja
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Christel Reese
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Knut Albrecht
- Brandenburgisches Landesinstitut für Rechtsmedizin, Lindstedter Chaussee 6, D-14469, Potsdam, Germany
| | - Michael Klintschar
- Institut für Rechtsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Marcel Lafos
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Alexander Grote
- Evangelisches Klinikum Bethel, Klinik für Neurochirurgie, Burgsteig 13, D-33617, Bielefeld, Germany
| | - Albert Becker
- Institut für Neuropathologie, Universitätsklinikum Bonn, Sigmund Freud Str. 25, D-53105, Bonn, Germany
| | - Jörg Hennenlotter
- Universitätsklinikum Tübingen, Klinik für Urologie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Arnulf Stenzl
- Universitätsklinikum Tübingen, Klinik für Urologie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Hossein Tezval
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
| | - Markus A Kuczyk
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, D-30625, Hannover, Germany
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Kawahara T. Re: Quality of life in patients aged 65 years and older with overactive bladder treated with mirabegron across eight European countries: Secondary analysis of BELIEVE. Int J Urol 2019; 27:188. [PMID: 31847049 DOI: 10.1111/iju.14167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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Moran M, Nickens D, Adcock K, Bennetts M, Charnley N, Fife K. Augmenting the randomized controlled trial with real-world data to aid clinical decision making in metastatic renal cell carcinoma: a systematic review and meta-analysis. Future Oncol 2019; 15:3987-4001. [DOI: 10.2217/fon-2019-0421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: To evaluate how efficacy outcomes from real-world data (RWD) can support those from randomized controlled trials (RCTs), in the context of first-line tyrosine kinase inhibitor treatment of metastatic renal cell carcinoma. Patients & methods: PubMed, Ovid, MEDLINE and EMBASE were searched for RCTs and RWD studies with ≥50 adult patients per arm published in 2000–2017. Outcome measures were median progression-free survival, median overall survival and objective response rate. Results: A total of 13 RCTs and 22 RWD studies met eligibility criteria; 31, 28 and 25 studies, respectively, reported median progression-free survival, median overall survival and objective response rate. Summary outcome measures were similar in RWD and RCTs. Conclusion: RWD validates efficacy-based outcomes from RCTs and may provide supportive evidence to inform clinical decisions.
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Affiliation(s)
| | | | | | | | | | - Kate Fife
- Cambridge University Hospital, Cancer Services, Cambridge, UK
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