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Rebuzzi SE, Signori A, Stellato M, Santini D, Maruzzo M, De Giorgi U, Pedrazzoli P, Galli L, Zucali PA, Fantinel E, Carella C, Procopio G, Milella M, Boccardo F, Fratino L, Sabbatini R, Ricotta R, Panni S, Massari F, Sorarù M, Santoni M, Cortellini A, Prati V, Soto Parra H, Atzori F, Di Napoli M, Caffo O, Messina M, Morelli F, Prati G, Nolè F, Vignani F, Cavo A, Roviello G, Llaja Obispo MA, Porta C, Buti S, Fornarini G, Banna GL. The prognostic value of baseline and early variations of peripheral blood inflammatory ratios and their cellular components in patients with metastatic renal cell carcinoma treated with nivolumab: The Δ-Meet-URO analysis. Front Oncol 2022; 12:955501. [PMID: 36212433 PMCID: PMC9541611 DOI: 10.3389/fonc.2022.955501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Treatment choice for metastatic renal cell carcinoma (mRCC) patients is still based on baseline clinical and laboratory factors. Methods By a pre-specified analysis of the Meet-URO 15 multicentric retrospective study enrolling 571 pretreated mRCC patients receiving nivolumab, baseline and early dynamic variations (Δ) of neutrophil, lymphocyte, and platelet absolute cell counts (ACC) and their inflammatory ratios (IR) were evaluated alongside their association with the best disease response and overall (OS) and progression-free survival (PFS). Multivariable analyses on OS and PFS between baseline and Δ ACC and IR values were investigated with receiving operating curves-based cut-offs. Results The analysis included 422 mRCC patients. Neutrophil-to-lymphocyte ratio (NLR) increased over time due to consistent neutrophil increase (p < 0.001). Higher baseline platelets (p = 0.044) and lower lymphocytes (p = 0.018), increasing neutrophil Δ (p for time-group interaction <0.001), higher baseline IR values (NLR: p = 0.012, SII: p = 0.003, PLR: p = 0.003), increasing NLR and systemic immune-inflammatory index (SII) (i.e., NLR x platelets) Δ (p for interaction time-group = 0.0053 and 0.0435, respectively) were associated with disease progression. OS and PFS were significantly shorter in patients with baseline lower lymphocytes (p < 0.001 for both) and higher platelets (p = 0.004 and p < 0.001, respectively) alongside early neutrophils Δ (p = 0.046 and p = 0.033, respectively). Early neutrophils and NLR Δ were independent prognostic factors for both OS (p = 0.014 and p = 0.011, respectively) and PFS (p = 0.023 and p = 0.001, respectively), alongside baseline NLR (p < 0.001 for both) and other known prognostic variables. Conclusions Early neutrophils and NLR Δ may represent new dynamic prognostic factors with clinical utility for on-treatment decisions.
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Affiliation(s)
- Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Marco Stellato
- SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Santini
- Department of Medical Oncology, Università Campus Bio-Medico of Roma, Rome, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Medical Oncology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Galli
- Medical Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- Department of Oncology, IRCCS, Humanitas Clinical and Research Center, Milano, Italy
| | - Emanuela Fantinel
- Department of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - Claudia Carella
- Division of Medical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Giuseppe Procopio
- SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michele Milella
- Department of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino of Genova, Genova, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Italy
| | - Roberto Sabbatini
- Medical Oncology Unit, Department of Oncology and Hemathology, University Hospital of Modena, Modena, Italy
| | | | - Stefano Panni
- Medical Oncology Unit, ASSTl– Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | | | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, United Kingdom
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Veronica Prati
- Department of Medical Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Hector Josè Soto Parra
- Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Italy
| | - Francesco Atzori
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Marco Messina
- UOC Oncologia Medica, Istituto Fondazione G. Giglio, Cefalù, Italy
| | | | - Giuseppe Prati
- Department of Oncology and Advanced Technologies AUSL - IRCCS, Reggio Emilia, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head and Neck Tumors, IEO, European Institute of Oncology IRCCS, Milano, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy
| | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Firenze, Firenze, Italy
| | | | - Camillo Porta
- Interdisciplinary Department of Medicine, University of Bari “A. Moro”, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Sebastiano Buti,
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Luigi Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
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Komiyama T, Kim H, Tanaka M, Isaki S, Yokoyama K, Miyajima A, Kobayashi H. RNA-seq and Mitochondrial DNA Analysis of Adrenal Gland Metastatic Tissue in a Patient with Renal Cell Carcinoma. BIOLOGY 2022; 11:biology11040589. [PMID: 35453788 PMCID: PMC9030821 DOI: 10.3390/biology11040589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to clarify whether genetic mutations participate in renal cell carcinoma (RCC) metastasis to the adrenal gland (AG). Our study analyzed whole mitochondrial gene and ribonucleic acid sequencing (RNA-seq) data from a male patient in his 60s with metastatic RCC. We confirmed common mutation sites in the mitochondrial gene and carried out Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis using RNA-seq data for RCC and adrenal carcinoma. Furthermore, we confirmed the common mutation sites of mitochondrial genes in which the T3394Y (p.H30Y) site transitioned from histidine (His.; H) to tyrosine (Tyr.; Y) in the NADH dehydrogenase subunit 1 (ND1) gene. The R11,807G (p.T350A) site transitioned from threonine (Thr.; T) to alanine (Ala.; A). Additionally, the G15,438R or A (p.G231D) site transitioned from glycine (Gly.; G) to aspartic acid (Asp.; D) in cytochrome b (CYTB). Furthermore, pathway analysis, using RNA-seq, confirmed the common mutant pathway between RCC and adrenal carcinoma as cytokine–cytokine receptor (CCR) interaction. Confirmation of the original mutation sites suggests that transfer to AG may be related to the CCR interaction. Thus, during metastasis to the AG, mitochondria DNA mutation may represent the initial origin of the metastasis, followed by the likely mutation of the nuclear genes.
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Affiliation(s)
- Tomoyoshi Komiyama
- Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan;
- Correspondence: (T.K.); (H.K.); Tel.: +81-463-93-1121 (T.K.)
| | - Hakushi Kim
- Department of Urology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
- Correspondence: (T.K.); (H.K.); Tel.: +81-463-93-1121 (T.K.)
| | - Masayuki Tanaka
- Medical Science College Office, Tokai University, Isehara 259-1193, Kanagawa, Japan; (M.T.); (S.I.); (K.Y.)
| | - Sanae Isaki
- Medical Science College Office, Tokai University, Isehara 259-1193, Kanagawa, Japan; (M.T.); (S.I.); (K.Y.)
| | - Keiko Yokoyama
- Medical Science College Office, Tokai University, Isehara 259-1193, Kanagawa, Japan; (M.T.); (S.I.); (K.Y.)
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan;
| | - Hiroyuki Kobayashi
- Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan;
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Nasso C, Sabbatini R, Baldessari C, Dominici M, Vitale MG. Long progression-free survival with cabozantinib in a heavily pretreated patient with metastatic renal cell carcinoma: a case report. TUMORI JOURNAL 2021; 107:NP33-NP36. [PMID: 33526000 DOI: 10.1177/0300891621990732] [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] [Indexed: 11/15/2022]
Abstract
Renal cell carcinoma accounts for 3% of all tumors. Over the last decades, the prognosis of metastatic renal cell carcinoma (mRCC) has improved owing to the approval of several drugs such as tyrosine kinase inhibitors and immunotherapy. The median progression-free survival (PFS) does not exceed 8 months with the available drugs in pretreated patients with mRCC. We present a case of a patient with a long-term response to fourth-line treatment with cabozantinib. Our patient obtained a PFS of 33 months, which is much higher than that reported in literature.
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Affiliation(s)
- Cecilia Nasso
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Roberto Sabbatini
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
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Wu J, Huang H. Acquired Hypothyroidism in Patients with Metastatic Renal Cell Carcinoma Treated with Tyrosine Kinase Inhibitors. Drug Des Devel Ther 2020; 14:3977-3982. [PMID: 33061302 PMCID: PMC7532040 DOI: 10.2147/dddt.s270210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We analyze a number of studies that describe the relationship between the onset of hypothyroidism and the prognosis of patients with metastatic renal cell carcinoma (mRCC) treated with TKIs. PATIENTS AND METHODS Targeted therapies are currently considered as the first-line treatment for patients with mRCC. The occurrence of hypothyroidism in the treatment of mRCC with TKIs is a major side effect. A comprehensive search was performed in Pubmed, Cochrane Library, Institute for Scientific Information, and CKNI. The following keywords and descriptors were used during the search and were combined in a number of sequences in English and Chinese languages: protein kinase inhibitors (including sunitinib, pazopanib, tivozanib, cabozantinib, axitinib, sorafenib), hypothyroidism and renal cell carcinoma. RESULTS Scholars have studied the clinical relationship between hypothyroidism and TKI treatment and its molecular biology mechanism. Most studies hold that hypothyroidism occurring during TKI therapy may serve as potential biomarkers of response and efficacy of treatment, but there is no consensus on this point. CONCLUSION The mechanism of hypothyroidism occurring is still unclear. Therefore, more studies are needed to clarify whether better outcomes are associated with TKI-induced hypothyroidism in mRCC patients, helping to maximize the treatment outcome of mRCC patients.
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Affiliation(s)
- Jialu Wu
- Sichuan University, Department of Endocrinology and Metabolism, West China Hospital, Chengdu610064, Sichuan Province, People’s Republic of China
| | - Hui Huang
- Sichuan University, Department of Endocrinology and Metabolism, West China Hospital, Chengdu610064, Sichuan Province, People’s Republic of China
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Jiang Y, Li W, Huang C, Tian C, Chen Q, Zeng X, Cao Y, Chen Y, Yang Y, Liu H, Bo Y, Luo C, Li Y, Zhang T, Wang R. Preoperative CT Radiomics Predicting the SSIGN Risk Groups in Patients With Clear Cell Renal Cell Carcinoma: Development and Multicenter Validation. Front Oncol 2020; 10:909. [PMID: 32850304 PMCID: PMC7402386 DOI: 10.3389/fonc.2020.00909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: The stage, size, grade, and necrosis (SSIGN) score can facilitate the assessment of tumor aggressiveness and the personal management for patients with clear cell renal cell carcinoma (ccRCC). However, this score is only available after the postoperative pathological evaluation. The aim of this study was to develop and validate a CT radiomic signature for the preoperative prediction of SSIGN risk groups in patients with ccRCC in multicenters. Methods: In total, 330 patients with ccRCC from three centers were classified into the training, external validation 1, and external validation 2 cohorts. Through consistent analysis and the least absolute shrinkage and selection operator, a radiomic signature was developed to predict the SSIGN low-risk group (scores 0–3) and intermediate- to high-risk group (score ≥ 4). An image feature model was developed according to the independent image features, and a fusion model was constructed integrating the radiomic signature and the independent image features. Furthermore, the predictive performance of the above models for the SSIGN risk groups was evaluated with regard to their discrimination, calibration, and clinical usefulness. Results: A radiomic signature consisting of sixteen relevant features from the nephrographic phase CT images achieved a good calibration (all Hosmer–Lemeshow p > 0.05) and favorable prediction efficacy in the training cohort [area under the curve (AUC): 0.940, 95% confidence interval (CI): 0.884–0.973] and in the external validation cohorts (AUC: 0.876, 95% CI: 0.811–0.942; AUC: 0.928, 95% CI: 0.844–0.975, respectively). The radiomic signature performed better than the image feature model constructed by intra-tumoral vessels (all p < 0.05) and showed similar performance with the fusion model integrating radiomic signature and intra-tumoral vessels (all p > 0.05) in terms of the discrimination in all cohorts. Moreover, the decision curve analysis verified the clinical utility of the radiomic signature in both external cohorts. Conclusion: Radiomic signature could be used as a promising non-invasive tool to predict SSIGN risk groups and to facilitate preoperative clinical decision-making for patients with ccRCC.
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Affiliation(s)
- Yi Jiang
- Medical College, Guizhou University, Guiyang, China.,Department of Medical Records and Statistics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Wuchao Li
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Key Laboratory of Intelligent Medical Image Analysis and Precision Diagnosis, Guizhou Provincial People's Hospital, Guiyang, China
| | - Chencui Huang
- Research Collaboration Department, R&D Center, Beijing Deepwise & League of PHD Technology Co. Ltd, Beijing, China
| | - Chong Tian
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Key Laboratory of Intelligent Medical Image Analysis and Precision Diagnosis, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qi Chen
- Department of Medical Records and Statistics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xianchun Zeng
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Key Laboratory of Intelligent Medical Image Analysis and Precision Diagnosis, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yin Cao
- Department of Pathology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yi Chen
- Department of Pathology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yintong Yang
- Department of Pathology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yonghua Bo
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chenggong Luo
- Department of Urinary Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yiming Li
- Research Collaboration Department, R&D Center, Beijing Deepwise & League of PHD Technology Co. Ltd, Beijing, China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Rongping Wang
- Medical College, Guizhou University, Guiyang, China.,Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China.,Guizhou Provincial Key Laboratory of Intelligent Medical Image Analysis and Precision Diagnosis, Guizhou Provincial People's Hospital, Guiyang, China
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Zhang W, Zheng X, Xie S, Zhang S, Mao J, Cai Y, Lu X, Chen W, Ni H, Xie L. TBOPP enhances the anticancer effect of cisplatin by inhibiting DOCK1 in renal cell carcinoma. Mol Med Rep 2020; 22:1187-1194. [PMID: 32626999 PMCID: PMC7339706 DOI: 10.3892/mmr.2020.11243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
The treatment of renal cell carcinoma (RCC) with chemotherapy remains a challenge; therefore, improving the knowledge of the molecular mechanisms underlying RCC chemoresistance and developing novel therapeutic strategies is important. Dedicator of cytokinesis 1 (DOCK1), the first member of the DOCK family to be discovered, displays various roles during tumorigenesis; however, its role during RCC progression is not completely understood. Therefore, the present study aimed to clarify the function of DOCK1 and 1-[2-(3′-(trifluoromethyl)-(1,1′-biphenyl)-4-yl)-2-oxoethyl]-5-pyrrolidinylsulfonyl-2 (1H)-pyridone (TBOPP), a DOCK1-sensitive inhibitor, during RCC development and chemoresistance. The results of CCK-8 and EdU assay indicated that TBOPP decreased RCC cell viability and proliferation compared with the control group, and sensitized RCC cells to cisplatin. Moreover, RCC cells with high DOCK1 expression levels displayed increased resistance to cisplatin, whereas DOCK1 knockdown enhanced the lethal effects of cisplatin on RCC cells. Furthermore, the results determined by western blotting, CCK-8 and cell apoptosis assay indicated that TBOPP effectively reduced DOCK1 expression levels compared with the control group, and the TBOPP-mediated cisplatin sensitizing effect was mediated by DOCK1 inhibition. The present study suggests that DOCK1 plays a vital role in RCC cell chemoresistance to cisplatin; therefore, TBOPP may serve as a novel therapeutic agent for RCC chemoresistance.
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Affiliation(s)
- Wei Zhang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiaoxiao Zheng
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Shangzhi Xie
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Shufen Zhang
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Jiayan Mao
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Ying Cai
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Xuemei Lu
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Wei Chen
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Haibin Ni
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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Zielli T, Gnetti L, Buti S. Activity of lenvatinib plus everolimus combination in a heavily pretreated patient with papillary renal cell carcinoma: a case report. TUMORI JOURNAL 2020; 106:NP79-NP83. [PMID: 32458743 DOI: 10.1177/0300891620924472] [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: 11/17/2022]
Abstract
BACKGROUND Papillary renal cell carcinoma (pRCC) represents the second most common histologic subtype of renal cell carcinoma and comprises 2 subtypes. Prognosis for type 2 is associated with poor clinical outcome. Current guidelines are based on phase II trials, phase III trials in patients with clear cell histology, or retrospective data. CASE DESCRIPTION To our knowledge, we describe for the first time a case of a patient with heavily pretreated metastatic pRCC who benefited from the combination of lenvatinib plus everolimus for more than 2 years. CONCLUSION According to immunohistologic and biological findings in our patient both on primary tumor and liver metastasis, we hypothesize that selected patients with metastatic pRCC, progressed to standard/available treatments (including angiogenic drugs, mTOR inhibitors, and immunotherapy) and dissociated response to everolimus, could benefit from adding lenvatinib to everolimus.
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Affiliation(s)
- Teresa Zielli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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Di Franco G, Gianardi D, Palmeri M, Furbetta N, Guadagni S, Bianchini M, Bonari F, Sbrana A, Vasile E, Pollina LE, Mosca F, Di Candio G, Morelli L. Pancreatic resections for metastases: A twenty-year experience from a tertiary care center. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 46:825-831. [PMID: 31806518 DOI: 10.1016/j.ejso.2019.11.514] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Literature data about pancreatic resections for metastases are limited to small series, so that the role of surgery in this setting remains unclear. We herein report our experience from a tertiary care center, analyzing the outcomes of patients who underwent pancreatic resections for metastases and discussing the role of surgical resection in their management. MATERIALS AND METHODS From January 1999 to January 2019, 26 patients underwent pancreatic resections for metastases from renal cell carcinoma (RCC-group) or other primitive tumors (non-RCC-group). Details regarding pre-, intra-, post-operative course, and follow-up, prospectively collected in a database of pancreatic resection, were retrospectively analyzed and compared. RESULTS RCC-group was composed of 21 patients, non-RCC-group of 5 patients. RCC-group presented a longer disease-free interval: 96.4 vs. 5.4 months (p < 0.001). In 9/21 patients (42.9%) of RCC-group the surgical resection of other organs or vascular structures was performed, while in non-RCC-group pancreatic resection alone was performed in all cases, p = 0.070. No local recurrence was reported in all cases. The systemic recurrence rate was 42.9% (9/21 patients) in RCC-group and 80% (4/5 patients) in non-RCC-group, p = 0.135. RCC-group presented a longer DFS and OS: 107.5 vs. 25.2 months (p = 0.002), and 109.1 vs. 36.2 months (p = 0.016), respectively. CONCLUSIONS Radical pancreatic resection may confer a survival benefit for RCC metastases, while for other primitive tumors it should be applied more selectively. For RCC pancreatic metastases, an aggressive surgical approach, even in patient with locally advanced tumors, or associated extra-pancreatic localizations, or recurrent metastases should be taken in consideration.
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Affiliation(s)
- Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Federica Bonari
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Andrea Sbrana
- Unit of Oncology 2, University Hospital of Pisa, Italy
| | - Enrico Vasile
- Unit of Oncology 2, University Hospital of Pisa, Italy
| | | | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Italy; EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Italy.
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