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Balli S, Bolek H, Ürün Y. Emerging Strategies in Adjuvant Immunotherapy: A Comparative Review of Bladder Cancer and Renal Cell Carcinoma Treatments. Clin Med Insights Oncol 2024; 18:11795549241257238. [PMID: 38827522 PMCID: PMC11143815 DOI: 10.1177/11795549241257238] [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: 12/11/2023] [Accepted: 05/04/2024] [Indexed: 06/04/2024] Open
Abstract
Recent progress in adjuvant immunotherapy offers hope for improving disease-free survival in high-risk bladder cancer (BC) and renal cell carcinoma (RCC). This review focuses on key trials such as CheckMate 274 and KEYNOTE-564, which show promising results with nivolumab in BC and pembrolizumab in RCC, including a 30% reduction in progression risk. Pembrolizumab also demonstrated overall survival (OS) benefit in RCC. The review also explores the potential of circulating tumor DNA (ctDNA) as a biomarker for better therapy selection and patient stratification. It emphasizes the need for ongoing research to establish survival benefits and suggests integrating biomarkers and risk stratification to optimize adjuvant immunotherapy in BC and RCC.
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Affiliation(s)
- Sevinc Balli
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
| | - Hatice Bolek
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
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2
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Zhang G, Wang Y, Lu S, Ding F, Wang X, Zhu C, Wang Y, Wang K. Molecular understanding and clinical outcomes of CAR T cell therapy in the treatment of urological tumors. Cell Death Dis 2024; 15:359. [PMID: 38789450 PMCID: PMC11126652 DOI: 10.1038/s41419-024-06734-2] [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] [Received: 01/15/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
Chimeric antigen receptor engineered T (CAR T) cell therapy has developed rapidly in recent years, leading to profound developments in oncology, especially for hematologic malignancies. However, given the pressure of immunosuppressive tumor microenvironments, antigen escape, and diverse other factors, its application in solid tumors is less developed. Urinary system tumors are relatively common, accounting for approximately 24% of all new cancers in the United States. CAR T cells have great potential for urinary system tumors. This review summarizes the latest developments of CAR T cell therapy in urinary system tumors, including kidney cancer, bladder cancer, and prostate cancer, and also outlines the various CAR T cell generations and their pathways and targets that have been developed thus far. Finally, the current advantages, problems, and side effects of CAR T cell therapy are discussed in depth, and potential future developments are proposed in view of current shortcomings.
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Affiliation(s)
- Gong Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yuan Wang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Shiyang Lu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Fengzhu Ding
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xia Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Chunming Zhu
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Yibing Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Kefeng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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3
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Goswamy R, Kalemoglu E, Master V, Bilen MA. Perioperative systemic treatments in renal cell carcinoma. Front Oncol 2024; 14:1362172. [PMID: 38841158 PMCID: PMC11151741 DOI: 10.3389/fonc.2024.1362172] [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] [Received: 12/27/2023] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
In this review, we aim to provide a comprehensive assessment of the evolving landscape of the perioperative management in renal cell carcinoma (RCC), emphasizing its dynamic and intricate nature. We explore academic and clinical insights into the perioperative treatment paradigm of RCC. Up-to-date treatment options are discussed and the evolving role of neoadjuvant and adjuvant therapy in RCC is highlighted.
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Affiliation(s)
- Rohit Goswamy
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Ecem Kalemoglu
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, United States
| | - Viraj Master
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
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4
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Dibajnia P, Cardenas LM, Lalani AKA. The emerging landscape of neo/adjuvant immunotherapy in renal cell carcinoma. Hum Vaccin Immunother 2023; 19:2178217. [PMID: 36775257 PMCID: PMC10026863 DOI: 10.1080/21645515.2023.2178217] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Adjuvant and neoadjuvant therapies that reduce the risk of renal cell carcinoma (RCC) recurrence remain an area of unmet need. Advances have been made in metastatic RCC recently by leveraging PD-1/PD-L1 immune checkpoint inhibitors (ICIs). These agents are currently being investigated in the adjuvant and neoadjuvant settings to determine if intervention early in the disease trajectory offers a clinically meaningful benefit. While a disease-free survival benefit has been demonstrated with pembrolizumab, results from other ICI studies have not been positive to date. More mature data from these studies are needed to determine whether there is a survival benefit to ICIs in the curative-intent setting. The success of ICIs has also ushered a new wave of studies combining ICIs with other agents such as targeted therapies and vaccines, which are in early stages of investigation. We review the current state of adjuvant/neoadjuvant therapy in RCC and highlight opportunities for ongoing study.
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Affiliation(s)
- Pooya Dibajnia
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
| | - Luisa M Cardenas
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
| | - Aly-Khan A Lalani
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON , Canada
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5
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Bolek H, Ürün Y. Adjuvant therapy for renal cell carcinoma: A systematic review of current landscape and future directions. Crit Rev Oncol Hematol 2023; 192:104144. [PMID: 37748694 DOI: 10.1016/j.critrevonc.2023.104144] [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: 06/17/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023] Open
Abstract
The advent of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) has been transformative for the treatment of advanced renal cell carcinoma (RCC). Their efficacy post-surgical resection remains a contentious point. Various phase 3 RCTs have assessed their potency. Amongst evaluated agents, sunitinib and pembrolizumab have demonstrated notable disease-free survival benefits. Sunitinib's potential is diminished due to absence of clear overall survival (OS) benefits and side-effect profile. Pembrolizumab shows better tolerance, conclusive OS data are forthcoming. This scenario underscores the pressing need for advanced risk stratification methods and discovery of novel biomarkers. Existing strategies, largely pre-dating TKI and ICI therapeutic era, lack sufficient accuracy in predicting relapse-risk. Our review offers a comprehensive analysis of key phase 3 RCTs, focusing on TKIs, mTOR-inhibitors, and ICIs for adjuvant RCC treatment. The intent is to shed light on the intricate landscape of RCC treatment, guiding future research directions for optimizing patient outcomes.
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Affiliation(s)
- Hatice Bolek
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey.
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey; Ankara University Cancer Research Institute, Ankara, Turkey.
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6
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Alevizakos M, McDermott D. Adjuvant immunotherapy for locally advanced renal cell carcinoma. Expert Opin Biol Ther 2023; 23:1265-1275. [PMID: 38069655 DOI: 10.1080/14712598.2023.2294001] [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: 06/29/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Locally advanced renal cell carcinoma (RCC) presents a therapeutic challenge due to 20-40% relapse risk post-nephrectomy. There has been substantial interest in utilizing immunotherapy interrupting the PD-1/PD-L1 axis in the perioperative space, especially in the adjuvant setting, in order to minimize such risk. AREAS COVERED We conducted a PubMed search using the terms 'adjuvant' and 'RCC.' We begin by examining landmark studies in the postoperative space for locally advanced RCC, with special emphasis on immunotherapeutic biologics. Important considerations are outlined in an effort to explain the conflicting data on the benefit of adjuvant immunotherapy as well as to adequately assess the magnitude of potential benefit of the recently approved adjuvant pembrolizumab. Relevant contemporary challenges and opportunities as well as future directions of the field are also discussed. EXPERT OPINION Systemic immunotherapy with monoclonal antibodies targeting the PD-1/PD-L1 axis likely holds promise, either alone or potentially in combinations, in minimizing recurrence risk for locally advanced RCC. However, emphasis on post-protocol care, robust endpoint selection, and continued work and validation on predictive biomarkers are needed to confidently select those patients that may benefit the most and minimize biologic and financial toxicity.
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Affiliation(s)
- Michail Alevizakos
- Department of Hematology/Medical Oncology, Riverside Cancer Specialists of Tidewater, Chesapeake, VA, USA
| | - David McDermott
- Hematology/Oncology Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Tsimafeyeu I, Basin MF, Bratslavsky G. Adjuvant therapy for renal cell carcinoma in 2023: hopes and disappointments. World J Urol 2023; 41:1855-1859. [PMID: 37310435 DOI: 10.1007/s00345-023-04450-8] [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: 01/25/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023] Open
Abstract
PURPOSE It is known that 30% of clear cell renal cell carcinomas (ccRCC) will develop progressive disease after surgical treatment. These patients with high-risk ccRCC require adjuvant therapy after nephrectomy or resection of metastases. The article presents an overview of the results of recent studies in adjuvant therapy. METHODS We analyzed the results of randomized trials of targeted therapy and checkpoint inhibitors in high-risk ccRCC patients. RESULTS Targeted therapy did not significantly reduce this risk or/and did not affect overall survival. Three randomized studies investigating nivolumab, ipilimumab, and atezolizumab in the adjuvant setting also failed without improving disease-free survival. Pembrolizumab had a significant impact on the disease-free survival in the entire population, with the greatest effect in patients after metastasectomy, but mature overall survival data are not yet available. CONCLUSIONS In conclusion, it must be noted that, at present, it has not been possible to achieve magnificent success in adjuvant therapy of RCC in patients at high risk of relapse after surgical treatment. There remains hope for adjuvant pembrolizumab, which has been used for high-risk population including patients with removed metastases who may benefit more from therapy.
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Affiliation(s)
- Ilya Tsimafeyeu
- Bureau for Cancer Research, 526 West 158th str., New York, NY, 10032, USA.
| | - Michael F Basin
- State University of New York, SUNY, Upstate Medical University, Syracuse, NY, USA
| | - Gennady Bratslavsky
- State University of New York, SUNY, Upstate Medical University, Syracuse, NY, USA
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Leow JJ, Ray S, Dason S, Singer EA, Chang SL. The Promise of Neoadjuvant and Adjuvant Therapies for Renal Cancer. Urol Clin North Am 2023; 50:285-303. [PMID: 36948672 DOI: 10.1016/j.ucl.2023.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Because metachronous metastatic disease will develop in 20% to 40% of patients with presumed localized renal cell carcinoma (RCC) treated surgically, research is focused on neoadjuvant and adjuvant systemic therapy, to improve disease-free and overall survival. Neoadjuvant therapies trialed include anti-vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) agents, or combination therapies (immunotherapy with TKI), and aim to improve resectability of locoregional RCC. Adjuvant therapies trialed include cytokines, anti-VEGF TKI agents, or immunotherapy. These therapeutics can facilitate the surgical extirpation of the primary kidney tumor in the neoadjuvant setting and improve disease-free survival in the adjuvant setting.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Annex 1-L04-Uro, Singapore 308433, Singapore
| | - Shagnik Ray
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, 915 Olentangy River Road, Suite 3100, Columbus, OH 43212, USA
| | - Shawn Dason
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, 915 Olentangy River Road, Suite 3100, Columbus, OH 43212, USA
| | - Eric A Singer
- Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, 915 Olentangy River Road, Suite 3100, Columbus, OH 43212, USA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, 45 Francis Street, Suite ASBII-3, Boston, MA 02115, USA.
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Wang LL, Saidian A, Pan E, Panian J, Derweesh IH, McKay RR. Adjuvant Therapy in Renal Cell Carcinoma: Are we ready for prime time? KIDNEY CANCER 2022. [DOI: 10.3233/kca-220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The standard of care for localized renal cell carcinoma (RCC) is radical or partial nephrectomy. Despite complete resection, a subset of patients will develop locoregional recurrence or metastatic disease. Adjuvant immunotherapy has been studied since the 1980 s as the primary method to mitigate tumor recurrence after definitive surgery. We herein discuss published and ongoing clinical trials investigating adjuvant therapy in localized or locoregional RCC.
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Affiliation(s)
- Luke L. Wang
- University of California San Diego, La Jolla, CA, USA
| | - Ava Saidian
- University of California San Diego, La Jolla, CA, USA
| | - Elizabeth Pan
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Rana R. McKay
- University of California San Diego, La Jolla, CA, USA
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10
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The Continuing Question of Adjuvant Therapy in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14246018. [PMID: 36551504 PMCID: PMC9776072 DOI: 10.3390/cancers14246018] [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: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment advances in kidney cancer continually evolve. The focus of treatment options continues with oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) or intravenous immune checkpoint inhibitors (ICIs). Multiple trials exploring the role of adjuvant treatment after cytoreductive nephrectomy in high-risk clear cell renal cell carcinoma are currently ongoing. The discovery of biomarkers may help determine which patients benefit from these treatments, but these are not yet available outside clinical studies. Trials with combination therapies are also ongoing, especially using novel therapies with new mechanisms of action, and will hopefully provide more clues on proper patient and therapy selection in the adjuvant setting.
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11
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Renner A, Rojas C, Walton-Diaz A, Burotto M. Adjuvant therapy for renal cell carcinoma, finally a new standard? Front Oncol 2022; 12:926661. [PMID: 36249058 PMCID: PMC9557147 DOI: 10.3389/fonc.2022.926661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Localized renal cell carcinoma (RCC) has the potential to be cured with surgery alone; however, some patients have a high risk of relapse and may benefit from additional treatment. Several efforts have been made to identify effective strategies, with mostly negative results. However, recent results with immune checkpoint inhibitors may change the current standard, and several ongoing trials are exploring new alternatives. In this perspective, we aim to provide an overview of previous adjuvant therapy efforts, current data supporting the use of checkpoint blockade, and a future outlook for adjuvant therapy in renal cell carcinoma.
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Affiliation(s)
- Alex Renner
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
| | - Carlos Rojas
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
| | - Annerleim Walton-Diaz
- Department of Urology, Chilean National Cancer Institute, Urofusion Spa, and Department of Urology, Universidad de Chile, Santiago, Chile
| | - Mauricio Burotto
- Medical Oncology Department, Bradford Hill Clinical Research Center, Santiago, Chile
- *Correspondence: Mauricio Burotto,
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12
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Zhang Z, Li D, Yun H, Liu W, Chai K, Tong J, Zeng T, Gao Z, Xie Y. CAR-T Cells in the Treatment of Urologic Neoplasms: Present and Future. Front Oncol 2022; 12:915171. [PMID: 35860578 PMCID: PMC9292130 DOI: 10.3389/fonc.2022.915171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years, with the breakthrough of CAR-T cells in the treatment of hematological tumors, they are increasingly being used to treat solid tumors, including urologic neoplasms. There are many relatively specific targets for urologic neoplasms, especially prostate cancer. Besides, urologic neoplasms tend to progress more slowly than tumors in other organs of the body, providing ample time for CAR-T cell application. Therefore, CAR-T cells technology has inherent advantages in urologic neoplasms. CAR-T cells in the treatment of urologic neoplasms have been extensively studied and preliminary achievements have been made. However, no breakthrough has been made due to the problems of targeting extra-tumor cytotoxicity and poor anti-tumor activity. we systematacially summarized the research actuality of CAR-T cells in urologic neoplasms, discussed the potential value and difficulties of the research. The application of CAR-T cells in the treatment of urologic neoplasms requires improvement of function through screening for better targets, modification of CAR structures, or in combination with other antitumor approaches.
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Affiliation(s)
- Zhengchao Zhang
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
- Department of General Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Dong Li
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Heng Yun
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Wei Liu
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Keqiang Chai
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Jie Tong
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Tongwei Zeng
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
| | - Zhenghua Gao
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
- *Correspondence: Yongqiang Xie, ; Zhenghua Gao,
| | - Yongqiang Xie
- Department of Urology, The Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Baiyin, China
- *Correspondence: Yongqiang Xie, ; Zhenghua Gao,
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13
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Complementary roles of surgery and systemic treatment in clear cell renal cell carcinoma. Nat Rev Urol 2022; 19:391-418. [PMID: 35546184 DOI: 10.1038/s41585-022-00592-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
Standard-of-care management of renal cell carcinoma (RCC) indisputably relies on surgery for low-risk localized tumours and systemic treatment for poor-prognosis metastatic disease, but a grey area remains, encompassing high-risk localized tumours and patients with metastatic disease with a good-to-intermediate prognosis. Over the past few years, results of major practice-changing trials for the management of metastatic RCC have completely transformed the therapeutic options for this disease. Treatments targeting vascular endothelial growth factor (VEGF) have been the mainstay of therapy for metastatic RCC in the past decade, but the advent of immune checkpoint inhibitors has revolutionized the therapeutic landscape in the metastatic setting. Results from several pivotal trials have shown a substantial benefit from the combination of VEGF-directed therapy and immune checkpoint inhibition, raising new hopes for the treatment of high-risk localized RCC. The potential of these therapeutics to facilitate the surgical extirpation of the tumour in the neoadjuvant setting or to improve disease-free survival in the adjuvant setting has been investigated. The role of surgery for metastatic RCC has been redefined, with results of large trials bringing into question the paradigm of upfront cytoreductive nephrectomy, inherited from the era of cytokine therapy, when initial extirpation of the primary tumour did show clinical benefits. The potential benefits and risks of deferred surgery for residual primary tumours or metastases after partial response to checkpoint inhibitor treatment are also gaining interest, considering the long-lasting effects of these new drugs, which encourages the complete removal of residual masses.
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14
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Mattila KE, Vainio P, Jaakkola PM. Prognostic Factors for Localized Clear Cell Renal Cell Carcinoma and Their Application in Adjuvant Therapy. Cancers (Basel) 2022; 14:cancers14010239. [PMID: 35008402 PMCID: PMC8750145 DOI: 10.3390/cancers14010239] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Approximately one fifth of patients with newly diagnosed renal cell carcinoma (RCC) present with metastatic disease and over one third of the remaining patients with localized RCC will eventually have metastases spread to distant sites after complete resection of the primary tumor in the kidney. Usually, disease recurrence is observed within the first five years of follow-up, but late recurrences after five years are seen in up to 10% of patients. Despite novel biomarkers, simple histopathological factors, such as tumor size, tumor grade, and tumor extension into the blood vessels or beyond the kidney, are still valid features in predicting the risk of disease recurrence after surgery. The optimal set of prognostic factors remains unclear. The results from ongoing placebo-controlled adjuvant therapy trials may elucidate prognostic features that help to define high-risk patients for disease recurrence. Abstract Approximately 20% of patients with renal cell carcinoma (RCC) present with primarily metastatic disease and over 30% of patients with localized RCC will develop distant metastases later, after complete resection of the primary tumor. Accurate postoperative prognostic models are essential for designing personalized surveillance programs, as well as for designing adjuvant therapy and trials. Several clinical and histopathological prognostic factors have been identified and adopted into prognostic algorithms to assess the individual risk for disease recurrence after radical or partial nephrectomy. However, the prediction accuracy of current prognostic models has been studied in retrospective patient cohorts and the optimal set of prognostic features remains unclear. In addition to traditional histopathological prognostic factors, novel biomarkers, such as gene expression profiles and circulating tumor DNA, are extensively studied to supplement existing prognostic algorithms to improve their prediction accuracy. Here, we aim to give an overview of existing prognostic features and prediction models for localized postoperative clear cell RCC and discuss their role in the adjuvant therapy trials. The results of ongoing placebo-controlled adjuvant therapy trials may elucidate prognostic factors and biomarkers that help to define patients at high risk for disease recurrence.
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Affiliation(s)
- Kalle E. Mattila
- Department of Oncology and Radiotherapy, FICAN West Cancer Centre, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
- Correspondence: ; Tel.: +358-2-3130000
| | - Paula Vainio
- Department of Pathology, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
| | - Panu M. Jaakkola
- Department of Oncology and Radiotherapy, FICAN West Cancer Centre, University of Turku, Turku University Hospital, Hämeentie 11, 20521 Turku, Finland;
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Efficacy of Enhanced Cytokine-Induced Killer Cells as an Adjuvant Immunotherapy for Renal Cell Carcinoma: Preclinical and Clinical Studies. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5709104. [PMID: 34540187 PMCID: PMC8443387 DOI: 10.1155/2021/5709104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022]
Abstract
Cytokine-induced killer (CIK) cells have been proved to be an effective method of tumor immunotherapy in numerous preclinical and clinical studies. In our previous study, a new method was developed to prime and propagate CIK cells by the combination of IL-2 and IL-15, and this kind of CIK cells had enhanced antitumor effect on lung cancer. For renal cell carcinoma (RCC), immunotherapy plays an important role because of the poor efficacy of radiotherapy and chemotherapy. In this study, we further evaluated the antitumor effects of these enhanced CIK cells against RCC. Enhanced CIK cells were generated by IL-2 combined with IL-15 and identified by flow cytometry. HEK-293 and ACHN cell lines were used to verify the efficiency of CIK cells in vitro, and then the ACHN tumor xenograft model was also employed for in vivo study. In addition, the secreted cytokines including IFN-γ, granzyme B, TNF-α, and perforin, as well as the local microstructure were also studied. Subsequently, 20 patients with RCC were enrolled into our study, and 11 patients were randomly divided into the autologous CIK treatment group for clinical research. The results showed that enhanced CIK cells exert better antitumor effects in RCC in vitro (p < 0.01 in HEK-293 and p < 0.05 in ACHN)and in vivo (p < 0.05). Patients benefit overall survival from enhanced CIK therapy in our clinical study. Our present preclinical and clinical studies for the first time elucidated that these enhanced CIK cells would be used as an effective adjuvant therapy in the treatment of RCC.
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16
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Larroquette M, Peyraud F, Domblides C, Lefort F, Bernhard JC, Ravaud A, Gross-Goupil M. Adjuvant therapy in renal cell carcinoma: Current knowledges and future perspectives. Cancer Treat Rev 2021; 97:102207. [PMID: 33906023 DOI: 10.1016/j.ctrv.2021.102207] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023]
Abstract
While many patients with non-metastatic renal cell carcinoma (RCC) can be cured with surgery alone, upward of 40% of patients recur in a short delay, raising the question of additional perioperative treatments. To address this clinical need, multiple trials have investigated the addition of systemic therapy after surgery in localized or locally advanced RCC. However, adjuvant systemic therapies in the past decades have provided disappointing results with only one positive study of antiangiogenic treatments. Debatable clinical benefit of adjuvant antiangiogenic tyrosine kinase inhibitors (TKIs) therapy at cost of high adverse event profiles have paved the way for development of alternative perioperative strategies, such as immune checkpoint inhibitors (ICIs). Further investigation into combination therapies with immunotherapy, neoadjuvant approaches and patient selection will be key to determining optimal adjuvant therapy regimens to improve outcomes and increase cure rates for patients with non-metastatic RCC. In this review, we extensively present the strong and weakness of the five adjuvant antiangiogenic TKI trials, highlight the main differences and discuss about the reasons of failure. We also expose the current ongoing clinical trials in the perioperative setting and provide new insights concerning the evolving landscape of the management of non-metastatic RCC.
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Affiliation(s)
- Mathieu Larroquette
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France.
| | - Florent Peyraud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France.
| | - Charlotte Domblides
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France.
| | - Félix Lefort
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France.
| | - Jean-Christophe Bernhard
- Bordeaux University, Bordeaux, France; Department of Urology, Bordeaux University Hospital, Bordeaux, France.
| | - Alain Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France; Bordeaux University, Bordeaux, France.
| | - Marine Gross-Goupil
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France.
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17
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Canil C, Kapoor A, Basappa NS, Bjarnason G, Bossé D, Dudani S, Graham J, Gray S, Hansen AR, Heng DY, Karakiewicz PI, Kollmannsberger C, Lalani AKA, North SA, Patenaude F, Soulières D, Thana M, Winquist E, Wood LA, Reaume MN, Maloni R, Hotte SJ. Management of advanced kidney cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2021. Can Urol Assoc J 2021; 15:84-97. [PMID: 33830005 PMCID: PMC8021420 DOI: 10.5489/cuaj.7245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Christina Canil
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Naveen S. Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Georg Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Dominick Bossé
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Shaan Dudani
- William Osler Health System, Brampton, ON, Canada
| | | | - Samantha Gray
- Department of Oncology, Dalhousie University, Saint John Regional Hospital, St. John, NB, Canada
| | - Aaron R. Hansen
- Department of Oncology, Princess Margaret Cancer Centre, Toronto ON, Canada
| | - Daniel Y.C. Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary AB, Canada
| | - Pierre I. Karakiewicz
- Department of Surgery, Le Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and the University of British Columbia, Vancouver, BC, Canada
| | | | - Scott A. North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - François Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Myuran Thana
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Lori A. Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - M. Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Ranjena Maloni
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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18
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Kazarian AG, Chawla NS, Muddasani R, Pal SK. Adjuvant Therapy in Renal Cell Carcinoma: Current Status and Future Directions. KIDNEY CANCER 2021. [DOI: 10.3233/kca-200105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In recent years, incredible progress has been made in the treatment of metastatic renal cell carcinoma, with a paradigm shift from the use of cytokines to tyrosine kinase inhibitors, and more recently, immune checkpoint inhibitors (ICIs). Despite advances in the metastatic setting, effective therapies in the adjuvant setting are a largely unmet need. Currently, sunitinib (Sutent, Pfizer) is the only therapy for the adjuvant treatment of RCC included in the National Comprehensive Cancer Network guidelines, which was approved by the FDA based on the improvement in disease-free survival (DFS) seen in the S-TRAC trial. However, improvement in DFS has not translated into an overall survival (OS) benefit for patients at high-risk of relapse post-nephrectomy, illustrating the need for more effective therapies. This manuscript will highlight attributes of both historical and current drug trials and their implications on the landscape of adjuvant therapy. Additionally, we will outline strategies for selecting patients in whom treatment would be most beneficial, as optimal patient selection is a crucial step towards improving outcomes in the adjuvant setting. This is especially critical, given the financial cost and pharmacological toxicity of therapeutic agents. Furthermore, we will review the design of clinical trials including the value of utilizing OS as an endpoint over DFS. Finally, we will discuss how the incorporation of genomic data into predictive models, the use of more sensitive imaging modalities for more accurate staging, and more extensive surgical intervention involving lymph node dissection, may impact outcomes.
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Affiliation(s)
| | - Neal S. Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ramya Muddasani
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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19
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Ravindranathan D, Alhalabi O, Rafei H, Shah AY, Bilen MA. Landscape of Immunotherapy in Genitourinary Malignancies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1342:143-192. [PMID: 34972965 PMCID: PMC11235092 DOI: 10.1007/978-3-030-79308-1_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The past decade has witnessed a revolution in the development of immune checkpoint inhibitors for the treatment of multiple tumor types, including genitourinary cancers. Immune checkpoint inhibitors have notably improved the treatment outcomes of patients with metastatic renal cell carcinoma and metastatic urothelial carcinoma. In prostate cancer, the role of immunotherapy with checkpoint inhibitors is not yet established except for microsatellite instability high (MSI-H) tumors. Other immunotherapeutic approaches that have been explored in these malignancies include cytokines, vaccines, and cellular therapy. Ongoing studies are exploring the use of immunotherapy combinations as well as combination with chemotherapy and targeted therapy in these types of tumors. The use of immunotherapy beyond the metastatic setting is an active area of research. Moreover, there is great interest in biomarker development to predict response to immunotherapy and risk of toxicity. This book chapter is a comprehensive review of immunotherapeutic approaches, both approved and investigational, for the treatment of renal cell carcinoma, urothelial carcinoma, and prostate cancer.
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Affiliation(s)
- Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Omar Alhalabi
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hind Rafei
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amishi Yogesh Shah
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.
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20
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Tacconi EMC, Tuthill M, Protheroe A. Review of Adjuvant Therapies in Renal Cell Carcinoma: Evidence to Date. Onco Targets Ther 2020; 13:12301-12316. [PMID: 33299326 PMCID: PMC7721274 DOI: 10.2147/ott.s174149] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/04/2020] [Indexed: 12/31/2022] Open
Abstract
In 2018, there were 400,000 new cases of renal cell carcinoma (RCC) globally, with 175,000 deaths attributable to the disease. Three quarters of patients have potentially curable localised disease at diagnosis; however, recurrence rates are as high as 40% following surgery. There are currently no adjuvant therapies in routine clinical use which reliably improve outcomes. Effective adjuvant therapy is an urgent unmet need to reduce recurrence risk and improve outcomes. Early efforts explored chemotherapy, radiotherapy, cytokine therapy, hormonal treatments and tumour cell vaccines as adjuvant therapies, however, have yielded disappointing results. More recently, interest shifted to evaluating tyrosine kinase inhibitors (TKIs) in the adjuvant setting, as they improve outcomes in metastatic disease. Five phase III clinical trials testing adjuvant use of a range of TKIs have been performed, with the results of a sixth trial awaited. Unfortunately, these studies have thus far yielded conflicting and disappointing results, and there is currently no strong evidence for routine adjuvant TKI therapy. In parallel, novel immunotherapy treatment approaches have recently been developed, transforming the management of a range of malignancies, particularly through immune checkpoint inhibitors (ICIs). These approaches are well established in the metastatic context in RCC, as well as in the adjuvant treatment of melanoma. On this basis, five phase III trials are currently ongoing to test the efficacy of a range of ICIs in adjuvant RCC patients, with initial results expected over the next few years. In this article, we review the current evidence for adjuvant therapies in RCC, discuss ongoing clinical trials and suggest directions for future work to address this unmet need.
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Affiliation(s)
- Eliana M C Tacconi
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Mark Tuthill
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Andrew Protheroe
- Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
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21
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The Role of Targeted Therapy in the Management of High-Risk Resected Kidney Cancer: What Have We Learned and How Will It Inform Future Adjuvant Trials. ACTA ACUST UNITED AC 2020; 26:376-381. [PMID: 32947305 DOI: 10.1097/ppo.0000000000000469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary treatment for localized renal cell carcinoma (RCC) is surgical resection with curative intent. Despite this, many patients, especially those with high-risk features, will develop recurrent or metastatic disease. Antiangiogenic therapies targeting vascular endothelial growth factor have been a mainstay of treatment of advanced RCC for more than 10 years. Evidence supporting the use of these therapies in the adjuvant setting is mixed, although one clinical trial, S-TRAC, has shown improvements in disease-free survival with 1 year of adjuvant sunitinib among patients with clear cell histology and high-risk features, leading to the first US Food and Drug Administration approval of an adjuvant therapy for high-risk RCC patients. Further investigation into combination therapies with immunotherapy, neoadjuvant approaches, and patient selection will be key to determining optimal adjuvant therapy regimens to improve outcomes and increase cure rates for patients with localized RCC.
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22
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Wood E, Donin N, Shuch B. Adjuvant Therapy for Localized High-Risk Renal Cell Carcinoma. Urol Clin North Am 2020; 47:345-358. [PMID: 32600536 DOI: 10.1016/j.ucl.2020.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This article reviews the use of adjuvant therapies for prevention of recurrence following resection of clinically localized renal cell carcinoma (RCC). Clinical trials evaluating adjuvant therapy for RCC have focused primarily on the use of tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors, which had improved outcome in patients with metastatic disease. However, all but 1 trial found no difference in disease-free survival in the adjuvant setting and none improved overall survival.
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Affiliation(s)
- Erika Wood
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas Donin
- Division of Urologic Oncology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brian Shuch
- Kidney Cancer Program, Division of Urologic Oncology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Abstract
Approximately 70% of cases of kidney cancer are localized or locally advanced at diagnosis. Among patients who undergo surgery for these cancers, 30-35% will eventually develop potentially fatal metachronous distant metastases. Effective adjuvant treatments are urgently needed to reduce the risk of recurrence of kidney cancer and of dying of metastatic disease. To date, almost all of the tested adjuvant agents have failed to demonstrate any benefit. Only two trials of an autologous renal tumour cell vaccine and of the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor sunitinib have shown positive results, but these have been criticized for methodological reasons and conflicting data, respectively. The results of two additional trials of targeted agents as adjuvant therapies have not yet been published. Novel immune checkpoint inhibitors are promising approaches to adjuvant therapy in kidney cancer, and a number of trials are now underway. An important component of the management of patients with kidney cancer, particularly those who undergo radical resection for localized renal cell carcinoma, is the preservation of kidney function to reduce morbidity and mortality. The optimal management of these patients therefore requires a multidisciplinary approach involving nephrologists, oncologists, urologists and pathologists.
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24
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Tsai YC, Hsueh FJ. Current and future aspect of immunotherapy for advanced renal cell carcinoma. UROLOGICAL SCIENCE 2020. [DOI: 10.4103/uros.uros_77_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Current Landscape of Immunotherapy in Genitourinary Malignancies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1244:107-147. [DOI: 10.1007/978-3-030-41008-7_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Hotte SJ, Kapoor A, Basappa NS, Bjarnason G, Canil C, Conter HJ, Czaykowski P, Graham J, Gray S, Heng DYC, Karakiewicz PI, Kollmannsberger C, Lalani AKA, North SA, Patenaude F, Soulières D, Violette P, Winquist E, Wood LA, Dudani S, Maloni R, Reaume MN. Management of Advanced Kidney Cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2019. Can Urol Assoc J 2019; 13:343-354. [PMID: 31603413 DOI: 10.5489/cuaj.6256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Anil Kapoor
- Urologic Research Center for Research & Innovation, McMaster University, Hamilton, ON, Canada.,The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Georg Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, The Ottawa Hospital Cancer Center and the University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Samantha Gray
- Department of Oncology, Dalhousie University, Saint John Regional Hospital, St. John, NB, Canada
| | - Daniel Y C Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Center, Calgary AB, Canada
| | - Pierre I Karakiewicz
- Department of Surgery, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Center, and the University of British Columbia, Vancouver, BC, Canada
| | | | - Scott A North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - François Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Phillippe Violette
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Shaan Dudani
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Center, Calgary AB, Canada
| | - Ranjena Maloni
- The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Center and the University of Ottawa, Ottawa, ON, Canada
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Sugiyama Y, Yatsuda J, Murakami Y, Ito N, Yamasaki T, Mikami Y, Ogawa O, Kamba T. Impact of tumor size on patient survival after radical nephrectomy for pathological T3a renal cell carcinoma. Jpn J Clin Oncol 2019; 49:465-472. [PMID: 30793163 DOI: 10.1093/jjco/hyy200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We recently reported the results from a multi-institutional retrospective outcome study involving 814 patients with renal cell carcinomas (RCCs) who had undergone radical surgery and whose diagnoses were confirmed via a central pathological review. This study aimed to clarify the impact of tumor size on survival outcomes in patients with pT3aN0M0 RCC after radical nephrectomy using this cohort. METHODS Using the Kaplan-Meier method, overall survival (OS), cancer-specific survival (CSS) and relapse-free survival (RFS) were estimated for 103 pT3aN0M0 patients. The differences in the OS, CSS and RFS according to tumor size were evaluated using the log-rank test. To identify independent prognostic factors that affected each survival outcome, clinicopathological factors were examined using univariate and multivariate analyses, and the Cox proportional hazards model. RESULTS The OS, CSS and RFS rates for 26 patients with pT3a RCCs ≤4 cm were significantly better than those for 77 patients with pT3a RCCs that were 4-7 cm or >7 cm (P = 0.0064, 0.0169 and 0.0001, respectively). Tumor size and venous invasion were independent prognosticators for OS, CSS and RFS. The OS and CSS for patients with pT3a tumors ≤4 cm were comparable with those for patients with pT1 RCCs, and the RFS for patients with pT3a RCCs ≤4 cm was similar to that for patients with pT1b RCCs. CONCLUSIONS Tumor size significantly influenced the prognosis for patients with pT3aN0M0 RCC. This study's results suggest that the postoperative management of pT3a RCCs could be individualized according to tumor size.
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Affiliation(s)
- Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Junji Yatsuda
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Yoji Murakami
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
| | - Noriyuki Ito
- Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama
| | - Toshinari Yamasaki
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto
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Riaz IB, Faridi W, Husnain M, Malik SU, Sipra QUAR, Gondal FR, Xie H, Yadav S, Kohli M. Adjuvant Therapy in High-Risk Renal Cell Cancer: A Systematic Review and Meta-analysis. Mayo Clin Proc 2019; 94:1524-1534. [PMID: 31303430 DOI: 10.1016/j.mayocp.2019.01.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating risk-benefit for adjuvant postoperative treatments in high-risk renal cell carcinoma by assessing reported disease-free survival (DFS), overall survival (OS), toxicity, and quality of life. METHODS A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials to identify relevant RCTs (from database inception through May 15, 2018). The results of the ATLAS trial were published while writing this manuscript, and the manuscript was updated accordingly. A generic variance-weighted random effects model was used to derive estimates for efficacy and common adverse effects. Heterogeneity was assessed using the Cochran Q statistic and was quantified using the I2 test. RESULTS Adjuvant therapy with tyrosine kinase inhibitors compared with placebo was observed to have a DFS hazard ratio [HR] of 0.92 (95% CI, 0.83-1.01) and an OS HR of 1.01 (95% CI, 0.89-1.15) (4 RCTs; 4417 patients). Analysis of DFS for sunitinib compared with placebo (n=1909) in the adjuvant setting detected an HR of 0.90 (95% CI, 0.67-1.19). Increased risk of grade 3 or 4 adverse events (relative risk [RR]=2.6; 95% CI, 2.28-2.97), diarrhea (RR=9.89; 95% CI, 4.22-23.14), fatigue (RR=3.11; 95% CI, 1.86-5.18), hypertension (RR=3.63; 95% CI, 2.99-4.41), and palmar/plantar dysesthesia (RR=2.70; 95% CI, 2.47-2.96) was observed. CONCLUSION Adjuvant vascular endothelial growth factor tyrosine kinase inhibitors in high-risk renal cell carcinoma did not improve OS or DFS, and there was a significant increased risk of toxicity in greater than half of the patients, leading to a decline in quality of life.
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Affiliation(s)
- Irbaz B Riaz
- Department of Oncology, Mayo Clinic, Rochester, MN.
| | - Warda Faridi
- Division of Hematology-Oncology, University of Arizona, Tucson
| | - Muhammad Husnain
- Department of Medicine, University of Arizona, Tucson; Division of Hematology and Oncology, University of Miami, FL
| | | | | | | | - Hao Xie
- Department of Oncology, Mayo Clinic, Rochester, MN
| | | | - Manish Kohli
- Department of Oncology, Mayo Clinic, Rochester, MN.
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Abstract
Immune modulatory treatment regimens, led by immune checkpoint inhibitors, have transformed the treatment of clear-cell renal cell carcinoma. First-in-class, the PD-1 inhibitor nivolumab improved overall survival in advanced renal cell carcinoma following prior anti-angiogenic therapy, an important shift in the management of clear-cell renal cell carcinoma. Further improvements of long-term outcomes will be driven by combinations in the first-line setting, including PD-1/PD-L1 associated with antiangiogenic therapies, or PD1/PD-L1 inhibitors with other immune checkpoint inhibitors such as anti-CTLA-4, anti-LAG-3 or TIM-3 targeted therapies. The first two randomized Phase 3 trials assessing these combinations have now challenged sunitinib in first-line setting. First, the CheckMate 214 trial demonstrated an objective response rate and overall survival benefit for the combination of nivolumab plus ipilimumab in the intermediate- and poor-risk patients. Second, the IMMotion 151 study demonstrated a progression-free survival benefit for the atezolizumab plus bevacizumab combination by investigator assessment. Further Phase 3 trials are awaited with tyrosine kinase and immune checkpoint inhibitor combinations. Clinical trials of immune checkpoint inhibitors are also actively investigated in the localized adjuvant or neoadjuvant setting. Nevertheless, the search for biomarkers along with new clinical trial designs will be crucial to better select the patients that may derive the greatest benefit from these advances. The continuing improvement of antitumor immunity comprehension and the emergence of new immune modulatory treatments will deeply change the management of renal cell carcinoma for the years to come.
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30
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Giuseppa Vitale M, Bracarda S, Cosmai L, Crocetti E, Di Lorenzo G, Lapini A, Mandressi A, Martorana G, Masini C, Montironi R, Ortega C, Passalacqua R, Porta C, Procopio G, Sepe P, Romano L, Luigi Pappagallo G, Conti G, Guida M, Martignoni G, Nolè F, Pignata S, Gori S, Cartenì G. Management of kidney cancer patients: 2018 guidelines of the Italian Medical Oncology Association (AIOM). TUMORI JOURNAL 2019; 105:3-12. [DOI: 10.1177/0300891619853392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In the past two decades, the treatment landscape for patients with metastatic renal cell carcinoma has significantly changed thanks to the approval of several targeted molecular therapies (VEGF and mTOR inhibitors) and recently immune-checkpoint inhibitors. The Italian Association of Medical Oncology (AIOM) Renal Cell Cancer (RCC) Guidelines Panel has developed clinical guidelines to provide evidence-based information and recommendations to oncologists, urologists and all professionals involved in the management of patients with renal cell cancer.
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Affiliation(s)
| | - Sergio Bracarda
- Medical Oncology Unit, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Division of Nephrology & Dialysis, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Giuseppe Di Lorenzo
- Medical Oncology Division, Department of Clinical Medicine and Surgery, University Federico II of Naples, Napoli, Italy
| | - Alberto Lapini
- Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy
| | - Alberto Mandressi
- Ospedale Humanitas Mater Domini, Via Gerenzano 2, Castellanza, Varese, Italy
| | - Giuseppe Martorana
- Department of Urology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Masini
- Medical Oncology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, United Hospital, School of Medicine, Polytechnic University of the Marche Region, Ancona, Italy
| | | | | | - Camillo Porta
- Department of Internal Medicine, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Giuseppe Procopio
- Medical Oncology-Genitourinary Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Pierangela Sepe
- Medical Oncology-Genitourinary Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luigia Romano
- Department of Radiology, A. Cardarelli Hospital, Napoli, Italy
| | | | - Giario Conti
- Urology Unit, Azienda Socio-Sanitaria Territoriale Lariana, Sant’Anna Hospital, Como, Italy
| | - Michele Guida
- Division of Medical Oncology; National Cancer Institute “Giovanni Paolo II”, Bari, Italy
| | - Guido Martignoni
- Department of Diagnostic and Public Health, University of Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours, European Institute of Oncology, Milano, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori “Fondazione G. Pascale”, Napoli, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, Azienda Ospedaliero di Rilievo Nazionale “A. Cardarelli”, Napoli, Italy
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31
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Gul A, Rini BI. Adjuvant therapy in renal cell carcinoma. Cancer 2019; 125:2935-2944. [DOI: 10.1002/cncr.32144] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/16/2019] [Accepted: 03/17/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Anita Gul
- Cleveland Clinic Taussig Cancer Institute Cleveland Ohio
| | - Brian I. Rini
- Cleveland Clinic Taussig Cancer Institute Cleveland Ohio
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32
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Affiliation(s)
- Iris Y. Sheng
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Brian I. Rini
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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33
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Martinez Chanza N, Tripathi A, Harshman LC. Adjuvant Therapy Options in Renal Cell Carcinoma: Where Do We Stand? Curr Treat Options Oncol 2019; 20:44. [DOI: 10.1007/s11864-019-0639-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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34
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Figlin RA, Leibovich BC, Stewart GD, Negrier S. Adjuvant therapy in renal cell carcinoma: does higher risk for recurrence improve the chance for success? Ann Oncol 2019; 29:324-331. [PMID: 29186296 DOI: 10.1093/annonc/mdx743] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The success of targeted therapies, including inhibitors of the vascular endothelial growth factor pathway or the mammalian target of rapamycin, in the treatment of metastatic renal cell carcinoma led to interest in testing their efficacy in the adjuvant setting. Results from the first trials are now available, with other studies due to report imminently. This review provides an overview of adjuvant targeted therapy in renal cell carcinoma, including interpretation of currently available conflicting data and future direction of research. We discuss the key differences between the completed targeted therapy adjuvant trials, and highlight the importance of accurately identifying patients who are likely to benefit from adjuvant treatment. We also consider reasons why blinded independent radiology review and treatment dose may prove critical for adjuvant treatment success. The implications of using disease-free survival as a surrogate end point for overall survival from the patient perspective and measurement of health benefit have recently been brought into focus and are discussed. Finally, we discuss how the ongoing adjuvant trials with targeted therapies and checkpoint inhibitors may improve our understanding and ability to prevent tumor recurrence after nephrectomy in the future.
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Affiliation(s)
- R A Figlin
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, USA.
| | | | - G D Stewart
- Academic Urology Group, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - S Negrier
- Centre Léon Bérard, University of Lyon, Lyon, France
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35
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Sharma T, Tajzler C, Kapoor A. Is there a role for adjuvant therapy after surgery in "high risk for recurrence" kidney cancer? An update on current concepts. Curr Oncol 2018; 25:e444-e453. [PMID: 30464696 PMCID: PMC6209555 DOI: 10.3747/co.25.3865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Although surgical resection remains the standard of care for localized kidney cancers, a significant proportion of patients experience systemic recurrence after surgery and hence might benefit from effective adjuvant therapy. So far, several treatment options have been evaluated in adjuvant clinical trials, but only a few have provided promising results. Nevertheless, with the recent development of targeted therapy and immunomodulatory therapy, a series of clinical trials are in progress to evaluate the potential of those novel agents in the adjuvant setting. In this paper, we provide a narrative review of the progress in this field, and we summarize the results from recent adjuvant trials that have been completed. Methods A literature search was conducted. The primary search strategy at the medline, Cochrane reviews, and http://ClinicalTrials.gov/databases included the keywords "adjuvant therapy," "renal cell carcinoma," and "targeted therapy or/and immunotherapy." Conclusions Data from the s-trac study indicated that, in the "highest risk for recurrence" patient population, disease-free survival was increased with the use of adjuvant sunitinib compared with placebo. The assure trial showed no benefit for adjuvant sunitinib or sorafenib in the "intermediate- to high-risk" patient population. The ariser (adjuvant girentuximab) and protect (adjuvant pazopanib) trials indicated no survival benefit, but subgroup analyses in both trials recommended further investigation. The inconsistency in some of the current results can be attributed to a variety of factors pertaining to the lack of standardization across the trials. Nevertheless, patients in the "high risk of recurrence" category after surgery for their disease would benefit from a discussion about the potential benefits of adjuvant treatment and enrolment in ongoing adjuvant trials.
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Affiliation(s)
- T Sharma
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - C Tajzler
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - A Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
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36
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Lawrence NJ, Martin A, Davis ID, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Smith B, Ritchie A, Meade A, Eisen T, Blinman P, Stockler MR. What Survival Benefits are Needed to Make Adjuvant Sorafenib Worthwhile After Resection of Intermediate- or High-Risk Renal Cell Carcinoma? Clinical Investigators' Preferences in the SORCE Trial. KIDNEY CANCER 2018; 2:123-131. [PMID: 30740581 PMCID: PMC6364092 DOI: 10.3233/kca-180038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Decisions about adjuvant therapy involve trade-offs between possible benefits and harms. Objective We sought to determine the survival benefits that clinical investigators would judge as sufficient to warrant treatment with adjuvant sorafenib in the SORCE trial after nephrectomy for apparently localised renal cell carcinoma (RCC). Methods A subset of clinical investigators in the SORCE trial completed a validated questionnaire that elicited the minimum survival benefits they judged sufficient to warrant one year of adjuvant sorafenib in scenarios with hypothetical baseline survival times of 5 years and 15 years, and baseline survival rates at 5 years of 65% and 85%. Results The 100 participating SORCE investigators had a median age of 42 years, and 74 were male. For one year of sorafenib versus no therapy, the median benefits in survival times the investigators judged sufficient to warrant treatment were an extra nine months beyond five years and an extra 12 months beyond 15 years; the median benefits in survival rates were an extra 5% beyond baseline survival rates of both 65% and 85% at five years. The patients recruited in the SORCE trial by these investigators judged smaller benefits sufficient to warrant adjuvant sorafenib for both survival rate scenarios (p≤0.0001). The survival benefits the investigators judged sufficient to warrant one year of adjuvant therapy with sorafenib for RCC were similar to those of other clinicians considering three months of adjuvant chemotherapy for lung cancer, but smaller than those of clinicians considering six months of adjuvant chemotherapy for breast cancer. Conclusion SORCE investigators judged larger benefits necessary to warrant adjuvant sorafenib than their patients. The benefits required by the investigators were similar or smaller than those other clinicians considered sufficient to warrant adjuvant chemotherapy for other cancers. Clinicians should recognise that their patients and colleagues may have preferences that differ from their own when considering the potential benefits and harms of adjuvant treatment.
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Affiliation(s)
- Nicola J Lawrence
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Simon Troon
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Shomik Sengupta
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Hovey
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Nelune Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Xanthi Coskinas
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Richard Kaplan
- MRC Clinical Trials Unit, University College London, London, UK
| | - Benjamin Smith
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Angela Meade
- MRC Clinical Trials Unit, University College London, London, UK
| | - Tim Eisen
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Prunella Blinman
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
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37
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Kim W, Parikh M, Ryan C, Lara P. Reconciling the Role of Vascular Endothelial Growth Factor-Targeted Therapies in Adjuvant Renal Cell Carcinoma Treatment. KIDNEY CANCER 2018. [DOI: 10.3233/kca-180034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Won Kim
- University of California, San Francisco, San Francisco, CA, USA
| | - Mamta Parikh
- University of California, Davis, Sacramento, CA, USA
| | | | - Primo Lara
- University of California, Davis, Sacramento, CA, USA
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38
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Cochin V, Gross-Goupil M, Ravaud A. Quelle place pour les traitements médicaux avant et après chirurgie es stades localisés ? ONCOLOGIE 2018. [DOI: 10.3166/onco-2019-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La place des traitements médicaux adjuvants dans les stades localisés du cancer du rein reste en France du domaine de la recherche clinique en 2017. Seul l’essai S-TRAC évaluant un an de sunitinib versus placebo a montré une augmentation significative de la survie sans maladie de 5,6 à 6,8 ans (HR = 0,76 ; p = 0,03) contrairement aux deux essais publiés de phase III, ASSURE (sunitinib ou sorafénib versus placebo un an) et PROTECT (pazopanib versus placebo un an). De nombreux essais d’immunothérapie avec les inhibiteurs des points de contrôle de la réponse immunitaire sont en cours. Les inhibiteurs de tyrosine-kinase ont démontré une efficacité en néoadjuvant en termes de réponse tumorale (de 18 à 28 %) sans toxicité surajoutée lors de la chirurgie et permettant le plus souvent une épargne néphronique. Néanmoins, cette stratégie versus une néphrectomie partielle d’emblée dans une équipe entraînée n’a pas été démontrée.
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39
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Adjuvant Therapies in Nonmetastatic Renal-Cell Carcinoma: A Review of the Literature. Clin Genitourin Cancer 2018; 16:176-183. [DOI: 10.1016/j.clgc.2018.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023]
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40
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Meissner MA, McCormick BZ, Karam JA, Wood CG. Adjuvant therapy for advanced renal cell carcinoma. Expert Rev Anticancer Ther 2018; 18:663-671. [PMID: 29707987 DOI: 10.1080/14737140.2018.1469980] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Locally advanced, non-metastatic renal cell carcinoma (RCC) is conventionally managed with surgery. However, patients are at a high risk of RCC recurrence and have poor survival outcomes. An effective adjuvant systemic treatment is needed to improve on these outcomes. Targeted molecular and immune-based therapies have been investigated, or are under investigation, but their role in this setting remains unclear. Areas covered: A comprehensive search of PubMed and ClinicalTrials.gov was performed for relevant literature. The following topics pertinent to adjuvant therapy in RCC were evaluated: strategies for patient selection, cytokine-based immunotherapy, vaccine therapy, VEGF and non-VEGF targeted molecular agents, and immune checkpoint inhibitors. Expert commentary: Strong evidence for the incorporation of adjuvant therapy in high-risk RCC is lacking. Multiple targeted molecular therapies have been examined with only one approved for use. Genetic and molecular-based prognostic models are needed to determine who may benefit from adjuvant therapy. Developing adjuvant therapy strategies in the future depends on the results of important ongoing trials with immunotherapy and targeted agents.
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Affiliation(s)
- Matthew A Meissner
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA
| | - Barrett Z McCormick
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA
| | - Jose A Karam
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA
| | - Christopher G Wood
- a Department of Urology , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA
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41
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Vaishampayan U. Landmark Trials in Renal Cancer. KIDNEY CANCER 2018. [DOI: 10.3233/kca-170026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Bhindi B, Wallis CJD, Boorjian SA, Thompson RH, Farrell A, Kim SP, Karam JA, Capitanio U, Golijanin D, Leibovich BC, Gershman B. The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta-analysis. BJU Int 2018; 121:684-698. [PMID: 29319926 DOI: 10.1111/bju.14127] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Our objective was to evaluate the role of retroperitoneal lymph node dissection (LND) in non-metastatic (M0) and metastatic (M1) renal cell carcinoma (RCC). We searched Medline, EMBASE, Web of Science and Scopus from database inception to 29 August 2017 for studies of patients who underwent partial or radical nephrectomy for M0 or M1 RCC. Two investigators independently selected studies for inclusion. Risk of bias was assessed using the Newcastle-Ottawa scale, Cochrane Collaboration tool and National Heart, Lung and Blood Institute Quality Assessment Tool. Random effects meta-analysis was performed for all-cause-mortality. The GRADE approach was used to characterize quality of evidence. A total of 51 unique studies were included in the qualitative systematic review. Risk of bias was low in 41/51 (80%) studies. LND was not associated with all-cause mortality in either M0 (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.92-1.12; I2 = 0%; four studies), M1 (HR 1.04, 95% CI 0.83-1.29; I2 = 0%; two studies), or pooled M0 and M1 settings (HR 1.00, 95% CI 0.92-1.09; I2 = 0%; seven studies), with no statistically significant differences according to M stage subgroups (P = 0.50). In the three studies that examined M0 subgroups with a high risk of nodal metastasis, LND was not associated with improved oncological outcomes. Studies on the association of extent of LND with survival reported inconsistent results. Meanwhile, a small proportion of patients with pN1M0 disease demonstrate durable long-term oncological control after surgery, with 10-year cancer-specific survival of 21-31%. Nodal involvement is independently associated with adverse prognosis in both M0 and M1 settings. GRADE quality of evidence was moderate or low for the outcomes examined. Although LND yields independent prognostic information, the existing literature does not support a therapeutic benefit to LND in either M0 or M1 RCC. High-risk M0 patient groups warrant further study, as a subset of patients with isolated nodal metastases experience long-term survival after surgical resection.
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Affiliation(s)
- Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Ann Farrell
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Simon P Kim
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jose A Karam
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Umberto Capitanio
- Unit of Urology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Dragan Golijanin
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Boris Gershman
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.,Warren Alpert Medical School of Brown University, Providence, RI, USA
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43
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Blinman PL, Davis ID, Martin A, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Ritchie A, Meade A, Eisen T, Stockler MR. Patients' preferences for adjuvant sorafenib after resection of renal cell carcinoma in the SORCE trial: what makes it worthwhile? Ann Oncol 2018; 29:370-376. [PMID: 29177440 DOI: 10.1093/annonc/mdx715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We sought to determine the survival benefits that patients judged sufficient to warrant adjuvant therapy with sorafenib for 1 year, or for 3 years after resection of renal cell carcinoma in the SORCE trial. Methods SORCE participants from all sites in Australia and New Zealand, and selected sites in the UK, completed a validated preferences questionnaire at months 0, 3, 15, and 42 to elicit the minimum survival benefits they judged sufficient to warrant adjuvant sorafenib for 1 year (versus observation), or for 3 years (versus 1 year). The questionnaires used reference survival times of 5 and 15 years; and reference survival rates at 5 years of 65% and 85%. Results The 233 participants had a median age of 57 years (range 29-78) and 71% were male. For 1 year of sorafenib versus no adjuvant therapy, the median benefits in survival times judged sufficient to warrant treatment were an extra 9 months beyond 5 years and an extra 1 year beyond 15 years; the median benefit in survival rates were an extra 4% beyond 65% and an extra 3% beyond 85% at 5 years. For 3 years of sorafenib versus 1 year of sorafenib, the median benefit in survival time judged sufficient to warrant extended treatment was an extra 1 year beyond both 5 and 15 years. Participants randomly allocated to treatment with sorafenib judged larger benefits necessary than those allocated to placebo. Participants' preferences were not associated with their baseline characteristics or the interval from randomisation. Conclusion Most participants judged an extra year of survival necessary to warrant 1 year of adjuvant sorafenib worthwhile, and an additional year of survival to warrant extending the duration of sorafenib from 1 to 3 years. Patients' preferences are important in shared decision making. SORCE trial clinical trials number NCT00492258.
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Affiliation(s)
- P L Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia; ANZUP Cancer Trials Group, Camperdown, Australia.
| | - I D Davis
- ANZUP Cancer Trials Group, Camperdown, Australia; Eastern Health Clinical School, Monash University, Box Hill, Australia; Eastern Health, Box Hill, Australia
| | - A Martin
- ANZUP Cancer Trials Group, Camperdown, Australia; Eastern Health Clinical School, Monash University, Box Hill, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
| | - S Troon
- ANZUP Cancer Trials Group, Camperdown, Australia; Department of Medical Oncology, Royal Perth Hospital, Perth, Australia
| | - S Sengupta
- ANZUP Cancer Trials Group, Camperdown, Australia; Austin Health, Heidelberg, Australia
| | - E Hovey
- ANZUP Cancer Trials Group, Camperdown, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - X Coskinas
- ANZUP Cancer Trials Group, Camperdown, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, London, UK
| | - A Ritchie
- Gloucestershire Royal Hospital, Gloucester, UK
| | - A Meade
- MRC Clinical Trials Unit at UCL, London, UK
| | - T Eisen
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M R Stockler
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia; ANZUP Cancer Trials Group, Camperdown, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
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44
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Overview of Current and Future Adjuvant Therapy for High-Risk Localized Renal Cell Carcinoma. Curr Treat Options Oncol 2018; 19:2. [DOI: 10.1007/s11864-018-0522-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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45
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Harshman LC, Xie W, Moreira RB, Bossé D, Ruiz Ares GJ, Sweeney CJ, Choueiri TK. Evaluation of disease-free survival as an intermediate metric of overall survival in patients with localized renal cell carcinoma: A trial-level meta-analysis. Cancer 2017; 124:925-933. [PMID: 29266178 DOI: 10.1002/cncr.31154] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Overall survival (OS) is a critical endpoint in adjuvant trials but requires long durations to events and significant patient resources. In the current study, the authors assessed whether disease-free survival (DFS) can be an early clinical surrogate for OS in the adjuvant setting for localized renal cell carcinoma (RCC). METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors performed a systematic literature review of PubMed and the American Society of Clinical Oncology, European Society for Medical Oncology, and ClinicalTrial.gov Web sites (1996-2016). Inclusion in the current study required randomized controlled trials (RCTs) of adjuvant systemic therapy for localized RCC after nephrectomy with ≥3 years of outcomes data. Data regarding hazard ratios (HRs) and 5-year event-free rates from Kaplan-Meier estimates were extracted. A trial-level meta-analysis correlated estimates of 5-year DFS and 5-year OS as well as treatment effects (HRs) on these endpoints, weighted by the number of DFS events. R-squared ≥ 0.7 was prespecified as being indicative of a strong correlation and the potential for surrogacy. RESULTS Thirteen RCTs encompassing 6473 patients who were treated with a variety of systemic therapies met eligibility. Only a modest correlation was observed between 5-year DFS and 5-year OS rates (R-squared, 0.48; 95% confidence interval, 0.14-0.67) and between treatment effects as measured by DFS and OS HRs (R-squared, 0.44; 95% confidence interval, 0.00-0.69). CONCLUSIONS Across RCTs of adjuvant systemic therapy for localized RCC, there was no strong correlation noted between 5-year DFS and 5-year OS rates or between treatment effects on these endpoints. These results highlight the need to identify alternative and more rapid clinical or biologic endpoints to hasten drug development and improve clinical outcomes. Cancer 2018;124:925-33. © 2017 American Cancer Society.
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Affiliation(s)
- Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Wanling Xie
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Raphael B Moreira
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Oncoclinic Group, Alemao Oswaldo Cruz Hospital, Sao Paulo, Brazil
| | - Dominick Bossé
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Gustavo J Ruiz Ares
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Clinical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Christopher J Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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46
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Barata PC, Rini BI. Treatment of renal cell carcinoma: Current status and future directions. CA Cancer J Clin 2017; 67:507-524. [PMID: 28961310 DOI: 10.3322/caac.21411] [Citation(s) in RCA: 507] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE Over the past 12 years, medical treatment for renal cell carcinoma (RCC) has transitioned from a nonspecific immune approach (in the cytokine era), to targeted therapy against vascular endothelial growth factor (VEGF), and now to novel immunotherapy agents. Multiple agents-including molecules against vascular endothelial growth factor, platelet-derived growth factor, and related receptors; inhibitors of other targets, such as the mammalian target of rapamycin and the MET and AXL tyrosine-protein kinase receptors; and an immune-checkpoint inhibitor-have been approved based on significant activity in patients with advanced RCC. Despite these advances, important questions remain regarding biomarkers of efficacy, patient selection, and the optimal combination and sequencing of agents. The purpose of this review is to summarize present management and future directions in the treatment of metastatic RCC. CA Cancer J Clin 2017;67:507-524. © 2017 American Cancer Society.
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Affiliation(s)
- Pedro C Barata
- Experimental Therapeutics Fellow, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine; and Leader, Genitourinary Program, Glickman Urological and Kidney Institute, Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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47
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Bai Y, Li S, Jia Z, Ding Y, Gu C, Yang J. Adjuvant therapy for locally advanced renal cell carcinoma: A meta-analysis and systematic review. Urol Oncol 2017; 36:79.e1-79.e10. [PMID: 29110942 DOI: 10.1016/j.urolonc.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Many adjuvant therapies have been widely used in an attempt to reduce the local recurrence or distant metastasis of locally advanced renal cell carcinoma (RCC) after surgical resection. However, the benefits of adjuvant therapy remain controversial. Thus, we performed this study to analyze the role and safety of adjuvant therapy in renal cancer setting. METHODS AND METHODS We comprehensively searched PubMed, EMBASE, Web of Science, and the Cochrane Library for published randomized controlled trials comparing adjuvant therapy (chemotherapy, vaccine therapy, immune therapy, and targeted therapy) versus no active treatment after surgery among patients with locoregional RCC. Outcomes of interest were disease-free survival, overall survival, and severe toxicities. Different kinds of adjuvant therapy were evaluated separately. RESULTS Twelve studies (5,936 patients) were included in the present analysis. Adjuvant therapy did not contribute to overall survival (HR = 1.04; 95% CI: 0.95-1.15; P = 0.395; I2 = 0%) or disease-free survival (HR = 1.00; 95% CI: 0.92-1.08; P = 0.971; I2 = 35%) when compared to placebo or observation. No survival benefit was observed according to subgroup analyses (targeted therapy, vaccine therapy, and immune therapy). Moreover, adjuvant therapy increased obviously the risk of toxicities. CONCLUSIONS The addition of adjuvant therapy provided no survival benefit but increased the rates of adverse events for locally advanced RCC patients.
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Affiliation(s)
- Yangyang Bai
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China
| | - Songchao Li
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China
| | - Zhankui Jia
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China
| | - Yinghui Ding
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China
| | - Chaohui Gu
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China
| | - Jinjian Yang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China; Urology Laboratory, the First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan, Erqi District, Zhengzhou City, Henan province, China; Tumor Molecular Biology Key Laboratory of Zhengzhou, the First Affiliated Hospital of Zhengzhou University, Erqi District, Zhengzhou City, Henan province, China.
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48
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Identification of antigenic peptides from novel renal cancer stem-like cell antigen, DNAJB8. Biochem Biophys Res Commun 2017; 494:693-699. [PMID: 29107688 DOI: 10.1016/j.bbrc.2017.10.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To identify antigenic peptides of cancer stem-like cells (CSCs) antigen, DNAJB8, and establish a mouse CSCs-targeting immunotherapy model. MATERIALS AND METHODS To induce DNAJB8-specific immune reaction, we stimulated human CD8+ lymphocytes with antigen-presenting cells pulsed with a cocktail of three candidate HLA-A*24:02 restricted peptides and assessed peptide specific human cytotoxic T lymphocytes (CTLs) induction. One of the antigenic peptides showed identical amino acid sequence as corresponding mouse DNAJB8. We evaluated CTL induction with the peptide immunization in mouse model. RESULTS We confirmed peptide-specific interferon-γ secretions and cytotoxic activities of induced human CTLs. In vivo immunization with the peptide to mice, peptide-specific CTL response could be observed in mouse CD8+ T cells. Furthermore, immunization with the peptide showed significant anti-tumor effects compared with negative controls. CONCLUSION DNAJB8-derived peptide is a novel candidate for CSCs-targeting immunotherapy, and mouse models can be used to evaluate CSCs-targeting immunotherapy.
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49
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Subramanian P, Haas NB. Recent advances in localized RCC: A focus on VEGF and immuno-oncology therapies. Urol Oncol 2017; 36:23-30. [PMID: 29051029 DOI: 10.1016/j.urolonc.2017.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/26/2022]
Abstract
Recent advances in advanced renal cell cancer (RCC) research have produced new drugs and therapies for patients with metastatic disease leading to higher response rates, improvements in progression-free survival, and longer overall survival. These advances have yet to be realized in patients with early-stage kidney cancer, and to date, no drug has been approved for the adjuvant treatment of localized kidney cancer. The current standard of care for localized high-risk kidney cancers is resection of the primary tumor. Here, we review the results of recently completed adjuvant vascular endothelial growth factor receptor 2 (VEGFR2) tyrosine kinase inhibitor (TKI) trials in RCC that have been reported, or are awaiting results. Further, we discuss the new immune checkpoint inhibitor adjuvant trials planned. There is hope that these trials may lead to new options and longer survival for patients with localized high-risk kidney cancer.
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50
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Reaume MN, Basappa NS, Wood L, Kapoor A, Bjarnason GA, Blais N, Breau RH, Canil C, Cheung P, Conter HJ, Hotte SJ, Jeldres C, Jewett MAS, Karakiewicz PI, Kollmannsberger C, Patenaude F, So A, Soulières D, Venner P, Violette P, Zalewski P, Chappell H, North SA. Management of advanced kidney cancer: Canadian Kidney Cancer Forum (CKCF) consensus update 2017. Can Urol Assoc J 2017; 11:310-320. [PMID: 29382441 DOI: 10.5489/cuaj.4769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Neil Reaume
- Division of Medical Oncology, Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Lori Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada.,The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Normand Blais
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program and Division of Urology, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Claudio Jeldres
- Centre hospitalier de l'Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Pierre I Karakiewicz
- Service d'urologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and University of British Columbia, Vancouver, BC, Canada
| | - Francois Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Peter Venner
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Pawel Zalewski
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, ON, Canada
| | | | - Scott A North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
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