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Matsushita Y, Kojima T, Osawa T, Sazuka T, Hatakeyama S, Goto K, Numakura K, Yamana K, Kandori S, Fujita K, Ueda K, Tanaka H, Tomida R, Kurahashi T, Bando Y, Nishiyama N, Kimura T, Yamashita S, Kitamura H, Miyake H. Prognostic outcomes in patients with metastatic renal cell carcinoma receiving second-line treatment with tyrosine kinase inhibitor following first-line immune-oncology combination therapy. Int J Urol 2024; 31:526-533. [PMID: 38240169 DOI: 10.1111/iju.15396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy. METHODS This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO-IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO-TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients. RESULTS In the IO-IO and IO-TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively. CONCLUSIONS There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO-IO and IO-TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
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Affiliation(s)
- Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomokazu Sazuka
- Department of Urology, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Kazutoshi Yamana
- Department of Urology and Molecular Oncology, Niigata University Graduate school of medical and dental sciences, Niigata, Niigata, Japan
| | - Shuya Kandori
- Department of Urology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Toshifumi Kurahashi
- Department of Urology, Hyogo Prefectural Cancer Center, Akashi, Hyogo, Japan
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Wu HHL, Chinnadurai R, Walker RJ, Tennankore KK. Is It Time to Integrate Frailty Assessment in Onconephrology? Cancers (Basel) 2023; 15:cancers15061674. [PMID: 36980558 PMCID: PMC10046649 DOI: 10.3390/cancers15061674] [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: 02/16/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Simple Summary There are an increasing number of older people living with kidney cancer and/or cancer and kidney disease worldwide, sparking a wider discussion on the impact of frailty and the clinical significance of conducting frailty assessments for this patient population. We provide an update on the current evidence related to frailty assessment in onconephrology and identify areas where further research efforts are anticipated to address knowledge gaps within this topic. Abstract Onconephrology has emerged as a novel sub-specialty of nephrology dedicated to the intersection between the kidney and cancer. This intersection is broad and includes a number of important areas of focus, including concurrent chronic kidney disease (CKD) and cancer, acute kidney complications of cancer, and cancer-treatment-induced nephrotoxicity. The importance of onconephrology is even more evident when considering the global growth in the population of older adults, many of whom are living with some degree of frailty. Furthermore, a considerable proportion of older adults have CKD (some of whom eventually progress to kidney failure) and are at high risk of developing solid tumour and hematologic malignancies. Specific to kidney disease, the association between frailty status and kidney disease has been explored in depth, and tools to capture frailty can be used to guide the management and prognostication of older adults living with kidney failure. Whilst there is emerging data regarding the assessment and impact of frailty in onconephrology, there remains a relative paucity of knowledge within this topic. In this article, we evaluate the definition and operationalization of frailty and discuss the significance of frailty within onconephrology. We review evidence on current approaches to assessing frailty in onconephrology and discuss potential developments and future directions regarding the utilization of frailty in this patient population. A greater awareness of the intersections and interactions between frailty and onconephrology and further efforts to integrate frailty assessment in onconephrology to optimize the delivery of realistic and goal-directed management strategies for patients is needed.
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Affiliation(s)
- Henry H. L. Wu
- Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-9926-4751
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
| | - Robert J. Walker
- Department of Medicine, Dunedin Campus, University of Otago, Dunedin 9016, New Zealand
| | - Karthik K. Tennankore
- Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS B3H 4R2, Canada
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Sawhney P, Suyanto S, Michael A, Pandha H. First-line therapy for metastatic renal cell carcinoma. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221092949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To evaluate current first-line treatment strategies in advanced or metastatic renal cell carcinoma (RCC), and to review other promising treatments under investigations. Materials and methods: We reviewed all relevant pivotal first-line systemic therapy trials, and studies investigating the role of cytoreductive nephrectomy, metastectomy, and ablative radiotherapy in advanced or metastatic RCC. Results: In total we identified 21 relevant studies, investigating both systemic and non-systemic therapies, including treatments under investigations. Conclusion: Metastatic RCC (mRCC) is a highly heterogeneous disease that is notoriously difficult to treat, however, the discovery of novel targeted therapies over the past decade have revolutionised its management. The International mRCC Database Consortium (IMDC) is a prognostic model that is commonly used in both clinical trials and routine clinical care to risk-stratify patients with mRCC, which has helped with therapy selection for mRCC patients over the past decade. However, with an improved understanding of tumour biology and genetics, this has prompted a shift from cytokine therapy to receptor tyrosine kinase inhibitors, and now to Immune Checkpoint Inhibitors (ICIs). Recent promising results from clinical studies with ICI combination treatments have transformed the treatment landscape for the management of intermediate- and poor- risk clear cell RCC, however, further research is still needed for favourable-risk, and non-clear cell patients. Level of evidence: Not applicable
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Affiliation(s)
| | | | | | - Hardev Pandha
- St Luke’s Cancer Centre, Royal Surrey County Hospital, UK
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Courcier J, De La Taille A, Lassau N, Ingels A. Comorbidity and frailty assessment in renal cell carcinoma patients. World J Urol 2021; 39:2831-2841. [PMID: 33616708 DOI: 10.1007/s00345-021-03632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. METHODS Narrative, non-systematic review based on PubMed and EMBASE search with the terms "renal neoplasm", "elderly, frail", "comorbidities", "active surveillance", "metastatic". The selection was restricted to articles written in English. RESULTS Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson's scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients' risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. CONCLUSIONS Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
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Affiliation(s)
- Jean Courcier
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Alexandre De La Taille
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nathalie Lassau
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
- Department of Imaging, Institut Gustave Roussy, Villejuif, France
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
- Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France.
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Brown JT, Liu Y, Shabto JM, Martini D, Ravindranathan D, Hitron EE, Russler GA, Caulfield S, Yantorni L, Joshi SS, Kissick H, Ogan K, Nazha B, Carthon BC, Kucuk O, Harris WB, Master VA, Bilen MA. Modified Glasgow Prognostic Score associated with survival in metastatic renal cell carcinoma treated with immune checkpoint inhibitors. J Immunother Cancer 2021; 9:jitc-2021-002851. [PMID: 34326170 PMCID: PMC8323383 DOI: 10.1136/jitc-2021-002851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The modified Glasgow Prognostic Score (mGPS) is a composite biomarker that uses albumin and C reactive protein (CRP). There are multiple immune checkpoint inhibitor (ICI)-based combinations approved for metastatic renal cell carcinoma (mRCC). We investigated the ability of mGPS to predict outcomes in patients with mRCC receiving ICI. METHODS We retrospectively reviewed patients with mRCC treated with ICI as monotherapy or in combination at Winship Cancer Institute between 2015 and 2020. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of ICI until death or clinical/radiographical progression, respectively. The baseline mGPS was defined as a summary score based on pre-ICI values with one point given for CRP>10 mg/L and/or albumin<3.5 g/dL, resulting in possible scores of 0, 1 and 2. If only albumin was low with a normal CRP, no points were awarded. Univariate analysis (UVA) and multivariate analysis (MVA) were carried out using Cox proportional hazard model. Outcomes were also assessed by Kaplan-Meier analysis. RESULTS 156 patients were included with a median follow-up 24.2 months. The median age was 64 years and 78% had clear cell histology. Baseline mGPS was 0 in 36%, 1 in 40% and 2 in 24% of patients. In UVA, a baseline mGPS of 2 was associated with shorter OS (HR 4.29, 95% CI 2.24 to 8.24, p<0.001) and PFS (HR 1.90, 95% CI 1.20 to 3.01, p=0.006) relative to a score of 0; this disparity in outcome based on baseline mGPS persisted in MVA. The respective median OS of patients with baseline mGPS of 0, 1 and 2 was 44.5 (95% CI 27.3 to not evaluable), 15.3 (95% CI 11.0 to 24.2) and 10 (95% CI 4.6 to 17.5) months (p<0.0001). The median PFS of these three cohorts was 6.7 (95% CI 3.6 to 13.1), 4.2 (95% CI 2.9 to 6.2) and 2.6 (95% CI 2.0 to 5.6), respectively (p=0.0216). The discrimination power of baseline mGPS to predict survival outcomes was comparable to the IMDC risk score based on Uno's c-statistic (OS: 0.6312 vs 0.6102, PFS: 0.5752 vs 0.5533). CONCLUSION The mGPS is prognostic in this cohort of patients with mRCC treated with ICI as monotherapy or in combination. These results warrant external and prospective validation.
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Affiliation(s)
- Jacqueline T Brown
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Julie M Shabto
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dylan Martini
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deepak Ravindranathan
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emilie Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Greta Anne Russler
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Pharmaceutical Services, Emory University, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shreyas Subhash Joshi
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Haydn Kissick
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Ogan
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley C Carthon
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wayne B Harris
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA .,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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Graham J, Dudani S, Heng DYC. Prognostication in Kidney Cancer: Recent Advances and Future Directions. J Clin Oncol 2018; 36:JCO2018790147. [PMID: 30372388 DOI: 10.1200/jco.2018.79.0147] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The most common type of cancer originating in the kidney is renal cell carcinoma (RCC). In both localized and advanced RCC, a number of clinical, pathologic, and molecular factors have been identified as having prognostic significance. In localized disease, risk stratification has traditionally involved the anatomic extent of disease, and several integrated scoring systems have been developed to help predict outcomes after definitive local therapy. In metastatic RCC, integrated prognostic models have also been established. These are used to stratify patients in contemporary clinical trials and to guide risk-directed treatment selection in clinical practice. Although many prognostic factors are common to both localized and advanced disease, there are some important distinctions. In both of these types of disease, the prognostic role of specific molecular and genomic alterations is an area of active investigation. In this review, we highlight the current staging systems and prognostic factors in localized and metastatic RCC. We also explore future directions in this area, including the expanding role of molecular biomarkers and their integration into the traditional prognostic models.
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Affiliation(s)
- Jeffrey Graham
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
| | - Shaan Dudani
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Y C Heng
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Real-world evidence has played an important role in expanding our knowledge on the treatment and prognostication of advanced renal cell carcinoma. This type of data has been particularly helpful in providing a better understanding of groups that are traditionally excluded from randomized controlled trials. The International mRCC Database Consortium (IMDC) represents the largest collection of real-world data on patients with advanced kidney cancer treated with targeted therapies. The IMDC prognostic model has been used to stratify patients in contemporary clinical trials and to provide risk-directed treatment selection in everyday clinical practice. More recently, it has been shown to predict response to first-line combination immunotherapy in the phase III CheckMate 214 clinical trial. In this review, we highlight the real-world evidence associated with the treatment of mRCC. We focus on first-line therapy, as well as second-line and third-line therapeutic options, including novel immuno-oncology agents. We also address the real-world evidence for the use of cytoreductive nephrectomy in advanced renal cell carcinoma in the targeted therapy era.
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Affiliation(s)
- Jeffrey Graham
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Yc Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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