1
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Hamdan F, Cerullo V. Cancer immunotherapies: A hope for the uncurable? FRONTIERS IN MOLECULAR MEDICINE 2023; 3:1140977. [PMID: 39086690 PMCID: PMC11285639 DOI: 10.3389/fmmed.2023.1140977] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 08/02/2024]
Abstract
The use of cancer immunotherapies is not novel but has been used over the decades in the clinic. Only recently have we found the true potential of stimulating an anti-tumor response after the breakthrough of checkpoint inhibitors. Cancer immunotherapies have become the first line treatment for many malignancies at various stages. Nevertheless, the clinical results in terms of overall survival and progression free survival were not as anticipated. Majority of cancer patients do not respond to immunotherapies and the reasons differ. Hence, further improvements for cancer immunotherapies are crucially needed. In the review, we will discuss various forms of cancer immunotherapies that are being tested or already in the clinic. Moreover, we also highlight future directions to improve such therapies.
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Affiliation(s)
- Firas Hamdan
- Laboratory of Immunovirotherapy, Drug Research Program, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Vincenzo Cerullo
- Laboratory of Immunovirotherapy, Drug Research Program, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- TRIMM, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Drug Delivery, Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- iCAN Digital Precision Cancer Medicine Flagship, University of Helsinki, Helsinki, Finland
- Department of Molecular Medicine and Medical Biotechnology and CEINGE, Naples University Federico II, Naples, Italy
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2
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Jahangir M, Yazdani O, Kahrizi MS, Soltanzadeh S, Javididashtbayaz H, Mivefroshan A, Ilkhani S, Esbati R. Clinical potential of PD-1/PD-L1 blockade therapy for renal cell carcinoma (RCC): a rapidly evolving strategy. Cancer Cell Int 2022; 22:401. [PMID: 36510217 PMCID: PMC9743549 DOI: 10.1186/s12935-022-02816-3] [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: 07/10/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade therapy has become a game-changing therapeutic approach revolutionizing the treatment setting of human malignancies, such as renal cell carcinoma (RCC). Despite the remarkable clinical activity of anti-PD-1 or anti-PD-L1 monoclonal antibodies, only a small portion of patients exhibit a positive response to PD-1/PD-L1 blockade therapy, and the primary or acquired resistance might ultimately favor cancer development in patients with clinical responses. In light of this, recent reports have signified that the addition of other therapeutic modalities to PD-1/PD-L1 blockade therapy might improve clinical responses in advanced RCC patients. Until, combination therapy with PD-1/PD-L1 blockade therapy plus cytotoxic T lymphocyte antigen 4 (CTLA-4) inhibitor (ipilimumab) or various vascular endothelial growth factor receptors (VEGFRs) inhibitors axitinib, such as axitinib and cabozantinib, has been approved by the United States Food and Drug Administration (FDA) as first-line treatment for metastatic RCC. In the present review, we have focused on the therapeutic benefits of the PD-1/PD-L1 blockade therapy as a single agent or in combination with other conventional or innovative targeted therapies in RCC patients. We also offer a glimpse into the well-determined prognostic factor associated with the clinical response of RCC patients to PD-1/PD-L1 blockade therapy.
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Affiliation(s)
- Mohammadsaleh Jahangir
- grid.411746.10000 0004 4911 7066Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Yazdani
- grid.411600.2School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Saeed Kahrizi
- grid.411705.60000 0001 0166 0922Department of Surgery, Alborz University of Medical Sciences, Karaj, Alborz Iran
| | - Sara Soltanzadeh
- grid.411705.60000 0001 0166 0922Department of Radiation Oncology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Javididashtbayaz
- grid.411768.d0000 0004 1756 1744Baran Oncology Clinic, Medical Faculty, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Azam Mivefroshan
- grid.412763.50000 0004 0442 8645Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran
| | - Saba Ilkhani
- grid.411600.2Department of Surgery and Vascular Surgery, Shohada-ye-Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Romina Esbati
- grid.411600.2School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Yamana K, Ohashi R, Tomita Y. Contemporary Drug Therapy for Renal Cell Carcinoma- Evidence Accumulation and Histological Implications in Treatment Strategy. Biomedicines 2022; 10:2840. [PMID: 36359359 PMCID: PMC9687261 DOI: 10.3390/biomedicines10112840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 09/19/2023] Open
Abstract
Renal cell carcinoma (RCC) is a heterogeneous disease comprising a variety of histological subtypes. Approximately 70-80% of RCC cases are clear cell carcinoma (ccRCC), while the remaining subtypes constitute non-clear cell carcinoma (nccRCC). The medical treatment of RCC has greatly changed in recent years through advances in molecularly targeted therapies and immunotherapies. Most of the novel systemic therapies currently available have been approved based on ccRCC clinical trial data. nccRCC can be subdivided into more than 40 histological subtypes that have distinct clinical, histomorphological, immunohistochemical, and molecular features. These entities are listed as emerging in the 2022 World Health Organization classification. The diagnosis of nccRCC and treatments based on cancer histology and biology remain challenging due to the disease's rarity. We reviewed clinical trials focused on recent discoveries regarding clinicopathological features.
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Affiliation(s)
- Kazutoshi Yamana
- Department of Urology and Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan
| | - Riuko Ohashi
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan
| | - Yoshihiko Tomita
- Department of Urology and Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata 951-8510, Japan
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4
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Patient-Specific Mathematical Model of the Clear Cell Renal Cell Carcinoma Microenvironment. J Pers Med 2022; 12:jpm12101681. [PMID: 36294824 PMCID: PMC9605269 DOI: 10.3390/jpm12101681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/04/2022] Open
Abstract
The interactions between cells and molecules in the tumor microenvironment can give insight into the initiation and progression of tumors and their optimal treatment options. In this paper, we developed an ordinary differential equation (ODE) mathematical model of the interaction network of key players in the clear cell renal cell carcinoma (ccRCC) microenvironment. We then performed a global gradient-based sensitivity analysis to investigate the effects of the most sensitive parameters of the model on the number of cancer cells. The results indicate that parameters related to IL-6 have high a impact on cancer cell growth, such that decreasing the level of IL-6 can remarkably slow the tumor's growth.
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5
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Cardenas LM, Deluce JE, Khan S, Gulam O, Maleki Vareki S, Fernandes R, Lalani AKA. Next Wave of Targets in the Treatment of Advanced Renal Cell Carcinoma. Curr Oncol 2022; 29:5426-5441. [PMID: 36005167 PMCID: PMC9406353 DOI: 10.3390/curroncol29080429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
While surgical resection has remained the mainstay of treatment in early-stage renal cell carcinoma (RCC), therapeutic options in the advanced setting have remarkably expanded over the last 20 years. Tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor (VEGF-TKIs) and anti-programmed cell death 1 (PD-1)/anti-programmed death-ligand 1 (PD-L1)-based immune checkpoint inhibitors (ICIs) have become globally accepted options in the upfront metastatic setting, with different ICI-based combination strategies improving overall survival compared to single-agent Sunitinib. Although some patients benefit from long-term responses, most eventually develop disease progression. Ongoing efforts to better understand the biology of RCC and the different mechanisms of acquired resistance have led to the identification of promising therapeutic targets. Belzutifan, a novel agent targeting the angiogenic pathway involving hypoxia-inducible factors (HIFs), has already been approved for the treatment of early-stage tumors associated with VHL disease and represents a very promising therapy in advanced RCC. Other putative targets include epigenetic regulation enzymes, as well as several metabolites such as adenosine, glutaminase and tryptophan, which are critical players in cancer cell metabolism and in the tumor microenvironment. Different methods of immune regulation are also being investigated, including CAR-T cell therapy and modulation of the gut microbiome, in addition to novel agents targeting the interleukin-2 (IL-2) pathway. This review aims to highlight the emergent novel therapies for RCC and their respective completed and ongoing clinical trials.
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Affiliation(s)
- Luisa M. Cardenas
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Jasna E. Deluce
- London Regional Cancer Program, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada; (J.E.D.); (S.M.V.) (R.F.)
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada
| | - Shahrukh Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (O.G.)
| | - Omar Gulam
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (O.G.)
| | - Saman Maleki Vareki
- London Regional Cancer Program, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada; (J.E.D.); (S.M.V.) (R.F.)
- Division of Experimental Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5W9, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Ricardo Fernandes
- London Regional Cancer Program, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada; (J.E.D.); (S.M.V.) (R.F.)
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada
| | - Aly-Khan A. Lalani
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
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Shaker MA, Doré JJE, Younes HM. Controlled release of bioactive IL-2 from visible light photocured biodegradable elastomers for cancer immunotherapy applications. Pharm Dev Technol 2021; 27:40-51. [PMID: 34927547 DOI: 10.1080/10837450.2021.2019764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Biodegradable elastomeric controlled-release poly (decane-co-tricarballylate) (PDET) based matrices capable of maintaining the stability and bioactivity of Interleukin-2 (IL-2) through the utilization of visible-light curing and solvent-free loading of the cytokine are reported. The elastomeric devices were fabricated by intimately mixing lyophilized IL-2 powder with the acrylated prepolymer before photocrosslinking. The bioactivity of the released protein was assessed by its ability to stimulate the proliferation of the C57BL/6 mouse cytotoxic T lymphocyte, and its concentration was analysed using ELISA. The influence of changes in the polymer's physicochemical and mechanical properties on IL-2 release kinetics and bioactivity were also studied. The increase in the device's surface area and the incorporation of trehalose in the loaded lyophilized mix increased the IL-2 release rate with drug release proceeding via typical zero-order release kinetics. Moreover, the decrease in the degree of acrylation of the prepared devices increased the IL-2 release rate. The bioactivity assay showed that IL-2 retained over 94% of its initial bioactivity throughout 28 days of the release period. A new protein delivery vehicle composed of biodegradable PDET elastomers was demonstrated to be promising and effective for linear, constant, and sustained osmotic-driven release of bioactive IL-2 and other sensitive proteins and hormones.
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Affiliation(s)
- Mohamed A Shaker
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.,Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Jules J E Doré
- Biomedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Husam M Younes
- Tissue Engineering and Nanopharmaceuticals Research Laboratory, Office of Vice President for Research & Graduate Studies, Qatar University, Doha, Qatar
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Candelario N, Geiger C, Flaig T. Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is an aggressive form of kidney cancer that is associated with poor prognosis. It can arise from any histologic type of renal cell carcinoma. The majority of cases will present with advanced or metastatic disease requiring systemic therapy. Nephrectomy is the treatment of choice in locally resectable disease. The therapeutic options for sRCC have evolved in the past decade. Cytotoxic chemotherapy and monotherapy with targeted therapy (VEGF and mTOR) have historically shown poor response rates and survival in the treatment of metastatic sRCC. The use of checkpoint inhibitors and their combination with targeted therapy against VEGF has changed the landscape and outcomes for renal cell carcinoma. Given the rarity of sRCC most of the data on treatment is from small cohorts or extrapolation from larger clinical trials. The benefit from the combination of checkpoint inhibitors and targeted therapy to VEGF has shown promise in the sRCC population in post hoc analysis of large clinical trials. Future research focusing on further characterizing the unique biologic and clinical features of sRCC is critical in advancing the knowledge and developing effective therapy to improve clinical outcomes and survival.
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Affiliation(s)
- Nellowe Candelario
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher Geiger
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Flaig
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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8
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Brown JT, Bilen MA. Immunotherapy in sarcomatoid renal cell carcinoma: A case for optimism. Cancer Treat Res Commun 2020; 25:100257. [PMID: 33307510 DOI: 10.1016/j.ctarc.2020.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jacqueline T Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States; Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States; Winship Cancer Institute of Emory University, Atlanta, GA, United States.
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9
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Park JJ, Kellezi O, Hamasha R, Ali A, Alva AS. Immunotherapy in metastatic sarcomatoid renal cell carcinoma: A single institution experience. Cancer Treat Res Commun 2020; 25:100251. [PMID: 33310369 DOI: 10.1016/j.ctarc.2020.100251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (CPIs) were recently approved in advanced clear cell renal cell carcinoma (RCC) and could be a promising option for metastatic RCC with sarcomatoid differentiation (sRCC) which otherwise carry a poor prognosis. We sought to compare outcomes between patients who received immunotherapy (IO) including CPIs or high dose interleukin-2 (HD IL2) for metastatic sRCC versus those who did not. PATIENTS AND METHODS We performed a single-center retrospective data analysis of 44 consecutive sRCC patients with any percentage of sarcomatoid differentiation from our institutional RCC database of whom 34 received IO and 10 patients did not. RESULTS Baseline variables between the two groups were not significantly different except for a greater percentage of patients with ≥40% sarcomatoid differentiation in the non-IO cohort. At a median follow-up of 27.6 months, patients treated with IO had a median overall survival of 57.6 months compared to 6.6 months in patients not treated with IO (p = 0.0002). Overall response rates (ORR) between the IO and non-IO group were 35.3% and 0% respectively (p = 0.06). When IO was given in the 1st line setting, the ORR was 25.0%, as compared to 44.4% in the 2nd line setting and beyond though limitations of small sample sizes apply. Immune-related adverse events (IRAE) occurred in 38.2% of patients in the IO group, with grade 3 events (mostly gastrointestinal) in 20.6% with no grade 4 or 5 events. IRAEs led to interruption or discontinuation of immunotherapy in 26.5%. CONCLUSION Our results support IO as an effective therapeutic option for patients with metastatic sarcomatoid RCC. Further study of various IO regimens, including those affecting the interleukin-2 signaling pathway, and their efficacy in neoadjuvant and adjuvant settings are warranted in sRCC.
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Affiliation(s)
- Joseph J Park
- Department of Internal Medicine, University of Michigan, 7310 Rogel Comprehensive Cancer Center, Ann Arbor, MI, 48109, USA
| | - Olesia Kellezi
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Reema Hamasha
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Alicia Ali
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai S Alva
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
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Ray S, Jones R, Pritchard-Jones K, Dzhuma K, van den Heuvel-Eibrink M, Tytgat G, van der Beek J, Oades G, Murphy D. Pediatric and young adult renal cell carcinoma. Pediatr Blood Cancer 2020; 67:e28675. [PMID: 32869954 DOI: 10.1002/pbc.28675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
Renal cell carcinoma (RCC) is rare in children but is the most common renal tumor in adults. Pediatric RCC has different clinical characteristics, histopathology, and treatment compared with adult disease. Databases were reviewed from inception to February 2020, identifying 32 publications pertaining to 350 patients under 27 years. Surgery is the cornerstone for cure in localized RCC. Lymph node dissection remains controversial. Conventional radiotherapy has no curative role in RCC; similarly, conventional chemotherapy has not proven to be effective in large cohorts. Pediatric metastatic RCC has a poor outlook. There are no published prospective studies demonstrating which adjuvant therapy could improve outcome. Sunitinib, a tyrosine kinase inhibitor, is recommended in this group despite limited evidence. This review provides an overview for pediatric RCC, including the evolving role of precision medicine.
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Affiliation(s)
- Satyajit Ray
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, Scotland, UK
| | - Robert Jones
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | | | - Kristina Dzhuma
- University College London Institute of Child Health, London, UK
| | | | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Grenville Oades
- Department of Uro-Oncology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Dermot Murphy
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, Scotland, UK
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Blum KA, Gupta S, Tickoo SK, Chan TA, Russo P, Motzer RJ, Karam JA, Hakimi AA. Sarcomatoid renal cell carcinoma: biology, natural history and management. Nat Rev Urol 2020; 17:659-678. [PMID: 33051619 PMCID: PMC7551522 DOI: 10.1038/s41585-020-00382-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Sarcomatoid dedifferentiation is an uncommon feature that can occur in most histological subtypes of renal cell carcinomas (RCCs) and carries a decidedly poor prognosis. Historically, conventional treatments for sarcomatoid RCCs (sRCCs) have shown little efficacy, and median survival is commonly 6–13 months. Despite being first described in 1968, the mechanisms driving sarcomatoid dedifferentiation remain poorly understood, and information and treatment options available to physicians and patients are limited. When diagnosed at an early stage, surgical intervention remains the treatment of choice. However, preoperative identification through routine imaging or biopsy is unreliable and most patients present with advanced disease and systemic symptoms. For these patients, the role of cytoreductive nephrectomy is disputed. The expansion of immunotherapies approved for RCCs has generated a search for biomarkers that might be indicative of treatment response in sRCCs, although a proven effective systemic agent remains elusive. PDL1 expression is increased in sarcomatoid dedifferentiated renal tumours, which suggests that patients with sRCCs could benefit from PD1 and/or PDL1 immune checkpoint blockade therapy. Treatment outcomes for sarcomatoid tumours have remained relatively consistent compared with other RCCs, but further investigation of the tumour–immune cell microenvironment might yield insights into further therapeutic possibilities. In this Review, Blum et al. summarize the current knowledge on sarcomatoid renal cell carcinoma, a diagnosis characterized by the presence of sarcomatoid dedifferentiation and a poor prognosis. They discuss the origin, presentation, molecular biology and treatment of this disease. Sarcomatoid dedifferentiation is not considered to be a unique histological subtype of renal cell carcinomas (RCCs); rather, it can be present within any subtype of RCCs. Sarcomatoid dedifferentiation appears in ~4% of all RCCs, but is present in ~20% of all metastatic RCCs. According to WHO guidelines, any RCC with sarcomatoid dedifferentiation is a WHO–International Society of Urological Pathology grade 4 lesion. Sarcomatoid dedifferentiation is often heterogeneously present within RCCs, making routine imaging and biopsy unreliable for preoperative detection. Surgical resection for localized disease is the standard of care, with subsequent close monitoring of patients following surgery. In patients with metastatic disease, conventional therapies such as surgery and systemic agents have been ineffective and overall 5-year survival remains at 23.5–33%. Previous genomic analyses have failed to identify definitive mutational drivers of disease. However, sarcomatoid RCCs (sRCCs) have been shown to have higher PD1 and PDL1 expression than other subtypes of RCCs. Newer combinations of immune checkpoint inhibitor immunotherapies could yield improved responses and outcomes. Studies investigating sRCCs are limited by patient numbers owing to the low incidence of sRCCs and their advanced stage at presentation. Multi-institutional efforts to establish a consensus on treatment recommendations based on highly powered data are essential.
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Affiliation(s)
- Kyle A Blum
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sounak Gupta
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose A Karam
- Departments of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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12
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Kaur K, Khatik GL. Cancer Immunotherapy: An Effective Tool in Cancer Control and Treatment. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666190913184853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background::
Cancer immunotherapy is a type of cancer treatment which effectively
harnesses the natural ability of the immune system to fight against cancer cells. This approach
takes into consideration the fact that cancer cells express various types of antigens on their surface.
Such tumor antigens can be detected by the immune system. However, cancer cells normally
develop resistance to the defensive mechanisms presented by the immune system. Thus, cancer
immunotherapy has some challenges in its path but due to its impressive clinical effectiveness, it
is considered as the potential and effective mode of treatment for cancer.
Methods::
We searched the scientific database using cancer, immunotherapy, and tumor antigens
as the keywords. Herein, only peer-reviewed research articles were collected which were useful to
our current work.
Results::
Cells responsible for incurring natural immunity to the body are engineered in such a
way that they become able to efficiently recognize and bind to tumor antigens. Such type of immunotherapy
is referred to as active immunotherapy. Another type is passive immunotherapy,
which involves the process of modifying the existing natural immune responses against cancer
cells. A hybrid type of immunotherapy has also been developed which involves the combinative
use of both active and passive immunotherapy. Cancer immunotherapy has so far proven to be an
effective treatment for cancer as this therapy primarily aims at attacking cancer cells and not the
healthy body cells lying in close vicinity to them.
Conclusion::
In the review, we described the significance of immunotherapy in the management
of various types of cancer.
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Affiliation(s)
- Kawalpreet Kaur
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar- Delhi G.T. Road, Phagwara, Punjab (144411), India
| | - Gopal L. Khatik
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar- Delhi G.T. Road, Phagwara, Punjab (144411), India
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Alevizakos M, Gaitanidis A, Nasioudis D, Msaouel P, Appleman LJ. Sarcomatoid Renal Cell Carcinoma: Population-Based Study of 879 Patients. Clin Genitourin Cancer 2019; 17:e447-e453. [PMID: 30799129 DOI: 10.1016/j.clgc.2019.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sarcomatoid renal cell carcinoma (sRCC) constitutes a rare and aggressive subtype of renal cell carcinoma. We aimed to investigate its clinicopathologic characteristics and outcomes at a national level. PATIENTS AND METHODS We accessed the National Cancer Institute's Surveillance, Epidemiology, and End Results database (2010-2015) and extracted data on patients with sRCC. We estimated median, 1-, 3-, and 5-year disease-specific survival (DSS) probabilities after generation of Kaplan-Meier curves and used multivariable regression to evaluate variables associated with nephrectomy and DSS. RESULTS A total of 879 patients with sRCC were identified; 60.9% patients had stage IV disease at diagnosis, and the median tumor size was 8.3 cm (interquartile range, 5.5-12 cm). The 5-year DSS were 77.7%, 67.8%, 35.4%, and 3.5% for patients with stage I, II, III, and IV disease at diagnosis, respectively; median DSS was 9 months (interquartile range, 4-42 months) for the entire cohort. Older age (hazard ratio [HR] = 1.01; 95% confidence interval [CI], 1.00-1.02), higher tumor stage (stage III vs. I: HR = 3.81; 95% CI, 2.18-6.67; stage IV vs. I: HR = 9.89; 95% CI, 5.80-16.98), and performance of nephrectomy (HR = 0.53; 95% CI, 0.43-0.66) were found to independently affect DSS. CONCLUSION In the largest sRCC cohort to date, we found that most patients present with metastatic disease, and the prognosis for this disease remains extremely poor. Nephrectomy should be considered in all patients with acceptable surgical risk, including cytoreductive nephrectomy in carefully selected patients with metastatic disease.
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Affiliation(s)
- Michail Alevizakos
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Apostolos Gaitanidis
- Second Department of Surgery, University General Hospital of Alexandroupoli, Democritus University of Thrace Medical School, Alexandroupoli, Greece
| | - Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leonard J Appleman
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA
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14
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Sirohi D, Smith SC, Agarwal N, Maughan BL. Unclassified renal cell carcinoma: diagnostic difficulties and treatment modalities. Res Rep Urol 2018; 10:205-217. [PMID: 30510921 PMCID: PMC6248403 DOI: 10.2147/rru.s154932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Over the past few decades, the classification system of renal cell carcinoma (RCC) variants has witnessed tremendous and ongoing refinement driven by genomic profiling and morphological correlation that have provided valuable insights into tumor biology and characterization of this heterogeneous subset of tumors. The importance of accurate classification cannot be understated given the downstream impact on treatment decisions, risk stratification, and need for genetic testing. While the morphologic heterogeneity across these tumors is increasingly being recognized, all non-clear-cell RCCs are commonly categorized under one therapeutic category with management strategies that largely derive from clear-cell RCCs. As research in metastatic RCC progresses, there is a growing focus on rare subtypes and unclassified tumors, which is rapidly changing the treatment paradigm for non-clear-cell RCC. This review focuses on the histomorphologic diagnostic challenges of unclassified RCCs discussing the utility of contemporary diagnostic tools. It further discusses the current state of knowledge and guidelines for management of this class of tumors.
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Affiliation(s)
- Deepika Sirohi
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA,
| | - Steven C Smith
- Department of Pathology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.,Department of Urology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Neeraj Agarwal
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin L Maughan
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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15
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Lebacle C, Pooli A, Bessede T, Irani J, Pantuck AJ, Drakaki A. Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art. World J Urol 2018; 37:115-123. [PMID: 29858701 DOI: 10.1007/s00345-018-2355-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
Long recognized to confer an extremely poor prognosis, sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a tumor phenotype that is finally beginning to be better understood on the molecular and genetic levels. With an overall incidence that ranges from 1 to 32% depending on associated RCC subtype, the survival of sarcomatoid RCC patients rarely exceeds 2 years. The main reasons for its poor outcome include its aggressive biology, its tendency to present at an advanced or metastatic stage at the time of diagnosis, its high rate of tumor recurrence after nephrectomy, and its limited response to systemic therapies. Molecular pathology studies suggest that sarcomatoid dedifferentiation originates from a focal epithelial-mesenchymal transition (EMT) arising in the carcinomatous component of the tumor. It is hoped that the growing understanding of the molecular biology of sRCC will soon make it possible to adapt treatments based on the identification of actionable tumor alterations. The deliberate inclusion of these patients in the multicenter clinical trials of immune, targeted and combination therapies is a necessary next step in pioneering future treatment strategies.
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Affiliation(s)
- Cedric Lebacle
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France.
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas Bessede
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Jacques Irani
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra Drakaki
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
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