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Evans ST, Jani Y, Jansen CS, Yildirim A, Kalemoglu E, Bilen MA. Understanding and overcoming resistance to immunotherapy in genitourinary cancers. Cancer Biol Ther 2024; 25:2342599. [PMID: 38629578 PMCID: PMC11028033 DOI: 10.1080/15384047.2024.2342599] [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] [Indexed: 04/19/2024] Open
Abstract
The introduction of novel immunotherapies has significantly transformed the treatment landscape of genitourinary (GU) cancers, even becoming the standard of care in some settings. One such type of immunotherapy, immune checkpoint inhibitors (ICIs) like nivolumab, ipilimumab, pembrolizumab, and atezolizumab play a pivotal role by disturbing signaling pathways that limit the immune system's ability to fight tumor cells. Despite the profound impact of these treatments, not all tumors are responsive. Recent research efforts have been focused on understanding how cancer cells manage to evade the immune response and identifying the possible mechanisms behind resistance to immunotherapy. In response, ICIs are being combined with other treatments to reduce resistance and attack cancer cells through multiple cellular pathways. Additionally, novel, targeted strategies are currently being investigated to develop innovative methods of overcoming resistance and treatment failure. This article presents a comprehensive overview of the mechanisms of immunotherapy resistance in GU cancers as currently described in the literature. It explores studies that have identified genetic markers, cytokines, and proteins that may predict resistance or response to immunotherapy. Additionally, we review current efforts to overcome this resistance, which include combination ICIs and sequential therapies, novel insights into the host immune profile, and new targeted therapies. Various approaches that combine immunotherapy with chemotherapy, targeted therapy, vaccines, and radiation have been studied in an effort to more effectively overcome resistance to immunotherapy. While each of these combination therapies has shown some efficacy in clinical trials, a deeper understanding of the immune system's role underscores the potential of novel targeted therapies as a particularly promising area of current research. Currently, several targeted agents are in development, along with the identification of key immune mediators involved in immunotherapy resistance. Further research is necessary to identify predictors of response.
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Affiliation(s)
- Sean T Evans
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yash Jani
- Undergraduate studies, Mercer University, Macon, GA, USA
| | - Caroline S Jansen
- Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA, USA
- Genitourinary Medical Oncology Program, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Ahmet Yildirim
- Genitourinary Medical Oncology Program, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ecem Kalemoglu
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
- Department of Basic Oncology, Health Institute of Ege University, Izmir, Turkey
| | - Mehmet Asim Bilen
- Genitourinary Medical Oncology Program, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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2
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Sammarco E, Rossetti M, Salfi A, Bonato A, Viacava P, Masi G, Galli L, Faviana P. Tumor microenvironment and clinical efficacy of first line immunotherapy-based combinations in metastatic renal cell carcinoma. Med Oncol 2024; 41:150. [PMID: 38740647 PMCID: PMC11090963 DOI: 10.1007/s12032-024-02370-0] [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: 02/10/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024]
Abstract
The impact of tumor microenvironment (TME) in influencing clinical response to first-line immune checkpoint inhibitor (ICI)-based treatment in advanced renal cell carcinoma (RCC) is unclear. Immunohistochemistry (IHC) could identify biomarkers related to immune checkpoints and immune cell population. This study retrospectively characterized TME from 28 RCC patients who received first line ICI-based therapy through IHC assessment of selected markers and explored preliminary evidence about their possible correlation with treatment efficacy. We found a significantly higher count of CD80+, CD163+ cells and their ratio in RCC with clear cell component compared to those without clear cell features; additionally, patients with metastatic disease at diagnosis were associated with higher expression of CD163+ cells, while higher count of CD4+ cells and CD4+/CD8+ ratio were found in RCC with sarcomatoid features. Patients achieving partial or complete response were associated with lower expression of CD163+ cells (median 28 vs 47; p = 0.049). Furthermore, lower expression of CD163+ was associated with better PFS (median PFS 20.0 vs 4.7 months; HR 0.22 p = 0.011) and OS (median OS NR vs 14.4 months; HR 0.28 p = 0.036). A longer OS was reported in PD-L1 CPS negative patients (median OS NR vs 11.8 months; HR 0.20 p = 0.024). High infiltration of CD163+ macrophages, who typically present "anti-inflammatory" M2-like phenotype, could identify a subgroup of patients with poor survival after receiving first-line ICI.
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MESH Headings
- Humans
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/metabolism
- Tumor Microenvironment/immunology
- Kidney Neoplasms/pathology
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/immunology
- Kidney Neoplasms/metabolism
- Male
- Female
- Middle Aged
- Aged
- Retrospective Studies
- Immune Checkpoint Inhibitors/therapeutic use
- Adult
- Immunotherapy/methods
- Receptors, Cell Surface/metabolism
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/analysis
- Aged, 80 and over
- Treatment Outcome
- Antigens, Differentiation, Myelomonocytic/metabolism
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Affiliation(s)
- Enrico Sammarco
- Medical Oncology Unit, Livorno Hospital, Azienda Toscana Nord Ovest, Livorno, Italy
| | - Martina Rossetti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Alessia Salfi
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Adele Bonato
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paolo Viacava
- Pathology Unit, Livorno Hospital, Azienda Toscana Nord Ovest, Livorno, Italy
| | - Gianluca Masi
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Galli
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
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Mathis S, Sierpina VS. Kidney Cancer Integrative Oncology: Possible Options for Care. Curr Oncol Rep 2023; 25:1071-1080. [PMID: 37466849 DOI: 10.1007/s11912-023-01437-x] [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] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW This study aims to review how complementary and integrative medicine (CIM), defined as therapies utilizing nutrition, physical activity, herbs, supplements, mind-body therapies, homeopathy, and other non-traditional therapies, can address the prevention, treatment, side effects, and recurrence of kidney cancer. This review discusses advances and discoveries in research, gaps in research, current debates on the subject, and directions for future research. We queried Ovid MEDLINE and PubMed databases using the search terms kidney cancer, integrative medicine, integrative oncology, nutrition, supplements, treatment, prevention, and therapy. Searches were limited to integrative medicine and integrative oncology. We reviewed CIM therapies related to prevention, treatment, side effect mitigation, and recurrence of kidney cancers. RECENT FINDINGS Search results yielded 211 studies, of which 87 were relevant to this review. Studies related to CIM and kidney cancer were clustered into themes, including nutrition, physical activity, supplements, mind-body therapies, and alternative therapies. This review provides a foundation for utilizing the principles of integrative medicine in the prevention of and care for patients with kidney cancer and the need for further focused research on the effectiveness of CIM in kidney cancers.
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Affiliation(s)
- Samuel Mathis
- Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd, Rt. 1123, Galveston, TX, 77555-1123, USA.
| | - Victor S Sierpina
- Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd, Rt. 1123, Galveston, TX, 77555-1123, USA
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4
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Mrdenovic S, Wang Y, Yin L, Chu GCY, Ou Y, Lewis MS, Heffer M, Posadas EM, Zhau HE, Chung LWK, Edderkaoui M, Pandol SJ, Wang R, Zhang Y. A cisplatin conjugate with tumor cell specificity exhibits antitumor effects in renal cancer models. BMC Cancer 2023; 23:499. [PMID: 37268911 PMCID: PMC10236852 DOI: 10.1186/s12885-023-10878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/24/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer and is notorious for its resistance to both chemotherapy and small-molecule inhibitor targeted therapies. Subcellular targeted cancer therapy may thwart the resistance to produce a substantial effect. METHODS We tested whether the resistance can be circumvented by subcellular targeted cancer therapy with DZ-CIS, which is a chemical conjugate of the tumor-cell specific heptamethine carbocyanine dye (HMCD) with cisplatin (CIS), a chemotherapeutic drug with limited use in ccRCC treatment because of frequent renal toxicity. RESULTS DZ-CIS displayed cytocidal effects on Caki-1, 786-O, ACHN, and SN12C human ccRCC cell lines and mouse Renca cells in a dose-dependent manner and inhibited ACHN and Renca tumor formation in experimental mouse models. Noticeably, in tumor-bearing mice, repeated DZ-CIS use did not cause renal toxicity, in contrast to the CIS-treated control animals. In ccRCC tumors, DZ-CIS treatment inhibited proliferation markers but induced cell death marker levels. In addition, DZ-CIS at half maximal inhibitory concentration (IC50) sensitized Caki-1 cells to small-molecule mTOR inhibitors. Mechanistically, DZ-CIS selectively accumulated in ccRCC cells' subcellular organelles, where it damages the structure and function of mitochondria, leading to cytochrome C release, caspase activation, and apoptotic cancer cell death. CONCLUSIONS Results from this study strongly suggest DZ-CIS be tested as a safe and effective subcellular targeted cancer therapy.
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Affiliation(s)
- Stefan Mrdenovic
- Division of Hematology, Department of Internal Medicine, University Hospital Osijek, Osijek, Croatia
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Yanping Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lijuan Yin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gina Chia-Yi Chu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yan Ou
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Lewis
- Departments of Pathology, Cedars-Sinai Medical Center and the VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Marija Heffer
- Department of Medical Biology and Genetics, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Edwin M Posadas
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haiyen E Zhau
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leland W K Chung
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mouad Edderkaoui
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ruoxiang Wang
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Pathology, Cedars-Sinai Medical Center and the VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Yi Zhang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Davis 3059, 90048, Los Angeles, CA, USA.
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5
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Chatwal MS, Chahoud J, Spiess PE. Revisiting mechanisms of resistance to immunotherapies in metastatic clear-cell renal-cell carcinoma. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:314-326. [PMID: 37457132 PMCID: PMC10344725 DOI: 10.20517/cdr.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023]
Abstract
Renal-cell carcinoma (RCC) remains a leading cause of cancer-related mortality worldwide. Though newer therapeutic combinations of immune checkpoint inhibitors and targeted therapies have greatly improved outcomes, resistance to these therapies is becoming a challenge for long-term control. Mechanisms of resistance have been explored in a variety of solid tumors, including RCC. Based upon our review of the current literature on the mechanisms of resistance to immunotherapies for the management of metastatic clear-cell renal cell carcinomas (mccRCC), the ensuing conclusions have been made: The management of mccRCC has progressed substantially with the advent of checkpoint inhibitors and targeted oral therapies, alone and/or in combination. Nevertheless, innate or developed resistance to these therapies remains an ongoing challenge, particularly to immune checkpoint inhibitors (ICIs). Several of the known mechanisms of resistance have been well defined, but recent progression in cellular therapies helps to expand the armamentarium of potential combination options that may overcome these modes of resistance and improve long-term disease control and survival for an otherwise dismal disease. In the ensuing review and update of the literature on the mechanisms of resistance to immunotherapies in mccRCC, we have revisited the known resistance mechanisms of immunotherapies in metastatic clear-cell RCC and explored ongoing and future strategies to overcome them.
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Affiliation(s)
- Monica Sheila Chatwal
- Correspondence to: Dr. Monica Sheila Chatwal, Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL33612, USA. E-mail:
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6
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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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7
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Mulgaonkar A, Elias R, Woolford L, Guan B, Nham K, Kapur P, Christie A, Tcheuyap VT, Singla N, Bowman IA, Stevens C, Hao G, Brugarolas J, Sun X. ImmunoPET Imaging with 89Zr-Labeled Atezolizumab Enables In Vivo Evaluation of PD-L1 in Tumorgraft Models of Renal Cell Carcinoma. Clin Cancer Res 2022; 28:4907-4916. [PMID: 36074149 PMCID: PMC9669181 DOI: 10.1158/1078-0432.ccr-22-1547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) targeting the programmed cell death protein 1 and its ligand (PD-1/PD-L1) have transformed the treatment paradigm for metastatic renal cell carcinoma (RCC). However, response rates to ICIs as single agents or in combination vary widely and predictive biomarkers are lacking. Possibly related to the heterogeneity and dynamic nature of PD-L1 expression, tissue-based methods have shown limited value. Immuno-positron emission tomography (immunoPET) may enable noninvasive, comprehensive, and real-time PD-L1 detection. Herein, we systematically examined the performance of immunoPET for PD-L1 detection relative to IHC in an RCC patient-derived tumorgraft (TG) platform. EXPERIMENTAL DESIGN Eight independent RCC TGs with a wide range of PD-L1 expression (0%-85%) were evaluated by immunoPET. Uptake of 89Zr-labeled atezolizumab ([89Zr]Zr-DFO-ATZ) was compared with PD-L1 expression in tumors by IHC through double-blind analyses. Clinical outcomes of ICI-treated patients whose TGs were examined were analyzed to evaluate the clinical role of immunoPET in RCC. RESULTS ImmunoPET with [89Zr]Zr-DFO-ATZ (day 6/7 postinjection) revealed a statistically significant association with PD-L1 IHC assays (P = 0.0014; correlation ρXY = 0.78). Furthermore, immunoPET can be used to assess the heterogeneous distribution of PD-L1 expression. Finally, studies in the corresponding patients (n = 4) suggest that PD-L1 signal may influence ICI responsiveness. CONCLUSIONS ImmunoPET with [89Zr]Zr-DFO-ATZ may enable a thorough and dynamic assessment of PD-L1 across sites of disease. The power of immunoPET to predict ICI response in RCC is being explored in an ongoing clinical trial (NCT04006522).
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Affiliation(s)
- Aditi Mulgaonkar
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roy Elias
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Layton Woolford
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bing Guan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kien Nham
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Payal Kapur
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vanina T. Tcheuyap
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirmish Singla
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - I. Alex Bowman
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christina Stevens
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Guiyang Hao
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Internal Medicine, Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Xiankai Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Zapała Ł, Kunc M, Sharma S, Pęksa R, Popęda M, Biernat W, Radziszewski P. Immune checkpoint receptor VISTA on immune cells is associated with expression of T-cell exhaustion marker TOX and worse prognosis in renal cell carcinoma with venous tumor thrombus. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04329-y. [PMID: 36042047 DOI: 10.1007/s00432-022-04329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed to determine the expression of VISTA and TOX within venous tumor thrombus and primary clear cell renal cell carcinoma (ccRCC) and to assess their prognostic value. METHODS The study enrolled 82 patients with ccRCC and coexisting venous tumor thrombus treated radically from 2012 to 2019 in two tertiary centers. Tissue microarrays were prepared and stained with respective antibodies. The expression of markers was assessed separately on tumor cells (TCs) and/or tumor-associated immune cells (TAICs). RESULTS TOX expression was positively correlated with the percentage of VISTA-positive TAICs in venous thrombus (p = 0.011), but not in the primary tumor (p = 0.674). High TOX expression was associated with a higher percentage of PD-L1-positive TAICs in both compartments (p = 0.001, p = 0.011, respectively). Positive expression of VISTA on TAICs was associated with PD-L1 expression on TCs (p = 0.005) and TAICs (p = 0.004) in the primary tumor, and only with PD-L1 on TAICs in thrombus (p = 0.006). The presence of VISTA-positive TAICs in venous thrombus was significantly more common in females (p = 0.034), and positively correlated with metastases (p = 0.028), and tumor necrosis (p = 0.013). The cases with VISTA-positive TAICs in venous tumor thrombi had significantly shorter OS than VISTA-negative cases (p = 0.041). CONCLUSION For the first time, we demonstrated the expression of VISTA- and TOX-positive TAICs in the venous tumor thrombus. We found the association between immune checkpoint receptors and T cell exhaustion markers in both tumor mass and venous thrombus. Finally, we demonstrated that abundance of VISTA-positive TAICs in venous tumor thrombus correlates with worse outcomes in ccRCC.
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Affiliation(s)
- Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdansk, 80-214, Gdańsk, Poland
| | - Sumit Sharma
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Rafał Pęksa
- Department of Pathomorphology, Medical University of Gdansk, 80-214, Gdańsk, Poland
| | - Marta Popęda
- Department of Pathomorphology, Medical University of Gdansk, 80-214, Gdańsk, Poland.,Laboratory of Translational Oncology, Intercollegiate Faculty of Biotechnology, Medical University of Gdańsk, 80-211, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, 80-214, Gdańsk, Poland
| | - Piotr Radziszewski
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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9
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Marvaso G, Corrao G, Oneta O, Pepa M, Zaffaroni M, Corso F, Gandini S, Cecconi A, Zerini D, Mazzola GC, Augugliaro M, Cossu Rocca M, Verri E, Cattani F, La Fauci F, Bergamaschi L, Luzzago S, Mistretta AF, Musi G, Nolè F, De Cobelli O, Orecchia R, Jereczek-Fossa BA. Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how? Clin Transl Oncol 2021; 23:1717-1726. [PMID: 33687659 DOI: 10.1007/s12094-021-02574-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. PATIENTS AND METHODS A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. RESULTS From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. CONCLUSION The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.
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Affiliation(s)
- G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.
| | - G Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - O Oneta
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - M Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Corso
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Department of Mathematics (DMAT), Politecnico di Milano, Milan, Italy.,Center for Analysis Decisions and Society (CADS), Human Technopole, Milan, Italy
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - A Cecconi
- Scientific Direction, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - D Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G C Mazzola
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - M Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Cossu Rocca
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - E Verri
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - F La Fauci
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - L Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - S Luzzago
- Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A F Mistretta
- Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.,Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Nolè
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - O De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.,Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - R Orecchia
- Scientific Direction, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
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