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Shah NJ, Shinde R, Moore KJ, Sainski-Nguyen A, Le LB, Cao F, Song R, Singhal P, Motzer RJ. Health Care Resource Use for Modern First-Line Treatments in Metastatic Renal Cell Carcinoma. JAMA Netw Open 2024; 7:e2422674. [PMID: 39052293 PMCID: PMC11273232 DOI: 10.1001/jamanetworkopen.2024.22674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/10/2024] [Indexed: 07/27/2024] Open
Abstract
Importance Immuno-oncology agents have changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). Such therapies improve survival but can impose considerable health care resource use (HCRU) and associated costs, necessitating their examination. Objective To compare HCRU, costs, and clinical outcomes among patients receiving first-line pembrolizumab plus axitinib (P+A) or ipilimumab plus nivolumab (I+N). Design, Setting, and Participants This retrospective cohort study used data from an administrative claims database on patients with mRCC receiving first-line P+A or I+N that was initiated between January 2018 and May 2020. Data were analyzed from February 2021 to July 2022. Exposure First-line P+A or I+N. Main Outcome and Measures HCRU and costs during the first 90 days, full first-line treatment, and full follow-up periods were assessed. Using Kaplan-Meier analysis, time on treatment, overall survival, time to first emergency department (ED) visit, and time to first inpatient stay were compared. Results Among 507 patients, there were 126 patients receiving P+A (91 male [72.2%]; mean [SD] age, 67.93 [9.66] y) and 381 patients receiving I+N (271 male [71.1%]; mean [SD] age, 66.52 [9.94] years). The median time on treatment was longer for the P+A compared with I+N group (12.4 months [95% CI, 8.40 months to not estimable] vs 4.1 months [95% CI, 3.07 to 5.30 months]; P < .001). The median time to first ED visit was longer for the P+A than I+N group (7.2 months [95% CI 3.9 to 11.1 months ] vs 3.3 months [95% CI, 2.6 to 3.9 months]; P = .005), as was time to first inpatient stay (9.0 months [95% CI 6.5 months to not estimable] vs 5.6 months [95% CI, 3.9 to 7.9 months]; P = .02). During the first 90 days, a lower proportion of the P+A than N+I group had ED visits (43 patients [34.1%] vs 182 patients [47.8%] and inpatient stays (24 patients [19.1%) vs144 patients [37.8%]; P < .001). During full follow-up, mean total adjusted costs were similar for P+A and I+N groups, but adjusted 12-month estimated total costs were higher for P+A than I+N groups ($325 574 vs $ 263 803; P = .03). Conclusions and Relevance In this study, treatment with P+A was associated with longer time on treatment, time to first ED visit, and inpatient stay, while 12-month estimated costs were higher for the P+A group. This is among the first clinical studies to evaluate economic burden associated with modern treatments for mRCC.
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Affiliation(s)
- Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, New York
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Tomita Y, Motzer RJ, Choueiri TK, Rini BI, Miyake H, Oya M, Albiges L, Aizawa M, Umeyama Y, Wang J, di Pietro A, Schmidinger M. Efficacy of avelumab plus axitinib versus sunitinib by numbers of IMDC risk factors and target tumor sites at baseline in advanced renal cell carcinoma: long-term follow-up results from JAVELIN Renal 101. ESMO Open 2023; 8:102034. [PMID: 37866029 PMCID: PMC10774904 DOI: 10.1016/j.esmoop.2023.102034] [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: 06/02/2023] [Revised: 09/01/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND In the phase III JAVELIN Renal 101 trial, first-line avelumab + axitinib improved progression-free survival (PFS) and objective response rate versus sunitinib in patients with advanced renal cell carcinoma across all International Metastatic RCC Database Consortium (IMDC) risk groups (favorable, intermediate, and poor); analyses of overall survival (OS) remain immature. Here, we report post hoc analyses of efficacy from the third interim analysis (data cut-off, April 2020) by the numbers of IMDC risk factors and target tumor sites at baseline. METHODS Efficacy endpoints assessed were PFS, objective response, and best overall response per investigator assessment (RECIST v1.1) and OS. Best percentage change and percentage change from baseline in target tumor size over time during the study were also assessed. RESULTS In patients with 0, 1, 2, 3, or 4-6 IMDC risk factors, hazard ratios [HRs; 95% confidence interval (CIs)] for OS with avelumab + axitinib versus sunitinib were 0.660 (0.356-1.223), 0.745 (0.524-1.059), 0.973 (0.668-1.417), 0.718 (0.414-1.248), and 0.443 (0.237-0.829), and HRs (95% CIs) for PFS were 0.706 (0.490-1.016), 0.709 (0.540-0.933), 0.711 (0.527-0.960), 0.501 (0.293-0.854), and 0.395 (0.214-0.727), respectively. In patients with 1, 2, 3, or ≥4 target tumor sites, HRs (95% CIs) for OS with avelumab + axitinib versus sunitinib were 0.912 (0.640-1.299), 0.715 (0.507-1.006), 0.679 (0.442-1.044), and 0.747 (0.346-1.615), and HRs (95% CIs) for PFS were 0.706 (0.548-0.911), 0.552 (0.422-0.723), 0.856 (0.589-1.244), and 0.662 (0.329-1.332), respectively. Across all subgroups, analyses of objective response rate and complete response rate favored avelumab + axitinib versus sunitinib, and a greater proportion of patients treated with avelumab + axitinib had tumor shrinkage. CONCLUSIONS In post hoc analyses, first-line treatment with avelumab + axitinib was generally associated with efficacy benefits versus treatment with sunitinib in patients with advanced renal cell carcinoma across subgroups defined by different numbers of IMDC risk factors or target tumor sites.
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Affiliation(s)
- Y Tomita
- Departments of Urology and Molecular Oncology, Niigata University Graduate School of Medicine, Niigata, Japan.
| | - R J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T K Choueiri
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - B I Rini
- Hematology Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - H Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - M Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - L Albiges
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | | | | | - J Wang
- Pfizer, Cambridge, MA, USA
| | | | - M Schmidinger
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Di S, Gong M, Lv J, Yang Q, Sun Y, Tian Y, Qian C, Chen W, Zhou W, Dong K, Shi X, Wang Y, Wang H, Chu J, Gan S, Pan X, Cui X. Glycolysis-related biomarker TCIRG1 participates in regulation of renal cell carcinoma progression and tumor immune microenvironment by affecting aerobic glycolysis and AKT/mTOR signaling pathway. Cancer Cell Int 2023; 23:186. [PMID: 37649034 PMCID: PMC10468907 DOI: 10.1186/s12935-023-03019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a hypermetabolic disease. Abnormal up-regulation of glycolytic signaling promotes tumor growth, and glycolytic metabolism is closely related to immunotherapy of renal cancer. The aim of the present study was to determine whether and how the glycolysis-related biomarker TCIRG1 affects aerobic glycolysis, the tumor microenvironment (TME) and malignant progression of clear cell renal cell carcinoma (ccRCC). METHODS Based on The Cancer Genome Atlas (TCGA, n = 533) and the glycolysis-related gene set from MSigDB, we identified the glycolysis-related gene TCIRG1 by bioinformatics analysis, analyzed its immunological properties in ccRCC and observed how it affected the biological function and glycolytic metabolism using online databases such as TIMER 2.0, UALCAN, LinkedOmics and in vitro experiments. RESULTS It was found that the expression of TCIRG1, was significantly increased in ccRCC tissue, and that high TCIRG1 expression was associated with poor overall survival (OS) and short progression-free interval (PFI). In addition, TCIRG1 expression was highly correlated with the infiltration immune cells, especially CD4+T cell Th1, CD8+T cell, NK cell, and M1 macrophage, and positively correlated with PDCD1, CTLA4 and other immunoinhibitors, CCL5, CXCR3 and other chemokines and chemokine receptors. More importantly, TCIRG1 may regulate aerobic glycolysis in ccRCC via the AKT/mTOR signaling pathway, thereby affecting the malignant progression of ccRCC cell lines. CONCLUSIONS Our results demonstrate that the glycolysis-related biomarker TCIRG1 is a tumor-promoting factor by affecting aerobic glycolysis and tumor immune microenvironment in ccRCC, and this finding may provide a new idea for the treatment of ccRCC by combination of metabolic intervention and immunotherapy.
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Grants
- No. 81974391, 82072806, 82173265,82002664;2022LJ002;23QC1401400;23ZR1441300;20204Y0042;21XHDB06; No. 2020-QN-02 Xingang Cui, Xiuwu Pan, Sishun Gan, Jian Chu, Qiwei Yang
- No. 81974391, 82072806, 82173265,82002664;2022LJ002;23QC1401400;23ZR1441300;20204Y0042;21XHDB06; No. 2020-QN-02 Xingang Cui, Xiuwu Pan, Sishun Gan, Jian Chu, Qiwei Yang
- No. 81974391, 82072806, 82173265,82002664;2022LJ002;23QC1401400;23ZR1441300;20204Y0042;21XHDB06; No. 2020-QN-02 Xingang Cui, Xiuwu Pan, Sishun Gan, Jian Chu, Qiwei Yang
- No. 81974391, 82072806, 82173265,82002664;2022LJ002;23QC1401400;23ZR1441300;20204Y0042;21XHDB06; No. 2020-QN-02 Xingang Cui, Xiuwu Pan, Sishun Gan, Jian Chu, Qiwei Yang
- No. 81974391, 82072806, 82173265,82002664;2022LJ002;23QC1401400;23ZR1441300;20204Y0042;21XHDB06; No. 2020-QN-02 Xingang Cui, Xiuwu Pan, Sishun Gan, Jian Chu, Qiwei Yang
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Affiliation(s)
- Sichen Di
- Department of Urinary Surgery, Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Min Gong
- Department of Urology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jianmin Lv
- Department of Urology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Qiwei Yang
- Department of Urology, Third Affiliated Hospital of the Second Military Medical University, Shanghai, 201805, China
- Department of Urology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200100, China
| | - Ye Sun
- Department of Urinary Surgery, Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yijun Tian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Cheng Qian
- Department of Urinary Surgery, Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wenjin Chen
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Wang Zhou
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Keqin Dong
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiaokai Shi
- Department of Urology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, 213000, China
| | - Yuning Wang
- Department of Urinary Surgery, Gongli Hospital, Second Military Medical University (Naval Medical University), Shanghai, China
| | - Hongru Wang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jian Chu
- Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai, 201908, China.
| | - Sishun Gan
- Department of Urology, Third Affiliated Hospital of the Second Military Medical University, Shanghai, 201805, China.
| | - Xiuwu Pan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xingang Cui
- Department of Urinary Surgery, Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Yinchuan, Ningxia, China.
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
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de Velasco G, Alonso-Gordoa T, Rodríguez-Vida A, Anguera G, Campayo M, Pinto Á, Ortega EM, Gallardo E, Núñez NF, García-Carbonero I, Reig O, Méndez-Vidal MJ, Fernández-Calvo O, Cassinello NV, Torregrosa D, López-Martín A, Rosero A, Valiente PG, de España CG, Climent MA, Santasusana MD, Sánchez ÁR, González IC, Afonso R, García Del Muro X, Casinello J, Fernández-Parra EM, García Sánchez L, Afonso J, Polo SH, Asensio Ú. Long-term Clinical Outcomes of a Spanish Cohort of Metastatic Renal Cell Carcinoma Patients with a Complete Response to Sunitinib. Clin Genitourin Cancer 2022; 21:e166-e174. [PMID: 36610891 DOI: 10.1016/j.clgc.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The long-term clinical outcomes of patients with metastatic renal cell carcinoma (mRCC) and a complete response (CR) to the tyrosine kinase inhibitor (TKI) sunitinib are poorly known. The characteristics of these patients could reveal previously undetected associations with clinical variables. PATIENTS AND METHODS This observational, retrospective study (ATILA) used data from a registry of patients with mRCC who had received first-line sunitinib and had achieved CR from 2007 to 2018 in Spain. RESULTS Sixty-two patients with CR were included; 48 patients (77.4%) received sunitinib in monotherapy and 14 (22.6%) combined with or followed by local treatment. Median age was 58.5 years (range, 32-81). Most patients (79.0%) had clear cell histology and had undergone previous nephrectomy (90.3%). The majority (70.2%) had an intermediate IMDC prognosis, 23% favorable and 7.0% poor. The median time on treatment with sunitinib was 28.2 months (IQR, 16.7-41.0) and the median time to CR was 10.9 months (IQR, 7.2-19.3). After a median follow-up of 8 years (range, 3-13 years), the median PFS was not reached. The overall median duration of complete response was 64.1 months (IQR, 32.2-99.4). The tolerance and safety profile of sunitinib was consistent with previous reports. CONCLUSION Durable CR to sunitinib was observed in patients regardless the prognosis group, metastasis site or histology type, with 75% of patients remaining in CR after 10 years. CLINICALTRIALS gov: NCT03916458.
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Affiliation(s)
| | - Teresa Alonso-Gordoa
- Department of Medical Oncology and Department of Genitourinary, Germ cell and Endocrine Tumors, Ramón y Cajal University Hospital and Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Alejo Rodríguez-Vida
- Department of Medical Oncology, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Georgia Anguera
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marc Campayo
- Department of Medical Oncology, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Álvaro Pinto
- Department of Medical Oncology, University Hospital La Paz, Madrid, Spain
| | | | - Enrique Gallardo
- Department of Medical Oncology, University Hospital Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Sabadell, Spain
| | | | | | - Oscar Reig
- Department of Medical Oncology, Hospital Clínic and Translational Genomics and Targeted Therapeutics in Solid Tumors Group (IDIBAPS), Barcelona, Spain
| | - María José Méndez-Vidal
- Department of Medical Oncology, University Hospital Reina Sofía, Maimónides Institute for Biomedical research of Córdoba (IMIBIC), Córdoba, Spain
| | | | - Natalia Vidal Cassinello
- Department of Medical Oncology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Dolores Torregrosa
- Department of Medical Oncology, University Hospital Dr. Peset, Valencia, Spain
| | - Ana López-Martín
- Medical Oncology Department, University Hospital Severo Ochoa, Madrid, Spain
| | - Adriana Rosero
- Department of Medical Oncology, University Hospital Infanta Cristina, Parla, Madrid, Spain
| | - Patricia G Valiente
- Department of Medical Oncology, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Miguel A Climent
- Department of Medical Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | - Isabel Chirivella González
- Department of Medical Oncology, Hospital Clínico Universitario, INCLIVA, University of Valencia, Valencia, Spain
| | - Ruth Afonso
- Department of Medical Oncology, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Xavier García Del Muro
- Genitourinary Cancer and Sarcoma Unit, Institut Català d'Oncologia, Hospitalet, Barcelona, Spain
| | - Javier Casinello
- Department of Medical Oncology, University Hospital of Guadalajara, Guadalajara, Spain
| | | | | | - Javier Afonso
- Department of Medical Oncology, University Hospital of Ferrol, A Coruña, Spain
| | - Susana Hernando Polo
- Department of Medical Oncology, University Hospital Fundación Alcorcón, Madrid, Spain
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Muacevic A, Adler JR, Owens J, Hussain S. Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment. Cureus 2022; 14:e31195. [PMID: 36505146 PMCID: PMC9728501 DOI: 10.7759/cureus.31195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
With cancer among the leading causes of death worldwide and kidney cancer among the more common cancers in the United States, it has become increasingly important to ensure that first-line treatments remain validated and supported in recent literature. Surgical intervention has long remained the gold standard for intervention but with newer techniques and technology on the horizon, there must be a constant review of other options that may provide improved outcomes and reduction of associated risks. Ablative techniques have gained traction and are becoming a valuable intervention for multiple different types of cancers, kidney cancer included. Cryoablation, a newer ablative technique taking advantage of extreme cold to freeze and destroy abnormal tissue, provides a promising option for treatment. Currently, no review article, to our knowledge, compares all the different treatment options for kidney cancer. Additionally, while some literature has addressed cryoablation in comparison to other methods of management, there has not been an extensive review to combine our current understanding of these comparisons. In this review article, we provide an overview of each of the commonly used treatments for kidney cancer and summarize the current literature regarding the advantages and disadvantages of each intervention. Finally, we seek to compare cryoablation, a newer option for treatment, to each of the approaches with the goal of evaluating the best methods for management and determining cryoablation's role alongside these current interventions.
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Zeng R, Li Y, He DM, Sun MZ, Huang WQ, Wang YH, Zhuo YM, Chen JJ, Chen TH, Guo JH, Huang J. Potassium channel-related genes are a novel prognostic signature for the tumor microenvironment of renal clear cell carcinoma. Front Oncol 2022; 12:1013324. [PMID: 36237326 PMCID: PMC9552761 DOI: 10.3389/fonc.2022.1013324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) accounts for 80% of renal cell carcinomas (RCCs), and its morbidity and prognosis are unfavorable. Surgical resection is the first-line treatment for ccRCC, but the oncogenesis of ccRCC is very complex. With the development of high-throughput sequencing technology, it is necessary to analyze the transcriptome to determine more effective treatment methods. The tumor microenvironment (TME) is composed of tumor cells, various immune-infiltrating cells, fibroblasts, many cytokines, and catalysts. It is a complex system with a dynamic balance that plays an essential role in tumor growth, invasion, and metastasis. Previous studies have confirmed that potassium channels can affect the immune system, especially T lymphocytes that require potassium channel activation. However, the effect of potassium channels on the TME of ccRCC remains to be studied. Therefore, this study aims to construct a prognostic signature for ccRCC patients based on potassium ion channel-related genes (PCRGs), assess patient risk scores, and divide patients into high- and low-risk groups based on the cutoff value. In addition, we investigated whether there were differences in immune cell infiltration, immune activator expression, somatic mutations, and chemotherapeutic responses between the high- and low-risk groups. Our results demonstrate that the PCRG signature can accurately assess patient prognosis and the tumor microenvironment and predict chemotherapeutic responses. In summary, the PCRG signature could serve as an auxiliary tool for the precision treatment of ccRCC.
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Affiliation(s)
- Rui Zeng
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
| | - Yi Li
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dong-ming He
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
| | - Meng-zhu Sun
- Department of Transfusion Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wen-qing Huang
- Department of Transfusion Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yu-hang Wang
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu-min Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun-jiang Chen
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
| | - Tai-heng Chen
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
| | - Jing-hui Guo
- Department of Physiology, School of Medicine, Jinan University, Guangzhou, China
- *Correspondence: Jing-hui Guo, ; Jun Huang,
| | - Jun Huang
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Jing-hui Guo, ; Jun Huang,
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Harada KI, Miyake H, Furukawa J, Fujimoto N, Fujisawa M. Comprehensive assessments of immuno-oncology drug-based combination therapies as first-line treatment for advanced renal cell carcinoma. Int J Urol 2022; 29:816-822. [PMID: 35636920 DOI: 10.1111/iju.14922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/19/2022] [Indexed: 12/12/2022]
Abstract
Over the last decade, there have been substantial progress in the field of systemic therapy for advanced renal cell carcinoma. Through the transition from treatment with cytokines to molecular-targeted agents, and currently to immuno-oncology drugs, the prognostic outcomes of patients with advanced renal cell carcinoma have been markedly improved. In particular, based on the promising outcomes of recently conducted pivotal randomized clinical trials, immuno-oncology drug-based combination therapy by either dual immune checkpoint inhibition or combined inhibition of an immune checkpoint and tyrosine kinase, is currently regarded as a standard of care for treatment-naïve advanced renal cell carcinoma patients. However, insufficient data are available with respect to the selection of optimal systemic therapies for advanced renal cell carcinoma in the first-line setting due to the lack of a head-to-head comparison between approved immuno-oncology drug-based combination therapies. In this review, therefore, we summarize interesting findings associated with first-line combination therapies for advanced renal cell carcinoma obtained from both randomized clinical trials and real-world clinical practices, in order to present useful guidance to help make treatment decisions for patients with treatment-naïve advanced renal cell carcinoma.
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Affiliation(s)
- Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junya Furukawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Kobayashi M, Numakura K, Hatakeyama S, Muto Y, Sekine Y, Sasagawa H, Kashima S, Yamamoto R, Koizumi A, Nara T, Saito M, Narita S, Ohyama C, Habuchi T. Severe Immune-Related Adverse Events in Patients Treated with Nivolumab for Metastatic Renal Cell Carcinoma Are Associated with PDCD1 Polymorphism. Genes (Basel) 2022; 13:genes13071204. [PMID: 35885987 PMCID: PMC9324515 DOI: 10.3390/genes13071204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) reportedly influence the effect of nivolumab in metastatic renal cell carcinoma (mRCC). This study aimed to evaluate the relationship between the clinical outcomes of patients with mRCC and SNPs in programmed cell death protein 1 (PD-1) protein-coding gene (PDCD1) and explore any potential correlation with patient prognosis and incidence of immune-related adverse events (irAEs). In total, 106 patients with mRCC, who were treated with nivolumab alone (n = 59) or nivolumab and ipilimumab (n = 47), were enrolled in the study. Three SNPs in the PDCD1 gene, namely PD-1.3, PD-1.5, and PD-1.6, were assessed. Patients harboring the PD-1.6 G allele experienced more severe (odds ratio, 3.390; 95% confidence interval 1.517–7.756; p = 0.003) and multiple (OR, 2.778; 95% CI, 1.020–6.993 p = 0.031) irAEs than those harboring the AA genotype. Thus, the existence of the PDCD1 PD-1.6 polymorphism (G allele) was associated with the occurrence of severe and multiple irAEs in patients with mRCC. Further evaluation of PDCD1 polymorphisms might help identify patients experiencing irAE by nivolumab treatment.
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Affiliation(s)
- Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
- Correspondence: ; Tel.: +81-18-884-6460
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8203, Japan; (S.H.); (C.O.)
| | - Yumina Muto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Hajime Sasagawa
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Soki Kashima
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Atsushi Koizumi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8203, Japan; (S.H.); (C.O.)
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (Y.S.); (H.S.); (S.K.); (R.Y.); (A.K.); (T.N.); (M.S.); (S.N.); (T.H.)
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Kovaleva OV, Podlesnaya P, Sorokin M, Mochalnikova V, Kataev V, Khlopko YA, Plotnikov AO, Stilidi IS, Kushlinskii NE, Gratchev A. Macrophage Phenotype in Combination with Tumor Microbiome Composition Predicts RCC Patients’ Survival: A Pilot Study. Biomedicines 2022; 10:biomedicines10071516. [PMID: 35884821 PMCID: PMC9312790 DOI: 10.3390/biomedicines10071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
The identification of new prognostic markers of renal cell carcinoma (RCC) is an urgent problem in oncourology. To investigate the potential prognostic significance of tumor microbiome and stromal inflammatory markers, we studied a cohort of 66 patients with RCC (23 clear cell RCC, 19 papillary RCC and 24 chromophobe RCC). The microbiome was analyzed in tumor and normal tissue by 16S rRNA amplicon sequencing. Characterization of the tumor stroma was performed using immunohistochemistry. A significant difference in alpha diversity was demonstrated between normal kidney tissue and all types of RCC. Further, we demonstrated that the bacterial burden was higher in adjacent normal tissue than in a tumor. For the first time, we demonstrated a significant correlation between bacterial burden and the content of PU.1+ macrophages and CD66b+ neutrophils in kidney tumors. Tumors with high content of PU.1+ cells and CD66b+ cells in the stroma were characterized by a lower bacterial burden. In the tumors with high bacterial burden, the number of PU.1+ cells and CD66b+ was associated with a poor prognosis. The identified associations indicate the great prognostic potential of a combined tumor microbiome and stromal cell analysis.
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Affiliation(s)
- Olga V. Kovaleva
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Polina Podlesnaya
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Maxim Sorokin
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Valeria Mochalnikova
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Vladimir Kataev
- Institute for Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences, 460000 Orenburg, Russia; (V.K.); (Y.A.K.); (A.O.P.)
| | - Yuriy A. Khlopko
- Institute for Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences, 460000 Orenburg, Russia; (V.K.); (Y.A.K.); (A.O.P.)
| | - Andrey O. Plotnikov
- Institute for Cellular and Intracellular Symbiosis of the Ural Branch of the Russian Academy of Sciences, 460000 Orenburg, Russia; (V.K.); (Y.A.K.); (A.O.P.)
| | - Ivan S. Stilidi
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Nikolay E. Kushlinskii
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
| | - Alexei Gratchev
- N.N. Blokhin National Medical Research Center of Oncology, 115478 Moscow, Russia; (O.V.K.); (P.P.); (M.S.); (V.M.); (I.S.S.); (N.E.K.)
- Correspondence: or ; Tel.: +7-906-736-1869
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10
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Jost T, Schuster B, Heinzerling L, Weissmann T, Fietkau R, Distel LV, Hecht M. Kinase inhibitors increase individual radiation sensitivity in normal cells of cancer patients. Strahlenther Onkol 2022; 198:838-848. [PMID: 35471558 PMCID: PMC9402507 DOI: 10.1007/s00066-022-01945-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 11/06/2022]
Abstract
Purpose Kinase inhibitors (KI) are known to increase radiosensitivity, which can lead to increased risk of side effects. Data about interactions of commonly used KI with ionizing radiation on healthy tissue are rare. Patients and methods Freshly drawn blood samples were analyzed using three-color FISH (fluorescence in situ hybridization) to measure individual radiosensitivity via chromosomal aberrations after irradiation (2 Gy). Thresholds of 0.5 and 0.6 breaks/metaphase (B/M) indicate moderate or clearly increased radiosensitivity. Results The cohorts consisted of healthy individuals (NEG, n = 219), radiosensitive patients (POS, n = 24), cancer patients (n = 452) and cancer patients during KI therapy (n = 49). In healthy individuals radiosensitivity (≥ 0.6 B/M) was clearly increased in 5% of all cases, while in the radiosensitive cohort 79% were elevated. KI therapy increased the rate of sensitive patients (≥ 0.6 B/M) to 35% significantly compared to 19% in cancer patients without KI (p = 0.014). Increased radiosensitivity of peripheral blood mononuclear cells (PBMCs) among patients occurred in six of seven KI subgroups. The mean B/M values significantly increased during KI therapy (0.47 ± 0.20 B/M without compared to 0.50 ± 0.19 B/M with KI, p = 0.047). Conclusions Kinase inhibitors can intensify individual radiosensitivity of PBMCs distinctly in 85% of tested drugs.
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Affiliation(s)
- Tina Jost
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. .,Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Barbara Schuster
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lucie Heinzerling
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital München, Ludwig-Maximilian-Universität (LMU), Munich, Germany
| | - Thomas Weissmann
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Luitpold V Distel
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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11
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Lee HW. Multidiscipline Immunotherapy-Based Rational Combinations for Robust and Durable Efficacy in Brain Metastases from Renal Cell Carcinoma. Int J Mol Sci 2021; 22:ijms22126290. [PMID: 34208157 PMCID: PMC8230742 DOI: 10.3390/ijms22126290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
Advanced imaging techniques for diagnosis have increased awareness on the benefits of brain screening, facilitated effective control of extracranial disease, and prolonged life expectancy of metastatic renal cell carcinoma (mRCC) patients. Brain metastasis (BM) in patients with mRCC (RCC-BM) is associated with grave prognoses, a high degree of morbidity, dedicated assessment, and unresponsiveness to conventional systemic therapeutics. The therapeutic landscape of RCC-BM is rapidly changing; however, survival outcomes remain poor despite standard surgery and radiation, highlighting the unmet medical needs and the requisite for advancement in systemic therapies. Immune checkpoint inhibitors (ICIs) are one of the most promising strategies to treat RCC-BM. Understanding the role of brain-specific tumor immune microenvironment (TIME) is important for developing rationale-driven ICI-based combination strategies that circumvent tumor intrinsic and extrinsic factors and complex positive feedback loops associated with resistance to ICIs in RCC-BM via combination with ICIs involving other immunological pathways, anti-antiangiogenic multiple tyrosine kinase inhibitors, and radiotherapy; therefore, novel combination approaches are being developed for synergistic potential against RCC-BM; however, further prospective investigations with longer follow-up periods are required to improve the efficacy and safety of combination treatments and to elucidate dynamic predictive biomarkers depending on the interactions in the brain TIME.
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Affiliation(s)
- Hye-Won Lee
- Center for Urologic Cancer, National Cancer Center, Department of Urology, Goyang 10408, Korea
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