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Carril-Ajuria L, Lavaud P, Dalban C, Negrier S, Gravis G, Motzer RJ, Chevreau C, Tannir NM, Oudard S, McDermott DF, Laguerre B, Hammers HJ, Barthelemy P, Plimack ER, Borchiellini D, Gross-Goupil M, Jiang R, Lee CW, de Silva H, Rini BI, Escudier B, Albigès L. Validation of the Lung Immune Prognostic Index (LIPI) as a prognostic biomarker in metastatic renal cell carcinoma. Eur J Cancer 2024; 204:114048. [PMID: 38653033 DOI: 10.1016/j.ejca.2024.114048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The Lung Immune Prognostic Index (LIPI) is associated with immune checkpoint inhibitors (ICI) outcomes across different solid tumors, particularly in non-small cell lung cancer. Data regarding the prognostic and/or predictive role of LIPI in metastatic renal cell carcinoma (mRCC) are still scarce. The aim of this study was to evaluate whether LIPI could be predictive of survival in mRCC patients. METHODS We used patient level data from three different prospective studies (NIVOREN trial: nivolumab; TORAVA trial: VEGF/VEGFR-targeted therapy (TT); CheckMate 214: nivolumab-ipilimumab vs sunitinib). LIPI was calculated based on a derived neutrophils/(leukocyte-neutrophil) ratio > 3 and lactate-dehydrogenase >upper limit of normal, classifying patients into three groups (LIPI good, 0 factors;LIPI intermediate (int), 1 factor;LIPI poor, 2 factors) and/or into two groups (LIPI good, 0 factors;LIPI int/poor, 1-2 factors) according to trial sample size. Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS In the Nivolumab dataset (n = 619), LIPI was significantly associated with OS (LIPI-good 30.1 vs 13.8 months in the LIPI int/poor; HR= 0.47) and PFS (HR=0.74). In the VEGF/VEGFR-TT dataset (n = 159), only a correlation with PFS was observed. In the CheckMate214 dataset (n = 1084), LIPI was significantly associated with OS (nivolumab-ipilimumab OS LIPI good vs int/poor: HR=0.55, p < 0.0001; sunitinib: OS LIPI good vs int/poor: 0.38, p < 0.0001) in both treatment groups in univariate and multivariate analysis. CONCLUSIONS Pretreatment-LIPI correlated with worse survival outcomes in mRCC treated with either ICI or antiangiogenic therapy, confirming LIPI's prognostic role in mRCC irrespective of systemic treatment used.
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Affiliation(s)
| | | | - Cecile Dalban
- Department of Biostatistics, Centre Leon Bernard, Lyon, France
| | | | | | | | | | - Nizar M Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stéphane Oudard
- Hôpital Européen Georges Pompidou, Oncology department, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | | | | | | | | | | | - Marine Gross-Goupil
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
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2
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Mourey L, Rainho LT, Dalban C, Carril-Ajuria L, Negrier S, Chevreau C, Gravis G, Thibault C, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Tantot F, Chaput N, Naigeon M, Teixeira M, Escudier B, Flippot R, Albiges L. Safety and efficacy of nivolumab in elderly patients with metastatic clear cell renal cell carcinoma: Analysis of the NIVOREN GETUG-AFU 26 study. Eur J Cancer 2024; 201:113589. [PMID: 38382153 DOI: 10.1016/j.ejca.2024.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Immune checkpoint inhibitors are standard of care in metastatic renal cell carcinoma but their activity and safety in elderly patients is insufficiently explored. We evaluated outcomes of elderly patients with mRCC treated with nivolumab in the GETUG-AFU 26 NIVOREN phase 2 trial (NCT03013335) and conducted exploratory circulating biomarker analyses. METHODS Patients with mRCC were treated with nivolumab after at least one antiangiogenic therapy. The main endpoint of this analysis was safety in patients ≥ 70 years old (y.o), as per the rate of treatment-related grade 3-5 events (TRAE). Secondary endpoints included overall response rate (ORR), progression-free survival (PFS), overall survival. Exploration of candidate biomarkers associated with aging included baseline circulating cytokines involved in inflammation, adhesion, immune checkpoints, angiogenesis (IL6, IL7, IL8, BAFF, CXCL13, VCAM-1, 4-1BB, VEGF). RESULTS Of 720 patients, 515 were < 70 y.o and 205 ≥ 70 y.o. Patients ≥ 70 y.o exhibited numerically less IMDC poor risk disease (21.0% vs 26.9%), sarcomatoid component (4.9% vs 9.8%) or brain metastases (5.9% vs. 14.7%), but more previous treatment lines (≥ 2 in 54.1% vs 48.5%). TRAE were higher in patients ≥ 70 y.o (24.9% vs. 17.9%, p = 0.033). Respective ORR (19.2% vs. 22.1%) and median PFS (4.5 versus 3.0 months, HR 0.97 [95%CI 0.81-1.15]) were similar. Overall survival was shorter in patients ≥ 70 y.o (19.3 versus 26.9 months, HR 1.26 [95%CI 1.04-1.51]), but not significantly in a competitive risk model. Only V-CAM1 and 4-1BB were found to be increased in patients ≥ 70 y.o. CONCLUSIONS Nivolumab displayed higher grade 3/4 TRAE but manageable toxicity in elderly patients, with sustained activity. Elderly patients did not display specific inflammatory or angiogenic circulating profiles.
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Affiliation(s)
- Loïc Mourey
- IUCT-Oncopole Claudius Regaud, Toulouse, France
| | - Larissa Tames Rainho
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | - Lucía Carril-Ajuria
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | | | - Gwenaëlle Gravis
- Institut Paoli-Calmettes, Department of Medical Oncology, Aix Marseille Univ, INSERM, CNRS, CRCM, Immunity and Cancer Team, Marseille, France
| | | | | | | | | | - Marine Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire Saint-André, Bordeaux, France
| | | | | | | | | | - Nathalie Chaput
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marie Naigeon
- Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Marcus Teixeira
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Bernard Escudier
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France; Immunomonitoring Laboratory, UMS CNRS3655 & INSERM US23, Gustave Roussy, Paris Saclay University, Villejuif, France.
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Montemagno C, Jacquel A, Pandiani C, Rastoin O, Dawaliby R, Schmitt T, Bourgoin M, Palenzuela H, Rossi AL, Ambrosetti D, Durivault J, Luciano F, Borchiellini D, Le Du J, Gonçalves LCP, Auberger P, Benhida R, Kinget L, Beuselinck B, Ronco C, Pagès G, Dufies M. Unveiling CXCR2 as a promising therapeutic target in renal cell carcinoma: exploring the immunotherapeutic paradigm shift through its inhibition by RCT001. J Exp Clin Cancer Res 2024; 43:86. [PMID: 38504270 PMCID: PMC10949812 DOI: 10.1186/s13046-024-02984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In clear cell renal cell carcinoma (ccRCC), first-line treatment combines nivolumab (anti-PD-1) and ipilimumab (anti-CTLA4), yielding long-term remissions but with only a 40% success rate. Our study explored the potential of enhancing ccRCC treatment by concurrently using CXCR2 inhibitors alongside immunotherapies. METHODS We analyzed ELR + CXCL levels and their correlation with patient survival during immunotherapy. RCT001, a unique CXCR2 inhibitor, was examined for its mechanism of action, particularly its effects on human primary macrophages. We tested the synergistic impact of RCT001 in combination with immunotherapies in both mouse models of ccRCC and human ccRCC in the presence of human PBMC. RESUTS Elevated ELR + CXCL cytokine levels were found to correlate with reduced overall survival during immunotherapy. RCT001, our optimized compound, acted as an inverse agonist, effectively inhibiting angiogenesis and reducing viability of primary ccRCC cells. It redirected M2-like macrophages without affecting M1-like macrophage polarization directed against the tumor. In mouse models, RCT001 enhanced the efficacy of anti-CTLA4 + anti-PD1 by inhibiting tumor-associated M2 macrophages and tumor-associated neutrophils. It also impacted the activation of CD4 T lymphocytes, reducing immune-tolerant lymphocytes while increasing activated natural killer and dendritic cells. Similar effectiveness was observed in human RCC tumors when RCT001 was combined with anti-PD-1 treatment. CONCLUSIONS RCT001, by inhibiting CXCR2 through its unique mechanism, effectively suppresses ccRCC cell proliferation, angiogenesis, and M2 macrophage polarization. This optimization potentiates the efficacy of immunotherapy and holds promise for significantly improving the survival prospects of metastatic ccRCC patients.
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Affiliation(s)
| | | | - Charlotte Pandiani
- Institute for Research On Cancer and Aging (IRCAN), UMR 7284 and INSERM U1081, Université Côte d'Azur, CNRS, 33 Avenue de Valombrose, 06107, Nice, France
| | | | | | | | | | | | - Anne-Laure Rossi
- Institute for Research On Cancer and Aging (IRCAN), UMR 7284 and INSERM U1081, Université Côte d'Azur, CNRS, 33 Avenue de Valombrose, 06107, Nice, France
| | - Damien Ambrosetti
- Department of Pathology, Université Côte d'Azur, CHU Nice, Nice, France
| | - Jerome Durivault
- Biomedical Department, Centre Scientifique de Monaco (CSM), 98000, Monaco, Monaco
| | - Frederic Luciano
- Institute for Research On Cancer and Aging (IRCAN), UMR 7284 and INSERM U1081, Université Côte d'Azur, CNRS, 33 Avenue de Valombrose, 06107, Nice, France
| | - Delphine Borchiellini
- Centre Antoine Lacassagne, Department of Medical Oncology, Université Côte d'Azur, Nice, France
| | | | | | | | - Rachid Benhida
- Roca Therapeutics, 06000, Nice, France
- Institut de Chimie de Nice, UMR 7272, Université Côte d'Azur, CNRS, 06108, Nice, France
| | - Lisa Kinget
- Department of General Medical Oncology, University Hospitals Leuven, 3000, Louvain, Belgium
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, 3000, Louvain, Belgium
| | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, 3000, Louvain, Belgium
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, 3000, Louvain, Belgium
| | - Cyril Ronco
- Roca Therapeutics, 06000, Nice, France
- Institut de Chimie de Nice, UMR 7272, Université Côte d'Azur, CNRS, 06108, Nice, France
- Institut Universitaire de France (IUF), Paris, France
| | - Gilles Pagès
- Institute for Research On Cancer and Aging (IRCAN), UMR 7284 and INSERM U1081, Université Côte d'Azur, CNRS, 33 Avenue de Valombrose, 06107, Nice, France.
- Roca Therapeutics, 06000, Nice, France.
| | - Maeva Dufies
- Institute for Research On Cancer and Aging (IRCAN), UMR 7284 and INSERM U1081, Université Côte d'Azur, CNRS, 33 Avenue de Valombrose, 06107, Nice, France.
- Roca Therapeutics, 06000, Nice, France.
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Colomba E, Jonas SF, Eymard JC, Delva R, Brachet PE, Neuzillet Y, Penel N, Roubaud G, Bompas E, Mahammedi H, Longo R, Helissey C, Barthélemy P, Borchiellini D, Hasbini A, Priou F, Saldana C, Voog E, Narcisso B, Ladoire S, Berdah JF, Aisenfarb JB, Foulon S, Fizazi K. A Randomized, Open-label, Cross-over Phase 2 Trial of Darolutamide and Enzalutamide in Men with Asymptomatic or Mildly Symptomatic Metastatic Castrate-resistant Prostate Cancer: Patient Preference and Cognitive Function in ODENZA. Eur Urol 2024; 85:274-282. [PMID: 37271630 DOI: 10.1016/j.eururo.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Darolutamide and enzalutamide are second-generation androgen receptor inhibitors with activity in men with castrate-resistant prostate cancer (CRPC) and different toxicity profiles. OBJECTIVE ODENZA is a prospective, randomized, multicenter, cross-over, phase 2 trial designed to assess preference between darolutamide and enzalutamide in men with asymptomatic or mildly symptomatic metastatic CRPC (mCRPC). DESIGN, SETTING, AND PARTICIPANTS Patients were randomized 1:1 to receive either darolutamide 1200 mg/d for 12 wk followed by enzalutamide 160 mg/d for 12 wk or enzalutamide followed by darolutamide. In both arms, the second treatment was given in absence of cancer progression. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was patient preference between the two drugs, as assessed by a preference questionnaire (p value calculated with the Prescott test). After week 24, patients entered an extension period during which they received their preferred treatment until progression or toxicity. The main secondary objectives included reasons for patient preference, response at week 12, tolerance of each drug, and measurement compared with baseline of cognitive outcomes assessed using tablet questionnaires. RESULTS AND LIMITATIONS Overall, 249 patients, with a median age of 72 yr, were randomized. Among the 200 patients who fulfilled the preplanned criteria for the evaluation of the primary endpoint of preference, 97 (49% [41; 56]), 80 (40% [33; 47]), and 23 (12% [7; 16]) chose darolutamide, chose enzalutamide, and had no preference, respectively (p = 0.92). Reduced fatigue, easier administration, and better quality of life were the main criteria that influenced patient choice. A moderate benefit in episodic memory from darolutamide was observed for the acquisition of new information (least square [LS] means difference = 2.2, effect size = 0.5) and for the recall of that information after a brief delay (LS means difference = 0.7, effect size = 0.3). Using the Brief Fatigue Inventory questionnaire, patients reported greater fatigue with enzalutamide (3.3 [3.0; 3.6]) than with darolutamide (2.7 [2.4; 3.0]). There was no difference in terms of depression, seizures, and falls. CONCLUSIONS The study did not show a difference in preference between the two treatments. In men with mCRPC, darolutamide was associated with a clinically meaningful benefit in episodic memory and less fatigue compared with enzalutamide. PATIENT SUMMARY Preference between darolutamide and enzalutamide was well balanced in men with castrate-resistant prostate cancer. Darolutamide was associated with a significant benefit in verbal learning and less fatigue compared with enzalutamide.
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Affiliation(s)
- Emeline Colomba
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France.
| | - Sarah Flora Jonas
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris Saclay University, Villejuif, France
| | | | | | | | - Yann Neuzillet
- Department of Urology, Hospital Foch, University of Paris Saclay - UVSQ, Suresnes, France
| | - Nicolas Penel
- Lille University, Lille, France; Centre Oscar Lambret, Lille, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | | | | | | | | | | | - Ali Hasbini
- Clinique Pasteur De Brest CFRO, Brest, France
| | | | | | - Eric Voog
- Centre Jean Bernard, Le Mans, France
| | | | | | | | | | - Stéphanie Foulon
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Karim Fizazi
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France
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5
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Plimack ER, Powles T, Stus V, Gafanov R, Nosov D, Waddell T, Alekseev B, Pouliot F, Melichar B, Soulières D, Borchiellini D, McDermott RS, Vynnychenko I, Chang YH, Tamada S, Atkins MB, Li C, Perini R, Molife LR, Bedke J, Rini BI. Corrigendum to "Pembrolizumab Plus Axitinib Versus Sunitinib as First-line Treatment of Advanced Renal Cell Carcinoma: 43-month Follow-up of the Phase 3 KEYNOTE-426 Study" [Eur Urol 84(5) (2023) 449-454]. Eur Urol 2024; 85:e58-e59. [PMID: 38071169 DOI: 10.1016/j.eururo.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Affiliation(s)
| | - Thomas Powles
- Barts Health NHS Trust and the Royal Free NHS Foundation Trust, Barts Cancer Institute, London, UK; Queen Mary University of London, London, UK
| | - Viktor Stus
- Dnipro State Medical University, Dnipro, Dnipropetrovsk Oblast, Ukraine
| | - Rustem Gafanov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - Dmitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russia
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Boris Alekseev
- P. A. Herzen Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Bohuslav Melichar
- Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Raymond S McDermott
- Adelaide and Meath Hospital, University College Dublin, Belfield, Dublin, Ireland
| | - Ihor Vynnychenko
- Sumy Regional Oncology Center, Sumy State University, Sumy, Sumy Oblast, Ukraine
| | | | | | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | | | | | - Jens Bedke
- University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Brian I Rini
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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6
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Guilhem-Ducléon G, Dalban C, Negrier S, Gravis G, Laguerre B, Chevreau C, Oudard S, Barthelemy P, Ladoire S, Boughalem E, Borchiellini D, Linassier C, Nenan S, Flippot R, Albiges L, Goupil MG. Impact of First Line Antiangiogenic Therapy Duration on Nivolumab Outcome in Metastatic Renal Cell Carcinoma Patients Treated in the GETUG-AFU 26 NIVOREN. Clin Genitourin Cancer 2023; 21:643-652. [PMID: 37635052 DOI: 10.1016/j.clgc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In metastatic renal clear cell carcinoma (ccRCC), vascular endothelial growth factor receptor (VEGFR) and immune checkpoint are 2 main therapeutic targets. We investigated the impact of duration exposure to antiangiogenic on immunotherapy clinical outcomes in metastatic ccRCC. METHODS Patients from NIVOREN trial who received nivolumab after only 1 prior antiangiogenic therapy were included. Response rate, clinical benefit, progression free survival (PFS) and overall survival (OS) were prospectively analyzed depending on the duration of the first line (< 6 months, ≥6 months) and exploratory in patients with long first line exposure (≥18 months). The circulating levels of 8 plasma proteins and cytokines at baseline were collected and compared according to first line antiangiogenic duration. RESULTS Among 354 patients, 127 (36%) and 227 (64%) patients had received first line antiangiogenic for < 6months and ≥ 6months respectively. Respective duration of first line therapy was not associated with objective response to nivolumab (20.5% vs. 23.9%, P = .50), or PFS (HR 0.92; P = .421). Median OS was respectively 16.6 and 31.3 months in the <6 and ≥6 months subgroups respectively. Adjusted on international metastatic renal cell carcinoma database consortium risk, age and metastatic site, OS was longer in patients with longer treatment duration in the first line setting (HR 0.73; P = .017). Duration of first line VEGFR TKI was independent from circulating levels of 8 proteins and cytokines at nivolumab baseline. CONCLUSION Nivolumab activity in second line is independent from first-line duration of VEGFR TKI. However, first line VEGFR TKI duration ≥ 6 months is associated with longer OS.
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Affiliation(s)
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre de Lutte Contre Le Cancer, Centre Léon Bérard, Lyon, France
| | | | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Paris, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Elouen Boughalem
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, 49055 Angers, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Claude Linassier
- Department of Medical Oncology, CHU Bretonneau et Université de Tours, Tours, France
| | | | - Ronan Flippot
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Marine Gross Goupil
- Department of Medical Oncology, University Hospital of Bordeaux, Bordeaux, France.
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7
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Plimack ER, Powles T, Stus V, Gafanov R, Nosov D, Waddell T, Alekseev B, Pouliot F, Melichar B, Soulières D, Borchiellini D, McDermott RS, Vynnychenko I, Chang YH, Tamada S, Atkins MB, Li C, Perini R, Molife LR, Bedke J, Rini BI. Pembrolizumab Plus Axitinib Versus Sunitinib as First-line Treatment of Advanced Renal Cell Carcinoma: 43-month Follow-up of the Phase 3 KEYNOTE-426 Study. Eur Urol 2023; 84:449-454. [PMID: 37500340 DOI: 10.1016/j.eururo.2023.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 07/29/2023]
Abstract
Previous analyses of KEYNOTE-426, an open-label, phase 3 randomized study, showed superior efficacy of first-line pembrolizumab plus axitinib to sunitinib in advanced clear cell renal cell carcinoma (ccRCC). We report results of the final protocol-prespecified analysis of KEYNOTE-426. Patients received pembrolizumab 200 mg intravenously every 3 wk plus axitinib 5 mg orally twice daily or sunitinib 50 mg orally once daily (4 wk per 6-wk cycle). The dual primary endpoints were overall survival (OS) and progression-free survival (PFS) as per RECIST v1.1 by a blinded independent central review. The secondary endpoints included objective response rate (ORR) and duration of response (DOR). The median study follow-up was 43 (range, 36-51) mo. Benefit with pembrolizumab plus axitinib versus sunitinib was maintained for OS (hazard ratio [HR], 0.73 [95% confidence interval {CI}, 0.60-0.88]), PFS (HR, 0.68 [95% CI, 0.58-0.80]), and ORR (60% vs 40%). The median DOR was 24 (range, 1.4+ to 43+) versus 15 (range, 2.3-43+) mo in the pembrolizumab plus axitinib versus the sunitinib arm. No new safety signals emerged. These results support pembrolizumab plus axitinib as a standard of care for patients with previously untreated advanced ccRCC. PATIENT SUMMARY: Extended results of KEYNOTE-426 support pembrolizumab plus axitinib as the standard of care for advanced clear cell renal cell carcinoma.
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Affiliation(s)
| | - Thomas Powles
- Barts Health NHS Trust and the Royal Free NHS Foundation Trust, Barts Cancer Institute, London, UK; Queen Mary University of London, London, UK
| | - Viktor Stus
- Dnipro State Medical University, Dnipro, Dnipropetrovsk Oblast, Ukraine
| | - Rustem Gafanov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - Dmitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russia
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Boris Alekseev
- P. A. Herzen Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Bohuslav Melichar
- Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Raymond S McDermott
- Adelaide and Meath Hospital, University College Dublin, Belfield, Dublin, Ireland
| | - Ihor Vynnychenko
- Sumy Regional Oncology Center, Sumy State University, Sumy, Sumy Oblast, Ukraine
| | | | | | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | | | | | - Jens Bedke
- University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Brian I Rini
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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8
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Plimack ER, Powles T, Stus V, Gafanov R, Nosov D, Waddell T, Alekseev B, Pouliot F, Melichar B, Soulières D, Borchiellini D, McDermott RS, Vynnychenko I, Chang YH, Tamada S, Atkins MB, Li C, Perini R, Rhoda Molife L, Bedke J, Rini BI. Corrigendum to "Pembrolizumab Plus Axitinib Versus Sunitinib as First-line Treatment of Advanced Renal Cell Carcinoma: 43-month Follow-up of the Phase 3 KEYNOTE-426 Study" [Eur. Urol. (2023)]. Eur Urol 2023; 84:e123-e124. [PMID: 37666734 DOI: 10.1016/j.eururo.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
| | - Thomas Powles
- Barts Health NHS Trust and the Royal Free NHS Foundation Trust, Barts Cancer Institute, London, UK; Queen Mary University of London, London, UK
| | - Viktor Stus
- Dnipro State Medical University, Dnipro, Dnipropetrovsk Oblast, Ukraine
| | - Rustem Gafanov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - Dmitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russia
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Boris Alekseev
- P. A. Herzen Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Bohuslav Melichar
- Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Raymond S McDermott
- Adelaide and Meath Hospital, University College Dublin, Belfield, Dublin, Ireland
| | - Ihor Vynnychenko
- Sumy Regional Oncology Center, Sumy State University, Sumy, Sumy Oblast, Ukraine
| | | | | | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | | | | | - Jens Bedke
- University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Brian I Rini
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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9
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Baudry E, Naoun N, Auclin E, Saldana C, Barthelemy P, Geoffrois L, Thibault C, de Vries-Brilland M, Borchiellini D, Maillet D, Hirsch L, Vauchier C, Carril-Ajuria L, Colomba E, Bernard-Tessier A, Escudier B, Flippot R, Albigès L. Efficacy and safety of cabozantinib rechallenge in metastatic renal cell carcinoma: A retrospective multicentric study. Eur J Cancer 2023; 193:113292. [PMID: 37717282 DOI: 10.1016/j.ejca.2023.113292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Despite metastatic renal cell carcinoma (mRCC) expanded treatment options, disease progression ultimately occurs for most patients. Rechallenge may be a compelling strategy in a refractory setting. Cabozantinib is the standard of care in first and later lines of therapy, but its activity in rechallenge is unknown. METHODS This retrospective study assessed the efficacy and safety of cabozantinib rechallenge, as defined by a second exposure after an interval of ≥3 months without treatment or ≥1 other treatment line, in patients with mRCC. The primary endpoint was median progression-free survival (PFS) at rechallenge. Secondary endpoints included overall survival, objective response rate, and safety at rechallenge. RESULTS We included 51 mRCC patients who received cabozantinib in a rechallenge setting between 2017 and 2022. Median age at diagnosis was 54 years, 78% were male, 90% had clear cell mRCC, and 92% had prior nephrectomy. 15 patients (29%) were rechallenged after a pause in treatment, whereas 36 (70.6%) had ≥1 other treatment lines between first cabozantinib exposure (CABO-1) and rechallenge (CABO-2). Median PFS was 15.1 months (mo, 95% Confidence interval 11.2-22.1) at CABO-1 and 14.4mo (95%CI 9.8-NR) at CABO-2. Median overall survival was 67.6mo for CABO-1 (95% CI 52.2-NR) and 27.4mo for CABO-2 (95%CI 17.2-NR); objective response rate was 70.6% for CABO-1 and 60% for CABO-2. CABO-2 PFS was higher for patients with CABO-1 PFS > 12 months, and for those who discontinued CABO-1 because of toxicity, without statistical significance. There were no unexpected adverse events. CONCLUSIONS Cabozantinib rechallenge is a feasible treatment option with potential clinical benefit for mRCC patients.
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Affiliation(s)
- Edwige Baudry
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France; Institut de Cancérologie de Lorraine, Department of Medical Oncology, Université de Lorraine, Nancy 54000, France
| | - Natacha Naoun
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France
| | - Edouard Auclin
- Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Department of Medical Oncology, Université Paris Cité, Paris 75015, France
| | - Carolina Saldana
- Hôpital Henri Mondor, AP-HP, Department of Medical Oncology, Université de Paris, Créteil 94000, France
| | - Philippe Barthelemy
- Institut de Cancérologie Strasbourg Europe, Department of Medical Oncology, Strasbourg 67200, France
| | - Lionnel Geoffrois
- Institut de Cancérologie de Lorraine, Department of Medical Oncology, Université de Lorraine, Nancy 54000, France
| | - Constance Thibault
- Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Department of Medical Oncology, Université Paris Cité, Paris 75015, France
| | - Manon de Vries-Brilland
- Institut de Cancérologie de l'Ouest, Department of Medical Oncology, Université d'Angers, Angers 49055, France
| | - Delphine Borchiellini
- Centre Antoine-Lacassagne, Department of Medical Oncology, Université Côte d'Azur, Nice 06100, France
| | - Denis Maillet
- Hôpital Lyon-Sud, Université de Lyon, Department of Medical Oncology, Pierre-Bénite 69495, France; Faculté de médecine Jacques Lisfranc, Saint Etienne 42270, France
| | - Laure Hirsch
- Hôpital Cochin-Port Royal, Department of Medical Oncology, AP-HP, Paris 75014, France
| | - Charles Vauchier
- Hôpital Bichat, AP-HP, Department of Thoracic Oncology, Université de Paris, Paris 75018, France
| | - Lucia Carril-Ajuria
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France; CHU Saint Pierre/CHU Brugmann, Brussels, Belgium
| | - Emeline Colomba
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France
| | - Alice Bernard-Tessier
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France
| | - Bernard Escudier
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France
| | - Ronan Flippot
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France
| | - Laurence Albigès
- Gustave Roussy, Department of Cancer Medicine, Université Paris-Saclay, Villejuif, France.
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10
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Billon E, Dalban C, Oudard S, Chevreau C, Laguerre B, Barthélémy P, Borchiellini D, Geoffrois L, Negrier S, Joly F, Thiery-Vuillemin A, Gross-Goupil M, Rolland F, Priou F, Mahammedi H, Tantot F, Escudier B, Chabaud S, Albiges L, Gravis G. Adrenal Metastases Are Associated with Poor Outcomes in Patients with Metastatic Clear Cell Renal Cell Carcinoma Treated with Nivolumab in the GETUG-AFU-26 NIVOREN Phase 2 Trial. Eur Urol Oncol 2023:S2588-9311(23)00200-6. [PMID: 37813745 DOI: 10.1016/j.euo.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Glandular metastases (GMs; adrenal gland, pancreas, thyroid, ovary, breast, or prostate) are rare in metastatic clear cell renal cell carcinoma (mccRCC). Previous studies have indicated that GM patients treated with antiangiogenic therapy experience significantly longer overall survival (OS). OBJECTIVES To assess outcomes for mccRCC with or without GMs treated with nivolumab. DESIGN, SETTING, AND PARTICIPANTS The GETUG-AFU-26 NIVOREN phase 2 trial evaluated the activity and safety of nivolumab in patients with mccRCC who experienced failure of antiangiogenic therapies (NCT03013335). In this ancillary study, patients were divided into two groups according to the presence or absence of at least one GM. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was OS; secondary outcomes were progression-free survival (PFS) and the objective response rate (ORR). Survival was estimated using the Kaplan-Meier method. Univariate and multivariable Cox regression models are used to estimate the hazard ratio (HR) with 95% confidence interval (CI) for survival outcomes. Subgroup analyses were performed for patients with pancreatic metastases and patients with adrenal metastases. RESULTS AND LIMITATIONS Among 720 patients treated with nivolumab between February 2016 and July 2017, 217 had GMs, of whom 151/217 had adrenal metastases and 86/217 had pancreatic metastasis. Patients with adrenal metastases had worse 12-mo OS (64% vs 71.1%) and 6-mo PFS (27.2% vs 36.6%) and a lower objective response rate (12.5%, 95% CI 7.6%-19.0%, vs 23.2%, 95% CI 19.8-27.0%; p = 0.005) than patients without adrenal metastases. Conversely, univariate analysis showed that patients with pancreatic metastases had significantly better 12-mo OS (82.3% vs 67.9%; HR 0.59, 95% CI 0.40-0.85) in comparison to patients with nonpancreatic GMs. On multivariable analysis, only adrenal metastasis remained associated with adverse prognosis. CONCLUSIONS Adrenal metastasis is an independent prognostic factor for poor response and survival in the GETUG-AFU-26 NIVOREN trial. Limited activity with nivolumab was observed for patients with mccRCC with adrenal metastases. These results warrant an evaluation of the prognostic value of adrenal metastases in patients treated with immunotherapy combinations with ipilimumab or tyrosine kinase inhibitors. PATIENT SUMMARY Our study showed that metastasis in the adrenal glands could be an independent factor associated with poor response to immunotherapy and survival for patients with metastatic kidney cancer. It would be useful to evaluate the prognostic value of adrenal gland metastasis in patients treated with immunotherapy combinations or immunotherapy agents combined with drugs called tyrosine kinase inhibitors.
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Affiliation(s)
- Emilien Billon
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.
| | | | - Stephane Oudard
- Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | | | | | | | | | - Lionnel Geoffrois
- Institut de Cancérologie de Lorraine, Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France
| | | | | | | | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | | | - Frank Priou
- CHD Vendee-Hopital Les Oudairies, La Roche-Sur-Yon, France
| | | | | | | | | | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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11
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O'Donnell PH, Milowsky MI, Petrylak DP, Hoimes CJ, Flaig TW, Mar N, Moon HH, Friedlander TW, McKay RR, Bilen MA, Srinivas S, Burgess EF, Ramamurthy C, George S, Geynisman DM, Bracarda S, Borchiellini D, Geoffrois L, Maroto Rey JP, Ferrario C, Carret AS, Yu Y, Guseva M, Homet Moreno B, Rosenberg JE. Enfortumab Vedotin With or Without Pembrolizumab in Cisplatin-Ineligible Patients With Previously Untreated Locally Advanced or Metastatic Urothelial Cancer. J Clin Oncol 2023; 41:4107-4117. [PMID: 37369081 PMCID: PMC10852367 DOI: 10.1200/jco.22.02887] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/26/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Patients with locally advanced or metastatic urothelial cancer (la/mUC) who are ineligible for cisplatin-based therapy have limited first-line (1L) treatment options and significant need for improved therapies. Enfortumab vedotin (EV) and pembrolizumab (Pembro) individually have shown a survival benefit in urothelial cancer in second-line + la/mUC settings. Here, we present data from the pivotal trial of EV plus Pembro (EV + Pembro) in the 1L setting. PATIENTS AND METHODS In Cohort K of the EV-103 phase Ib/II study, cisplatin-ineligible patients with previously untreated la/mUC were randomly assigned 1:1 to receive EV as monotherapy or in combination with Pembro. The primary end point was confirmed objective response rate (cORR) per blinded independent central review. Secondary end points included duration of response (DOR) and safety. There were no formal statistical comparisons between treatment arms. RESULTS The cORR was 64.5% (95% CI, 52.7 to 75.1) and 45.2% (95% CI, 33.5 to 57.3) for patients treated with EV + Pembro (N = 76) and EV monotherapy (N = 73), respectively. The median DOR was not reached for the combination and was 13.2 months for monotherapy; 65.4% and 56.3% of patients who responded to the combination and monotherapy, respectively, maintained a response at 12 months. The most common grade 3 or higher treatment-related adverse events (TRAEs) in patients treated with the combination were maculopapular rash (17.1%), fatigue (9.2%), and neutropenia (9.2%). EV TRAEs of special interest (any grade) in the combination arm included skin reactions (67.1%) and peripheral neuropathy (60.5%). CONCLUSION EV + Pembro showed a high cORR with durable responses as 1L treatment in cisplatin-ineligible patients with la/mUC. Patients who received EV monotherapy had a response and safety profile consistent with previous studies. Adverse events for EV + Pembro were manageable, with no new safety signals observed.
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Affiliation(s)
| | - Matthew I. Milowsky
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Thomas W. Flaig
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | | | - Helen H. Moon
- Kaiser Permanente Southern California, Riverside, CA
| | | | - Rana R. McKay
- University of California at San Diego, San Diego, CA
| | | | | | | | - Chethan Ramamurthy
- University of Texas Health Sciences Center at San Antonio, San Antonio, TX
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12
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Velev M, Dalban C, Chevreau C, Gravis G, Negrier S, Laguerre B, Gross-Goupil M, Ladoire S, Borchiellini D, Geoffrois L, Joly F, Priou F, Barthelemy P, Laramas M, Narciso B, Thiery-Vuillemin A, Berdah JF, Ferrari V, Dominique Thomas Q, Mione C, Curcio H, Oudard S, Tantot F, Escudier B, Chabaud S, Albiges L, Thibault C. Efficacy and safety of nivolumab in bone metastases from renal cell carcinoma: Results of the GETUG-AFU26-NIVOREN multicentre phase II study. Eur J Cancer 2023; 182:66-76. [PMID: 36746010 DOI: 10.1016/j.ejca.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Bone metastases (BM) in renal cell carcinoma (RCC) are associated with a poor prognosis based on retrospective studies evaluating antiangiogenic agents. Few data are available regarding immune checkpoint inhibitors (ICI) in patients with bone metastatic RCC. NIVOREN is a multicentre prospective study in which patients were treated with nivolumab after the failure of antiangiogenic agents. We aim to assess the impact of BM on prognosis, and the efficacy and safety of nivolumab in patients enrolled in the NIVOREN trial. MATERIALS AND METHODS All patients with BM at inclusion were included in our study. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), objective response rate (ORR), safety, and skeletal-related events (SRE). RESULTS Among 720 patients treated with nivolumab, 194 presented BM at inclusion. The median follow-up was 23.9 months. Median OS was 17.9 months in patients with BM versus 26.1 months in patients without BM (p = 0.0023). The difference was not statistically significant after adjustment (p = 0.0707). The median PFS was shorter in patients with BM even after adjustment (2.8 versus 4.6 months, p = 0.0045), as well as the ORR (14.8% versus 23.3%). SRE occurred for 36% of patients with BM. A post-hoc analysis evaluating the impact of bone-targeting agents (BTA) on SRE incidence showed a significant benefit of BTA on the incidence of SRE (OR = 0.367, CI95% [0.151-0.895]). CONCLUSION Nivolumab is associated with shorter PFS, and lower ORR in RCC patients with BM. Our study suggests that BTA in association with immunotherapy decreases the incidence of SRE.
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Affiliation(s)
- Maud Velev
- Departement of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Service d'oncologie médicale, Université Paris Cité, 20 rue Leblanc, 75015, Paris, France.
| | - Cécile Dalban
- Centre Léon Bérard Direction de la Recherche Clinique et de l'Innovation, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Christine Chevreau
- Institut Universitaire du Cancer Toulouse-Oncopole, Service d'oncologie médicale, 1 Av. Irène Joliot-Curie, 31100, Toulouse, France.
| | - Gwenaelle Gravis
- Institut Paoli Calmettes, Service d'oncologie médicale, 232 Bd de Sainte-Marguerite, 13009, Marseille, France.
| | - Sylvie Negrier
- Centre Léon Bérard, université Lyon I, Service oncologie médicale, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.
| | - Brigitte Laguerre
- Centre Eugene Marquis, Service d'oncologie médicale, Av. de la Bataille Flandres-Dunkerque CS 44229, 35000, Rennes, France.
| | - Marine Gross-Goupil
- Bordeaux University Hospital, Service d'oncologie medicale, Hôpital Pellegrin, Pl. Amélie Raba Léon, 33000, Bordeaux, France.
| | - Sylvain Ladoire
- Centre Georges François Leclerc, Service d'oncologie médicale, 1 Rue du Professeur Marion, 21000, Dijon, France.
| | - Delphine Borchiellini
- Centre Antoine Lacassagne, Université Côte d'Azur, Service d'oncologie médicale, 33 Av. de Valombrose, 06100, Nice, France.
| | - Lionnel Geoffrois
- Institut de Cancérologie de Lorraine, Service d'oncologie médicale, 6 Av. de Bourgogne, Institut de Cancérologie de Lorraine, 54519, Vandoeuvre-lès-Nancy, France.
| | - Florence Joly
- Centre François Baclesse, Service d'oncologie médicale, 3 Av. du Général Harris, 14000, Caen, France.
| | - Frank Priou
- Centre Hospitalier de Vendée, Service d'oncologie médicale, Bd Stéphane Moreau, 85000, La Roche sur Yon, France.
| | - Philippe Barthelemy
- Institut de Cancérologie Strasbourg Europe, Service d'oncologie médicale, 17 Rue Albert Calmette, 67200, Strasbourg, France.
| | - Mathieu Laramas
- Grenoble Alpes University Hospital, Grenoble, Service d'oncologie médicale, Av. des Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Berangère Narciso
- Tours University Hospital, Service d'oncologie médicale, 2 Bd Tonnellé, 37000, Tours, France.
| | - Antoine Thiery-Vuillemin
- Hôpital Jean-Minjoz, Service d'oncologie médicale, 3 Bd Alexandre Fleming, 25000, Besançon, France.
| | - Jean-François Berdah
- Centre Hospitalier de Hyères, Service d'oncologie médicale, Centre hospitalier d'Ajaccio, 27 Av. Impératrice Eugénie, 20000 Ajaccio, France.
| | - Victoria Ferrari
- Centre Antoine Lacassagne, Université Côte d'Azur, Service d'oncologie médicale, 33 Av. de Valombrose, 06100, Nice, France.
| | - Quentin Dominique Thomas
- Departement of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, Service d'oncologie médicale, Parc Euromédecine, 208 Av. des Apothicaires, 34090, Montpellier, France.
| | - Cécile Mione
- Université Clermont-Ferrand, 28 Pl. Henri Dunant, 63000, Clermont-Ferrand, France.
| | - Hubert Curcio
- Centre François Baclesse, Service d'oncologie médicale, 3 Av. du Général Harris, 14000, Caen, France
| | - Stephane Oudard
- Departement of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Service d'oncologie médicale, 20 rue Leblanc, 75015, Paris, France.
| | | | - Bernard Escudier
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Service d'oncologie médicale, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | | | - Laurence Albiges
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Service d'oncologie médicale, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Constance Thibault
- Departement of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Service d'oncologie médicale, 20 rue Leblanc, 75015, Paris, France.
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13
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Montemagno C, Durivault J, Gastaldi C, Dufies M, Vial V, He X, Ambrosetti D, Kamenskaya A, Negrier S, Bernhard JC, Borchiellini D, Cao Y, Pagès G. A group of novel VEGF splice variants as alternative therapeutic targets in renal cell carcinoma. Mol Oncol 2023. [PMID: 36810959 DOI: 10.1002/1878-0261.13401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
The efficacy of anti-angiogenic treatment by targeting VEGF/VEGF receptors in metastatic clear cell renal cell carcinoma (ccRCC) varies from patient to patient. Discovering the reasons behind this variability could lead to the identification of relevant therapeutic targets. Thus, we investigated novel splice variants of VEGF that are less efficiently inhibited by anti-VEGF/VEGFR targeting than the conventional isoforms. By in silico analysis we identified a novel splice acceptor in the last intron of the VEGF gene resulting in an insertion of 23 bp in VEGF mRNA. Such an insertion can shift the open reading frame in previously described splice variants of VEGF (VEGFXXX), leading to a change in the C-terminal part of the VEGF protein. Next, we analyzed the expression of these alternatively spliced VEGF new isoforms (VEGFXXX/NF.) in normal tissues and in RCC cell lines by qPCR and ELISA, and investigated the role of VEGF222/NF (equivalent to VEGF165) in physiological and pathological angiogenesis. Our in-vitro data demonstrated that recombinant VEGF222/NF stimulated endothelial cell proliferation and vascular permeability by activating VEGFR2. In addition, VEGF222/NF overexpression enhanced proliferation and metastatic properties of RCC cells, whereas downregulation of VEGF222/NF resulted in cell death. We also generated an in-vivo model of RCC by implanting RCC cells overexpressing VEGF222/NF in mice, which we treated with polyclonal anti-VEGFXXX/NF antibodies. VEGF222/NF overexpression enhanced tumor formation with aggressive properties and a fully functional vasculature , while treatment with anti-VEGFXXX/NF antibodies slowed tumor growth by inhibiting tumor cell proliferation and angiogenesis. In a patient cohort from the NCT00943839 clinical trial we investigated the relationship between plasmatic VEGFXXX/NF levels, resistance to anti-VEGFR therapy and survival. High plasmatic VEGFXXX/NF levels correlated with shorter survival and lower efficacy of anti-angiogenic drugs. Our data confirmed the existence of new VEGF isoforms that could serve as novel therapeutic targets in patients with RCC that are resistant to anti-VEGFR therapy.
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Affiliation(s)
- Christopher Montemagno
- Biomedical Department, Centre Scientifique de Monaco, 98000, Monaco.,University Côte d'Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284; INSERM U1081, Centre Antoine Lacassagne, 06200, Nice, France
| | - Jérôme Durivault
- Biomedical Department, Centre Scientifique de Monaco, 98000, Monaco
| | | | - Maeva Dufies
- Biomedical Department, Centre Scientifique de Monaco, 98000, Monaco
| | - Valérie Vial
- Biomedical Department, Centre Scientifique de Monaco, 98000, Monaco
| | - Xingkang He
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Damien Ambrosetti
- University Côte d'Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284; INSERM U1081, Centre Antoine Lacassagne, 06200, Nice, France.,University Côte d'Azur, Department of Pathology, CHU Nice, Nice, France
| | | | - Sylvie Negrier
- University Claude Bernard Lyon, Centre Léon Bérard, Lyon, France
| | - Jean-Christophe Bernhard
- Department of Urology, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000, Bordeaux, France
| | | | - Yihai Cao
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Gilles Pagès
- Biomedical Department, Centre Scientifique de Monaco, 98000, Monaco.,University Côte d'Azur, Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284; INSERM U1081, Centre Antoine Lacassagne, 06200, Nice, France.,LIA ROPSE, Laboratoire International Associé Université Côte d'Azur-Centre Scientifique de Monaco, 06100, Nice, France
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14
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Wespiser M, Carril-Ajuria L, Ilfad B, Thibault C, Flechon A, Martin S, Laramas M, Borchiellini D, Simon C, Mahammedi H, Linassier C, Goujon M, Zaibet S, Rolland F, Albiges L, Meurisse A, Falcoz A, Thiery-Vuillemin A. Natural history of patients with muscle metastases from renal cell carcinoma: Results of the French national ARTEMIS study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
618 Background: Muscle metastases (MM) are among rare secondary locations in renal cell carcinoma (RCC). Current guidelines do not provide specific advice on the management of these patients. There is a lack of scientific literature on the subject, mainly based on case reports or small retrospective monocentric cohorts. To date, therefore, there remains uncertainty about the clinical history, prognosis, and appropriate management of patients with MM. Methods: ARTEMIS is an ambispective national French multicenter, non-interventional study. It was opened to patients with metastatic RCC who had MM. The study was designed to assess overall survival (OS), progression-free survival (PFS), describe diagnostic and treatment modalities, and treatment-related serious adverse events in case of local treatments (TR-SAEs). Results: Median follow-up was 74.4 months IC95% [38.7-84.1]. The 146 enrolled patients were 73.6% male, with a median age of 57.6 years at diagnosis. They were initially diagnosed with stage IV RCC for 40.4% of them and had a favorable (36.2%), intermediate (45.7%), or poor (18.1%) IMDC risk score at the onset of metastases. Initially, metastases were mainly located in the lungs (55.5%), lymph nodes (26.7%), and bones (24.0%). Patients had a history of partial or total nephrectomy in 78.8% of cases. There were 30.0% of patients with synchronous MM. The median times from initial diagnosis or metastatic status to MM discovery were 25.5 [16.8-35.7] months and 8.4 [5.0-13.5] months, respectively. The majority (69.0%) of MM were discovered on conventional injected CT scans, whereas 8.3% were diagnosed clinically. Survival data are displayed on the table. Thirty-seven (25.3%) patients received local treatment of their MM which consisted of: external radiotherapy (48.6%), surgery (27.0%), cryotherapy (27.0%), stereotactic radiotherapy (5.4%), embolization (2.7%). Among them, local treatments prevented local relapse of MM in 28 patients (75.7%). Local TR-SAEs were seen in two patients (5.4%). Conclusions: ARTEMIS is the largest published cohort describing the disease history of patients with RCC suffering from MM. To our knowledge, this is the first study reporting the diagnostic and treatment modalities, also survival data. Despite its low incidence, the issue of these patients is not so rare in physicians’ practice. This work thus allows a greater understanding of clinical features and treatment of this pathology. [Table: see text]
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Affiliation(s)
| | | | | | - Constance Thibault
- Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP Centre, Université de Paris Cité, Paris, France
| | | | | | | | | | - Camille Simon
- Institut De Cancerologie De Lorraine, Vandœuvre-Lès-Nancy, France
| | | | | | - Morgan Goujon
- Hopital Nord Franche-Comté, site de cancérologie du Mittan Montbéliard, Trevenans, France
| | - Sonia Zaibet
- Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Laurence Albiges
- Medical Oncology, Gustave Roussy, Université Paris Saclay, Paris, France
| | - Aurelia Meurisse
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, INSERM UMR 1098, Besancon, France
| | - Antoine Falcoz
- Methodology and Quality of Life Unit in Oncology (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
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Thiery-Vuillemin A, Tartas S, Mourey L, Colomba E, Borchiellini D, Goujon M, Lefort F, Topart D, Barthelemy P, Lauridant G, Meurisse A, Vernerey D, Massard V. Activity and tolerability of maintenance avelumab (AVE) immunotherapy after first-line platinum-based polychemotherapy in patients (pts) with locally advanced or metastatic squamous cell penile carcinoma: Initial results of PULSE study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
8 Background: Metastatic squamous cell penile carcinoma (mSCPC) is an orphan disease with a virally induced oncogenesis. PD-L1 expression rate is around 60% with a strong correlation between PD-L1 in the primary tumour and metastases. The first line systemic treatment relies on platinum-based chemotherapies with a median progression free survival and overall survival around 7.5 and 16 months (mo), respectively. Immunotherapies targeting PD-1/PD-L1 axis are effective in other squamous cell or HPV related cancers. Methods: PULSE is a national prospective multicenter open label single arm phase II trial. Thirty-two pts will be enrolled after a radiological assessment showing a non-progressive disease after 3 to 6 cycles of a first line platinum-based polychemotherapy. Pts will receive AVE injections 10mg/kg every two weeks until progression or unacceptable toxicity. The primary endpoint will be the progression free survival (PFS) from AVE initiation according to RECIST v1.1 criteria. Key secondary endpoints will include, overall survival, safety. Here we report the results of the first interim analysis (IA). Results: From September 2019 to October 2022, 14 pts has been enrolled. Within the 9 first patients involved for the IA the median age was 69.9 years; 89% of pts had an ECOG 0-1. Of them, 1 patient and 8 pts had stage 3 and 4 disease at chemotherapy initiation, respectively. Median follow-up was 5.8 [2.3-17.2] mo. Chemotherapy regimens were triplets for 5 pts (56%), containing cisplatin for 56% and a taxane for all pts. Median duration of chemotherapy was 3.7 mo [1.2; 11.7]. At AVE initiation, 5 pts (56%) had partial or complete response and 4 pts (44%) had stable disease. Median duration of AVE was 3.7 mo with a majority (83%) of discontinuation linked to disease progression. Survival data are shown in the table. No new safety signal was identified. Conclusions: PULSE is the first prospective trial exploring avelumab maintenance activity in mSCPC. After the IA the DSMB have recommended to pursue the study based on these promising results. Updated results with additional patients, longer follow-up and ancillary explorations with biomarkers analysis will be presented at the meeting. Clinical trial information: NCT03774901 . [Table: see text]
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Affiliation(s)
| | | | - Loic Mourey
- Institut Claudius Regaud IUCT Oncopole, Toulouse, France
| | | | | | - Morgan Goujon
- Oncologie Médical, Institut Régional Fédératif du Cancer, CHRU Besançon, Besançon, France
| | - Felix Lefort
- Department of Medical Oncology, Hôpital Saint-André, University of Bordeaux-CHU Bordeaux, Bordeaux, France
| | | | | | | | - Aurelia Meurisse
- Methodology and Quality of Life Unit, Department of Oncology University Hospital, INSERM UMR 1098, Besancon, France
| | - Dewi Vernerey
- UMQVC; University Hospital of Besançon, Besançon, France
| | - Vincent Massard
- Institut de Cancérologie de Lorraine, Vandœuvre-Lès-Nancy, France
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16
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Vano YA, Phan L, Simonaggio A, Bennamoun M, Pannier D, Chevreau C, Borchiellini D, Maillet D, Gross-Goupil M, Laguerre B, Tournigand C, Barthelemy P, Coquan E, Gravis G, Sun CM, Meylan M, Fridman WH, Sautès-Fridman C, Elaidi R, Oudard S. Overall survival (OS) and efficacy results of second-line treatment in patients (pts) with metastatic clear cell renal cell carcinoma (mRCC) treated in the randomized phase II BIONIKK trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
607 Background: To date, no biomarker of efficacy of nivolumab+/-ipilimumab (N+/-I) or anti-VEGFR TKI has been prospectively validated in mRCC. The BIONIKK trial showed promising objective response rate (ORR) and progression-free survival (PFS) with these treatments in first line (L1) after selection by tumour molecular group. We report OS and efficacy results of the second-line (L2) treatment. Methods: BIONIKK is a French multicentre non-comparative phase II trial, randomising 199 mRCC pts to receive N (58), NI (101) or TKI (40) in L1 according to four molecular groups (ccrcc1-4). ORR and PFS were already reported. With an additional follow-up of ≥20 months, we report OS from randomization and from the start of L2, as well as ORR and PFS with a TKI in L2 by molecular group. Results: With a median follow-up of 42.1 months (40.5-45.2), 86 (43%) patients died: 27/58 (46.5%), 39/101 (39%) and 20/40 (50%) in the N, NI, and TKI arm, respectively. Median OS were 43.4 months (95%CI=31.4-NR) with N, 52.7 months (95%CI=46-NR) with NI and 38.1 months (95%CI=33.2-NR) with TKI (table). 175 (88%) patients discontinued first-line treatment, including 20 deaths, and 129 (74%) received a L2, 38/58 (65.5%), 64/101 (63%), and 27/40 (67.5%) after N, NI and TKI, respectively. The most frequent L2 received after N+/-I was a TKI in 96/102 (94%) pts, including cabozantinib in 49, sunitinib/pazopanib in 32, axitinib in 13, and lenvatinib in 2. N was the most frequent L2 after TKI, 20/27 (74%). ORR with TKI in L2 was 28.5% (10/35) after N, 39% (24/61) after NI and 80% (4/5) after TKI, with marked benefit in ccrcc2 pts (table). The mPFS with TKI in L2 was 8.2 (95%CI=6.9-19.3) after N, 11.4 (95%CI= 8.9-16.8) after NI, and 12.1 (95%CI =11.4-NR) months after TKI, with a higher benefit in ccrcc2 pts (vs. ccrcc1+4, p=0.04). Conversely, ORR and mPFS with N after TKI in ccrcc2-pts were 12.5% (2/16) and 5.4 (2.6-NR) months, respectively. Median OS L2 was reported in the table. The updated ORR and PFS in L1 will presented at the Meeting, as well as PFS2 and efficacy by TKI type in L2. Conclusions: We report for the first-time OS and L2 efficacy results by molecular group in a randomized trial. Molecular selection also has an impact on treatment efficacy in L2. These results, together with those reported in L1, can inform clinicians on the best treatment sequence in L1-2. Clinical trial information: NCT02960906 . [Table: see text]
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Affiliation(s)
- Yann-Alexandre Vano
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - Letuan Phan
- ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP. Centre – Université Paris Cité, Paris, France
| | - Audrey Simonaggio
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Diane Pannier
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Denis Maillet
- Department of Medical Oncology, IMMUCARE, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices de Lyon (IC-HCL); Faculté de médecine de Saint Etienne, Pierre-Bénite, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Centre Hospitalier Universitaire de Bordeaux - Hôpital Saint-André, Bordeaux, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugène - Marquis, Rennes, France
| | - Christophe Tournigand
- Department of Medical Oncology, Hôpital Henri-Mondor, AP-HP - Université de Paris Est, Créteil, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Elodie Coquan
- Department of Medical Oncology, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Universite, CRCM, Marseille, France
| | - Cheng-Ming Sun
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Maxime Meylan
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Wolf-Hervé Fridman
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Catherine Sautès-Fridman
- Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Réza Elaidi
- ARTIC - Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP. Centre – Université Paris Cité, Paris, France
| | - Stephane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, AP-HP.Centre – Université Paris Cité, Paris, France
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17
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Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Coquan E, Laramas M, Thibault C, Abbar B, Mesnard B, Borchiellini D, Dumont C, Boughalem E, Deville JL, Cancel M, Saldana C, Khalil A, Baciarello G, Flechon A, Walz J, Gravis G. Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group. Front Oncol 2023; 13:1110003. [PMID: 36741023 PMCID: PMC9892758 DOI: 10.3389/fonc.2023.1110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.
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Affiliation(s)
- M. Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,*Correspondence: M. Guerin,
| | - C. Miran
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - E. Colomba
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - M. Cabart
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - T. Herrmann
- Department of Medical Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - S. Pericart
- Department of Anatomo-pathology, Institut Universitaire du Cancer, Centre Hospital-Universitaire de Toulouse, Toulouse, France
| | - D. Maillet
- Department of Medical Oncology, Centre hospitalo-Universitaire Hospices civils, Lyon, France
| | - Y. Neuzillet
- Department of Urology, Hopital Foch, Paris, France
| | - A. Deleuze
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - E. Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M. Laramas
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Grenoble, France
| | - C. Thibault
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | - B. Abbar
- Department of Medical Oncology, Hopital Pitié-Salpetriere, Paris, France
| | - B. Mesnard
- Department of Urology, Centre Hospitalo-Universitaire, Nantes, France
| | - D. Borchiellini
- Department of Medical Oncology, Centre Lacassagne, Nice, France
| | - C. Dumont
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | - E. Boughalem
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - JL. Deville
- Department of Medical Oncology, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - M. Cancel
- Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France
| | - C. Saldana
- Department of Medical Oncology, Hopital Henri Mondor, Paris, France
| | - A. Khalil
- Department of Medical Oncology, Hopital tenon, Paris, France
| | - G. Baciarello
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - A. Flechon
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - J. Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - G. Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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Khene ZE, Borchiellini D, Bensalah K. Re: Adjuvant Atezolizumab Versus Placebo for Patients with Renal Cell Carcinoma at Increased Risk of Recurrence Following Resection (IMmotion010): A Multicentre, Randomised, Double-blind, Phase 3 Trial. Eur Urol 2023; 83:475-476. [PMID: 36609006 DOI: 10.1016/j.eururo.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Zine-Eddine Khene
- Department of Urology, CHU Pontchaillou, Rennes University, Rennes, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karim Bensalah
- Department of Urology, CHU Pontchaillou, Rennes University, Rennes, France.
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19
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Thouvenin J, Alhalabi O, Carlo M, Carril-Ajuria L, Hirsch L, Martinez-Chanza N, Négrier S, Campedel L, Martini D, Borchiellini D, Chahoud J, Lodi M, Barthélémy P, Hasanov E, Hahn AW, Gil T, Viswanathan SR, Bakouny Z, Msaouel P, Asim Bilen M, Choueiri TK, Albiges L, Tannir NM, Malouf GG. Efficacy of Cabozantinib in Metastatic MiT Family Translocation Renal Cell Carcinomas. Oncologist 2022; 27:1041-1047. [PMID: 35979929 DOI: 10.1093/oncolo/oyac158] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND MiT family translocation renal cell carcinoma (TRCC) is a rare and aggressive subgroup of renal cell carcinoma harboring high expression of c-MET. While TRCC response rates to VEGF receptor tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors are limited, efficacy of cabozantinib (a VEGFR, MET, and AXL inhibitor) in this subgroup is unclear. METHODS We performed a multicenter, retrospective, international cohort study of patients with TRCC treated with cabozantinib. The main objectives were to estimate response rate according to RECIST 1.1 and to analyze progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-two patients with metastatic TRCC treated in the participating centers and evaluable for response were included. Median age at metastatic diagnosis was 40 years (IQR 28.5-53). Patients' IMDC risk groups at diagnosis were favorable (9/52), intermediate (35/52), and poor (8/52). Eleven (21.2%) patients received cabozantinib as frontline therapy, 15 (28.8%) at second line, and 26 (50%) at third line and beyond. The proportion of patients who achieved an objective response was 17.3%, including 2 complete responses and 7 partial responses. For 26 (50%) patients, stable disease was the best response. With a median follow-up of 25.1 months (IQR 12.6-39), median PFS was 6.8 months (95%CI 4.6-16.3) and median OS was 18.3 months (95%CI 17.0-30.6). No difference of response was identified according to fusion transcript features. CONCLUSION This real-world study provides evidence of the activity of cabozantinib in TRCC, with more durable responses than those observed historically with other VEGFR-TKIs or ICIs.
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Affiliation(s)
- Jonathan Thouvenin
- Institut de Cancérologie Strasbourg Europe (ICANS/HUS), Strasbourg, France.,Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,Dana-Farber Cancer Institute (DFCI), Boston, MA, USA
| | | | - Maria Carlo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Laure Hirsch
- Dana-Farber Cancer Institute (DFCI), Boston, MA, USA
| | | | - Sylvie Négrier
- Université Claude Bernard, Centre Léon Bérard, Lyon, France
| | - Luca Campedel
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Dylan Martini
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Jad Chahoud
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Massimo Lodi
- Institut de Cancérologie Strasbourg Europe (ICANS/HUS), Strasbourg, France
| | | | | | | | | | | | - Ziad Bakouny
- Dana-Farber Cancer Institute (DFCI), Boston, MA, USA
| | | | | | | | | | | | - Gabriel G Malouf
- Institut de Cancérologie Strasbourg Europe (ICANS/HUS), Strasbourg, France
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20
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Pignot G, Thiery-Vuillemin A, Albigès L, Walz J, Lang H, Balssa L, Parier B, Geoffrois L, Bensalah K, Schlürmann F, Ladoire S, Bigot P, Borchiellini D, Cassuto O, Thibault C, Ingels A, Saldana V, Roubaud G, Bernhard JC, Gravis G, Barthélémy P. Oncological Outcomes of Delayed Nephrectomy After Optimal Response to Immune Checkpoint Inhibitors for Metastatic Renal Cell Carcinoma. Eur Urol Oncol 2022; 5:577-584. [PMID: 35853818 DOI: 10.1016/j.euo.2022.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/06/2022] [Accepted: 07/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the current era of immune checkpoint inhibitors (ICIs), the role and optimal timing of a nephrectomy in patients with metastatic renal cell carcinoma (mRCC) remain unknown. OBJECTIVE To assess the oncological outcomes of patients who responded to ICI-based treatments and were subsequently treated with a delayed nephrectomy. DESIGN, SETTING, AND PARTICIPANTS This national retrospective evaluation included 30 patients with mRCC who underwent a nephrectomy after a complete response (CR) or a major partial response (>80%) to ICI treatment at metastatic sites. INTERVENTION Partial or radical nephrectomy after a favorable response to ICI treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Disease-free survival (DFS), progression-free survival (PFS), overall survival (OS), and potential discontinuation of systemic treatment were assessed. RESULTS AND LIMITATIONS ICI-based treatments included ipilimumab-nivolumab (40%), ICI + tyrosine kinase inhibitor (10%), and nivolumab (50%). A delayed nephrectomy was performed after a median ICI treatment duration of 10 mo. In 19 cases (63.3%), surgeons faced difficulties due to adhesions or inflammatory changes. A complete pathological response was observed in 16.7% of patients. After a median follow-up of 19.5 mo after nephrectomy, 76.7% of patients achieved DFS. At 1 yr, 66.7% of patients were free from systemic treatment. The PFS and OS rates were, respectively, 96.7% and 100% at 1 yr, and 78.3% and 86.1% at 2 yr. Patients with a CR at metastatic sites had a better prognosis than those with a major partial response, in terms of DFS (p = 0.022) and PFS (p = 0.014). CONCLUSIONS Despite potentially challenging surgery, a delayed nephrectomy for patients who responded to ICI treatment provided promising oncological outcomes, and the majority of patients could discontinue systemic treatment. PATIENT SUMMARY In this study, we evaluated the clinical outcome in patients who responded well to immunotherapy, and subsequently underwent kidney ablation surgery. Three-quarters of patients experienced no recurrence, and in most cases, medical treatment could be discontinued.
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Affiliation(s)
- Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France.
| | | | - Laurence Albigès
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Hervé Lang
- Urology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Loïc Balssa
- Urology Department, CHRU Besancon - Hopital Jean Minjoz, Besançon, France
| | - Bastien Parier
- Urology Department, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre lès Nancy, France
| | - Karim Bensalah
- Department of Urology, CHU Rennes - Hopital Pontchaillou, Rennes, France
| | | | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Pierre Bigot
- Urology Department, CHU d'Angers, Angers, France
| | | | - Ophélie Cassuto
- Department of Medical Oncology, Polyclinique St Georges, Nice, France
| | - Constance Thibault
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Paris, France
| | | | | | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - Gwenaelle Gravis
- Medical Oncology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Inserm, CNRS, CRCM, Marseille, France
| | - Philippe Barthélémy
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
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Rosenberg J, Milowsky M, Ramamurthy C, Mar N, McKay R, Friedlander T, Ferrario C, Bracarda S, George S, Moon H, Geynisman D, Petrylak D, Borchiellini D, Burgess E, Rey JM, Carret AS, Yu Y, Guseva M, Moreno BH, O'Donnell P. LBA73 Study EV-103 Cohort K: Antitumor activity of enfortumab vedotin (EV) monotherapy or in combination with pembrolizumab (P) in previously untreated cisplatin-ineligible patients (pts) with locally advanced or metastatic urothelial cancer (la/mUC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Haberstich M, Pignot G, Rigaud J, Cancel M, Maillet D, Oudard S, Pouessel D, Serrate C, Campedel L, Dumont C, Borchiellini D, Barthelemy P, Boughalem E, Colomba E, Huillard O, Boyle H, Lefort F, Constans Schlurmann F, Audenet F, Thibault C. 1762P MERINOS: Metastatic non muscle invasive urothelial carcinoma - An observational study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Powles T, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, Hajek J, Gurney H, Chang YH, Lee JL, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Mahave M, Haas NB, Sawrycki P, Burgents JE, Xu L, Imai K, Quinn DI, Choueiri TK, Choueiri T, Park SH, Venugopal B, Ferguson TR, Hajek J, Lin TP, Symeonides SN, Lee JL, Sawrycki P, Haas NB, Gurney HP, Mahave M, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Chevreau C, Burke JM, Doshi G, Melichar B, Topart D, Oudard S, Kopyltsov E, Hammers HJ, Quinn DI, Alva A, Menezes JDJ, Silva AGE, Winquist EW, Hamzaj A, Procopio G, Karaszewska B, Nowakowska-Zajdel EM, Alekseev BY, Gafanov RA, Izmailov A, Semenov A, Afanasyev SG, Lipatov ON, Powles TB, Srinivas S, McDermott D, Kochuparambil ST, Davis ID, Peltola K, Sabbatini R, Chung J, Shkolnik MI, Matveev VB, Gajate Borau P, McCune S, Hutson TE, Dri A, Sales SC, Yeung C, Alcala Castro CM, Bostrom P, Laguerre B, Buttigliero C, de Giorgi U, Fomin EA, Zakharia Y, Hwang C, Singer EA, Yorio JT, Waterhouse D, Kowalyszyn RD, Alfie MS, Yanez Ruiz E, Buchler T, Kankaanranta K, Ferretti G, Kimura G, Nishimura K, Masumori N, Tamada S, Kato H, Kitamura H, Danielewicz I, Wojcik-Tomaszewska J, Sala Gonzalez N, Chiu KY, Atkins MB, Heath E, Rojas-Uribe GA, Gonzalez Fernandez ME, Feyerabend S, Pignata S, Numakura K, Cybulska Stopa B, Zukov R, Climent Duran MA, Maroto Rey PJ, Montesa Pino A, Chang CH, Vengalil S, Waddell TS, Cobb PW, Hauke R, Anderson DM, Sarantopoulos J, Gourdin T, Zhang T, Jayram G, Fein LE, Harris C, Beato PMM, Flores F, Estay A, Rubiano JA, Bedke J, Hauser S, Neisius A, Busch J, Anai S, Tsunemori H, Sawka D, Sikora-Kupis B, Arranz JA, Delgado I, Chen CH, Gunderson E, Tykodi S, Koletsky A, Chen K, Agrawal M, Kaen DL, Sade JP, Tatangelo MD, Parnis F, Barbosa FM, Faucher G, Iqbal N, Marceau D, Paradis JB, Hanna N, Acevedo A, Ibanez C, Villanueva L, Galaz PP, Durango IC, Manneh R, Kral Z, Holeckova P, Hakkarainen H, Ronkainen H, Abadie-Lacourtoisie S, Tartas S, Goebell PJ, Grimm MO, Hoefner T, Wirth M, Panic A, Schultze-Seemann W, Yokomizo A, Mizuno R, Uemura H, Eto M, Tsujihata M, Matsukawa Y, Murakami Y, Kim M, Hamberg P, Marczewska-Skrodzka M, Szczylik C, Humphreys AC, Jiang P, Kumar B, Lu G, Desai A, Karam JA, Keogh G, Fleming M, Zarba JJ, Leiva VE, Mendez GA, Harris SJ, Brown SJ, Antonio Junior JN, Costamilan RDC, Rocha RO, Muniz D, Brust L, Lalani AK, Graham J, Levesque M, Orlandi F, Kotasek R, Deville JL, Borchiellini D, Merseburger A, Rink M, Roos F, McDermott R, Oyama M, Yamamoto Y, Tomita Y, Miura Y, Ioritani N, Westgeest H, Kubiatowski T, Bal W, Girones Sarrio R, Rowe J, Prow DM, Senecal F, Hashemi-Sadraei N, Cole SW, Kendall SD, Richards DA, Schnadig ID, Gupta M. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022; 23:1133-1144. [PMID: 36055304 DOI: 10.1016/s1470-2045(22)00487-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The first interim analysis of the KEYNOTE-564 study showed improved disease-free survival with adjuvant pembrolizumab compared with placebo after surgery in patients with clear cell renal cell carcinoma at an increased risk of recurrence. The analysis reported here, with an additional 6 months of follow-up, was designed to assess longer-term efficacy and safety of pembrolizumab versus placebo, as well as additional secondary and exploratory endpoints. METHODS In the multicentre, randomised, double-blind, placebo-controlled, phase 3 KEYNOTE-564 trial, adults aged 18 years or older with clear cell renal cell carcinoma with an increased risk of recurrence were enrolled at 213 hospitals and cancer centres in North America, South America, Europe, Asia, and Australia. Eligible participants had an Eastern Cooperative Oncology Group performance status of 0 or 1, had undergone nephrectomy 12 weeks or less before randomisation, and had not received previous systemic therapy for advanced renal cell carcinoma. Participants were randomly assigned (1:1) via central permuted block randomisation (block size of four) to receive pembrolizumab 200 mg or placebo intravenously every 3 weeks for up to 17 cycles. Randomisation was stratified by metastatic disease status (M0 vs M1), and the M0 group was further stratified by ECOG performance status and geographical region. All participants and investigators involved in study treatment administration were masked to the treatment group assignment. The primary endpoint was disease-free survival by investigator assessment in the intention-to-treat population (all participants randomly assigned to a treatment). Safety was assessed in the safety population, comprising all participants who received at least one dose of pembrolizumab or placebo. As the primary endpoint was met at the first interim analysis, updated data are reported without p values. This study is ongoing, but no longer recruiting, and is registered with ClinicalTrials.gov, NCT03142334. FINDINGS Between June 30, 2017, and Sept 20, 2019, 994 participants were assigned to receive pembrolizumab (n=496) or placebo (n=498). Median follow-up, defined as the time from randomisation to data cutoff (June 14, 2021), was 30·1 months (IQR 25·7-36·7). Disease-free survival was better with pembrolizumab compared with placebo (HR 0·63 [95% CI 0·50-0·80]). Median disease-free survival was not reached in either group. The most common all-cause grade 3-4 adverse events were hypertension (in 14 [3%] of 496 participants) and increased alanine aminotransferase (in 11 [2%]) in the pembrolizumab group, and hypertension (in 13 [3%] of 498 participants) in the placebo group. Serious adverse events attributed to study treatment occurred in 59 (12%) participants in the pembrolizumab group and one (<1%) participant in the placebo group. No deaths were attributed to pembrolizumab. INTERPRETATION Updated results from KEYNOTE-564 support the use of adjuvant pembrolizumab monotherapy as a standard of care for participants with renal cell carcinoma with an increased risk of recurrence after nephrectomy. FUNDING Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ, USA.
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Affiliation(s)
- Thomas Powles
- Royal Free Hospital NHS Foundation Trust, University College London, London, UK; Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK.
| | - Piotr Tomczak
- Poznań University of Medical Sciences, Poznań, Poland
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Balaji Venugopal
- Beatson West of Scotland Cancer Centre, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Stefan N Symeonides
- Cancer Research UK Edinburgh Centre, Edinburgh, UK; Edinburgh Cancer Centre, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Piotr Sawrycki
- Wojewódzki Szpital Zespolony im L Rydygiera w Toruniu, Torun, Poland
| | | | - Lei Xu
- Merck & Co, Inc, Rahway, NJ, USA
| | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Meylan M, Sun CM, Elaidi RT, Moreira M, Bougouin A, Verkarre V, Bennamoun M, Chevreau C, Borchiellini D, Barthelemy P, Pannier D, Maillet D, Gross Goupil M, Tournigand C, Braychenko E, Phan L, Oudard S, Fridman WH, Sautes-Fridman C, Vano YA. 1451MO In-situ immune markers predict nivolumab (N) +/-ipilimumab (I) efficacy in frontline metastatic clear cell renal cell carcinoma (mccRCC): Key ancillary analyses from the BIONIKK randomized trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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25
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Khene ZE, Bigot P, Doumerc N, Ouzaid I, Boissier R, Nouhaud FX, Albiges L, Bernhard JC, Ingels A, Borchiellini D, Kammerer-Jacquet S, Rioux-Leclercq N, Roupret M, Acosta O, De Crevoisier R, Bensalah K. Application of Machine Learning Models to Predict Recurrence After Surgical Resection of Nonmetastatic Renal Cell Carcinoma. Eur Urol Oncol 2022:S2588-9311(22)00137-7. [PMID: 35987730 DOI: 10.1016/j.euo.2022.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Predictive tools can be useful for adapting surveillance or including patients in adjuvant trials after surgical resection of nonmetastatic renal cell carcinoma (RCC). Current models have been built using traditional statistical modelling and prespecified variables, which limits their performance. OBJECTIVE To investigate the performance of machine learning (ML) framework to predict recurrence after RCC surgery and compare them with current validated models. DESIGN, SETTING, AND PARTICIPANTS In this observational study, we derived and tested several ML-based models (Random Survival Forests [RSF], Survival Support Vector Machines [S-SVM], and Extreme Gradient Boosting [XG boost]) to predict recurrence of patients who underwent radical or partial nephrectomy for a nonmetastatic RCC, between 2013 and 2020, at 21 French medical centres. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point was disease-free survival. Model discrimination was assessed using the concordance index (c-index), and calibration was assessed using the Brier score. ML models were compared with four conventional prognostic models, using decision curve analysis (DCA). RESULTS AND LIMITATIONS A total of 4067 patients were included in this study (3253 in the development cohort and 814 in the validation cohort). Most tumours (69%) were clear cell RCC, 40% were of high grade (nuclear International Society of Urological Pathology grade 3 or 4), and 24% had necrosis. Of the patients, 4% had nodal involvement. After a median follow-up of 57 mo (interquartile range 29-76), 523 (13%) patients recurred. ML models obtained higher c-index values than conventional models. The RSF yielded the highest c-index values (0.794), followed by S-SVM (c-index 0.784) and XG boost (c-index 0.782). In addition, all models showed good calibration with low integrated Brier scores (all integrated brier scores <0.1). However, we found calibration drift over time for all models, albeit with a smaller magnitude for ML models. Finally, DCA showed an incremental net benefit from all ML models compared with conventional models currently used in practice. CONCLUSIONS Applying ML approaches to predict recurrence following surgical resection of RCC resulted in better prediction than that of current validated models available in clinical practice. However, there is still room for improvement, which may come from the integration of novel biological and/or imaging biomarkers. PATIENT SUMMARY We found that artificial intelligence algorithms could better predict the risk of recurrence after surgery for a localised kidney cancer. These algorithms may help better select patients who will benefit from medical treatment after surgery.
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Affiliation(s)
- Zine-Eddine Khene
- Department of Urology, University of Rennes 1, Rennes, France; LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | - Pierre Bigot
- Department of Urology, University of Angers, Angers, France
| | - Nicolas Doumerc
- Department of Urology, University of Toulouse, Toulouse, France
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France
| | - Romain Boissier
- Department of Urology, Aix-Marseille University, Marseille, France
| | | | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | - Morgan Roupret
- Department of Urology, La Pitie Salpétrière Hospital, Paris, France
| | - Oscar Acosta
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | - Renaud De Crevoisier
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France; Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Karim Bensalah
- Department of Urology, University of Rennes 1, Rennes, France; LTSI, Inserm U1099, Université de Rennes 1, Rennes, France.
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Bedke J, Rini BI, Plimack ER, Stus V, Gafanov R, Waddell T, Nosov D, Pouliot F, Soulières D, Melichar B, Vynnychenko I, Azevedo SJ, Borchiellini D, McDermott RS, Tamada S, Nguyen AM, Wan S, Perini RF, Rhoda Molife L, Atkins MB, Powles T. Health-related Quality of Life Analysis from KEYNOTE-426: Pembrolizumab plus Axitinib Versus Sunitinib for Advanced Renal Cell Carcinoma. Eur Urol 2022; 82:427-439. [PMID: 35843776 DOI: 10.1016/j.eururo.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the phase 3 KEYNOTE-426 (NCT02853331) trial, pembrolizumab + axitinib demonstrated improvement in overall survival, progression-free survival, and objective response rate over sunitinib monotherapy for advanced renal cell carcinoma (RCC). OBJECTIVE To evaluate health-related quality of life (HRQoL) in KEYNOTE-426. DESIGN, SETTING, AND PARTICIPANTS A total of 861 patients were randomly assigned to receive pembrolizumab + axitinib (n = 432) or sunitinib (n = 429). HRQoL data were available for 429 patients treated with pembrolizumab + axitinib and 423 patients treated with sunitinib. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS HRQoL end points were measured using the European Organisation for the Research and Treatment of Cancer Core (EORTC) Quality of Life Questionnaire (QLQ-C30), EQ-5D visual analog rating scale (VAS), and Functional Assessment of Cancer Therapy Kidney Cancer Symptom Index-Disease-Related Symptoms (FKSI-DRS) questionnaires. RESULTS AND LIMITATIONS Better or not different overall improvement rates from baseline between pembrolizumab + axitinib and sunitinib were observed for the FKSI-DRS (-0.79% improvement vs sunitinib; 95% confidence interval [CI] -7.2 to 5.6), QLQ-C30 (7.5% improvement vs sunitinib; 95% CI 1.0-14), and EQ-5D VAS (9.9% improvement vs sunitinib; 95% CI 3.2-17). For time to confirmed deterioration (TTcD) and time to first deterioration (TTfD), no differences were observed between arms for the QLQ-C30 (TTcD hazard ratio [HR] 1.0; 95% CI 0.82-1.3; TTfD HR 0.82; 95% CI 0.69-0.97) and EQ-5D VAS (TTcD HR 1.1; 95% CI 0.87-1.3; TTfD HR 0.98; 95% CI 0.83-1.2). TTfD was not different between treatment arms (HR 1.1; 95% CI 0.95-1.3) for the FKSI-DRS, but TTcD favored sunitinib (HR 1.4; 95% CI 1.1-1.7). Patients were assessed during the off-treatment period for sunitinib, which may have underestimated the negative impact of sunitinib on HRQoL. CONCLUSIONS Overall, patient-reported outcome scales showed that results between the pembrolizumab + axitinib and sunitinib arms were not different, with the exception of TTcD by the FKSI-DRS. PATIENT SUMMARY Compared with sunitinib, pembrolizumab + axitinib delays disease progression and extends survival, while HRQoL outcomes were not different between groups.
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Affiliation(s)
- Jens Bedke
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany.
| | - Brian I Rini
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Viktor Stus
- Dnipro State Medical University, Dnipro, Ukraine
| | - Rustem Gafanov
- Russian Scientific Center of Roentgen Radiology, Moscow, Russia
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Dimitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russia
| | | | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Bohuslav Melichar
- Palacký University Olomouc, Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Ihor Vynnychenko
- Sumy State University, Sumy Regional Oncology Center, Sumy, Ukraine
| | | | | | | | | | | | | | | | | | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trusts, Barts Cancer Institute, London, UK; Queen Mary University of London, London, UK
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Powles T, Plimack ER, Stus V, Waddell T, Gafanov R, Pouliot F, Nosov D, Melichar B, Soulieres D, Borchiellini D, Vynnychenko I, McDermott RS, Azevedo SJ, Tamada S, Kryzhanivska A, Li C, Burgents JE, Molife LR, Rini BI, Bedke J. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma (ccRCC): Analysis of progression after first subsequent therapy in KEYNOTE-426. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4513 Background: The randomized, open-label, phase 3 KEYNOTE-426 study (NCT02853331) met its primary and key secondary end points of improved OS, PFS, and ORR with pembro + axi versus sunitinib as first-line treatment for patients with advanced ccRCC. Extended follow-up (42.8-mo median follow-up) continued to show the superior efficacy of pembro + axi versus sunitinib in this patient population. We describe the results of PFS2 for all randomly assigned patients and across IMDC risk categories. Methods: Treatment-naive patients with advanced ccRCC, Karnofsky Performance Status Scale score ≥70% and measurable disease per RECIST v1.1 were randomly assigned 1:1 to receive pembro 200 mg IV every 3 weeks for up to 35 doses (̃2 y) + axi 5 mg orally twice daily or sunitinib 50 mg orally once daily on a 4-wk on/2-wk off schedule. The end point of this exploratory analysis was PFS2, defined as time from randomization to progression after first subsequent therapy or any-cause death. The Kaplan-Meier method was used to estimate PFS2 and hazard ratios were estimated using a Cox regression model. Results: Of 861 patients, 432 were assigned to receive pembro + axi; 429, to sunitinib. Median time from randomization to the database cutoff date (January 11, 2021) was 42.8 mo (range, 35.6-50.6). Overall, 47.2% of patients (204/432) in the pembro + axi arm and 65.5% of patients (281/429) in the sunitinib arm received ≥1 line of subsequent anticancer therapy. For patients who received subsequent therapy, anti–PD-1/PD-L1 agents were the first subsequent treatment for 11.3% of patients (23/204) in the pembro + axi arm and 54.8% of patients (154/281) in the sunitinib arm. In the pembro + axi arm, 82.8% of patients (169/204) received a VEGF/VEGFR inhibitor as first subsequent therapy, as did 43.4% (122/281) in the sunitinib arm. PFS2 results are displayed in the Table. Conclusions: In this exploratory analysis, PFS2 was longer for patients randomized to pembro + axi compared to sunitinib. Results were consistent across IMDC risk groups. These data support use of pembro + axi for the first-line treatment of patients with advanced ccRCC. Clinical trial information: NCT02853331. [Table: see text]
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Affiliation(s)
- Thomas Powles
- Barts Health NHS Trust and the Royal Free NHS Foundation Trust, Barts Cancer Institute, and Queen Mary University of London, London, United Kingdom
| | | | - Viktor Stus
- Dnipro State Medical University, Dnipro, Ukraine
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Rustem Gafanov
- Russian Scientific Center of Roentgenoradiology, Moscow, Russian Federation
| | | | - Dmitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russian Federation
| | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Denis Soulieres
- Centre Hospitalier de l’Universitaire de Montréal, Montréal, QC, Canada
| | | | - Ihor Vynnychenko
- Sumy State University, Sumy Regional Oncology Center, Sumy, Ukraine
| | | | | | | | - Anna Kryzhanivska
- Ivanko-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | | | | | | | - Jens Bedke
- Eberhard Karls Universität Tübingen, Tübingen, Germany
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Vano YA, Phan L, Gravis G, Korakis I, Schlürmann F, Maillet D, Bennamoun M, Houede N, Topart D, Borchiellini D, Barthelemy P, Ratta R, Ryckewaert T, Hasbini A, Hans S, Emambux S, Cournier S, Braychenko E, Elaidi RT, Oudard S. Cabozantinib-nivolumab sequence in metastatic renal cell carcinoma: the CABIR study. Int J Cancer 2022; 151:1335-1344. [PMID: 35603906 PMCID: PMC9541795 DOI: 10.1002/ijc.34126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/09/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
Nivolumab and cabozantinib are approved agents in mRCC patients after sunitinib/pazopanib (TKI) failure. However, the optimal sequence, cabozantinib then nivolumab (CN) or nivolumab then cabozantinib (NC), is still unknown. The CABIR study aimed to identify the optimal sequence between CN and NC after frontline VEGFR‐TKI. In this multicenter retrospective study, we collected data from mRCC pts receiving CN or NC, after frontline VEGFR‐TKI. A propensity score (PrS) was calculated to manage bias selection, and sequence comparisons were carried out with a cox model on a matched sample 1:1. The primary endpoint was progression‐free survival (PFS) from the start of second line to progression in third line (PFS2‐3). Key secondary endpoints included overall survival from second line (OS2). Out of 139 included mRCC patients, 38 (27%) and 101 (73%) received CN and NC, respectively. Overlap in PrS allowed 1:1 matching for each CN pts, with characteristics well balanced. For both PFS2‐3 and OS2, NC sequence was superior to CN (PFS2‐3: HR = 0.58 [0.34‐0.98], P = .043; OS2: 0.66 [0.42‐1.05], P = .080). Superior PFS2‐3 was in patients treated between 6 and 18 months with prior VEGFR‐TKI (P = .019) and was driven by a higher PFSL3 with cabozantinib when given after nivolumab (P < .001). The CABIR study shows a prolonged PFS of the NC sequence compared to CN in mRCC after first line VEGFR‐TKI failure. The data suggest that cabozantinib may be more effective than nivolumab in the third‐line setting, possibly related to an ability of cabozantinib to overcome resistance to PD‐1 blockade.
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Affiliation(s)
- Yann-Alexandre Vano
- Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP Centre - Université Paris Cité, Paris, France.,INSERM U970, PARCC, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Université Paris Cité, Sorbonne Université, Paris, France
| | - Letuan Phan
- ARTIC -Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP Centre, Paris, France
| | - Gwenaelle Gravis
- Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, CRCM, Marseille, France
| | - Iphigénie Korakis
- Medical Oncology, Institut Universitaire du Cancer -Toulouse- Oncopole, Toulouse, France
| | | | - Denis Maillet
- Medical Oncology, IMMUCARE, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices de Lyon (IC-HCL), Pierre-Bénite, France
| | | | - Nadine Houede
- Medical Oncology, Institut de cancérologie du Gard, Nimes, Montpellier University, France
| | - Delphine Topart
- Medical Oncology, Hopital Saint-Eloi (CHU de Montpellier), Montpellier, France
| | | | - Philippe Barthelemy
- Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | | | | | - Ali Hasbini
- Medical Oncology, Clinique Pasteur Lanroze, Brest, France
| | - Sophie Hans
- Department of Medical Oncology, Hôpital Henri-Mondor, AP-HP - Université de Paris Est, Créteil, France
| | - Sheik Emambux
- Medical Oncology, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Sandra Cournier
- ARTIC -Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP Centre, Paris, France
| | - Elena Braychenko
- ARTIC -Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP Centre, Paris, France
| | - Réza-Thierry Elaidi
- ARTIC -Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie; Hôpital Européen Georges Pompidou, AP-HP Centre, Paris, France
| | - Stéphane Oudard
- Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP Centre - Université Paris Cité, Paris, France.,INSERM U970, PARCC, Paris, France
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Borchiellini D, Maillet D. Clinical activity of immunotherapy-based combination first-line therapies for metastatic renal cell carcinoma: the right treatment for the right patient. Bull Cancer 2022; 109:2S4-2S18. [DOI: 10.1016/s0007-4551(22)00234-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Saillant A, Borchiellini D. Nouvelle AMM : association lenvatinib et pembrolizumab en première ligne du carcinome rénal à cellules claires avancé. Bull Cancer 2022; 109:737-738. [DOI: 10.1016/j.bulcan.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Gaillard V, Lhuillier A, Bigot C, Pierard L, Trensz P, Burgy M, Schuster C, Malouf G, Fritsch A, Lang H, Tricard T, Borchiellini D, Geoffrois L, Barthelemy P. Impact of the app-based and nurse-led supportive care program AKO@dom on dose intensity of oral-targeted therapies in patients with metastatic renal cell cancer: a multicentric observational retrospective study. Support Care Cancer 2022; 30:6583-6591. [PMID: 35484315 DOI: 10.1007/s00520-022-07088-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKIs) remain a cornerstone of metastatic kidney cancer (mRCC). Adverse events (AEs) may lead to dose downregulation, and optimal management of AEs is needed to maintain an efficient dose intensity (DI). The aim of our study was to evaluate the impact of an app-based and nurse-led supportive-care program on DI in mRCC patients. METHOD This multicenter (n = 3), retrospective study evaluated all consecutive mRCC patients who participated in the AKO@dom program, which consisted of an app-based and nurse-led weekly patient evaluation at home during the first 3 months of TKI intake. Treatment patterns and modifications were described, and the mean DI (mDI) was calculated at the end of AKO@dom. RESULTS Eighty-nine patients were included: 12 had sunitinib, 18 pazopanib, 12 axitinib, and 47 cabozantinib. Median age was 69 years (60-76). TKIs were mainly initiated at standard doses except for cabozantinib (53% started at 40 mg/day); 71% had prior systemic treatment. Nine patients discontinued permanent treatment during the program. Thirty-two patients required ≥ 1 dose interruption, and 29% experienced ≥ 1 grade 3 AE of any type. The mDI (in mg/day) at 3 months was 34.4 ± 17.7 for sunitinib, 672.8 ± 144 for pazopanib, 8.6 ± 2.6 for axitinib, and 40 (36-48) for cabozantinib. Fifty-five patients [68.75% (95% CI: 57-78%)] had a mDI ≥ than reported in the literature. Overall survival at 12 months was 64.2% (CI 95%: 55-75%). CONCLUSION The AKO@dom program allowed 68.75% of patients to maintain a high dose intensity after 3 months of TKI treatment. The impact on survival outcomes needs to be evaluated in randomized clinical trials.
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Affiliation(s)
- Victor Gaillard
- Department of Urology, University Hospital, Strasbourg, France.
| | - Albane Lhuillier
- Department of Medical Oncology, Institut de Cancérologie de Lorraine (ICL), Nancy, France
| | - Cécile Bigot
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Laure Pierard
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Trensz
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Mickael Burgy
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Caroline Schuster
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Aurélie Fritsch
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Hervé Lang
- Department of Urology, University Hospital, Strasbourg, France
| | | | | | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine (ICL), Nancy, France
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Gerard AO, Barbosa S, Parassol N, Andreani M, Merino D, Cremoni M, Laurain A, Pinel S, Bourneau-Martin D, Rocher F, Esnault VLM, Borchiellini D, Sicard A, Drici MD. Risk factors associated with immune checkpoint inhibitor-induced acute kidney injury compared to other immune-related adverse events: a case-control study. Clin Kidney J 2022; 15:1881-1887. [PMID: 36158153 PMCID: PMC9494514 DOI: 10.1093/ckj/sfac109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) foster anti-cancer immune responses. Their efficacy comes at the cost of immune-related adverse events (IRAEs). The latter affects various organs, including kidneys, mostly as acute tubulointerstitial nephritis, the pathophysiology of which remains unclear. We conducted a multicentre case–control study to compare the characteristics of patients with renal IRAEs (ICI-AKI) with those of patients diagnosed with other IRAEs. Methods We queried the French pharmacovigilance database for all adverse events involving ICIs. Reports were classified as ICI-AKI or extrarenal IRAE. For each ICI-AKI report, four reports of extrarenal IRAEs were randomly included (control group, 4:1 ratio). Variables showing an association with a P < 0.05 were included as covariates in a multivariate analysis. Results Therefore, 167 ICI-AKI reports were compared with 668 extrarenal IRAEs. At least one concomitant extrarenal IRAE was mentioned in 44.3% of ICI-AKI reports. Patients with ICI-AKI were significantly older than patients with extrarenal IRAEs (69.1 versus 64.6 years; P = 0.0135), and chronic kidney disease was significantly more prevalent (12.0% versus 3.3%; P = 0.0125). Patients with ICI-AKI were significantly more likely to be treated with fluindione [adjusted odds ratio (OR) 6.53, 95% confidence interval (95% CI) 2.21–19.31; P = 0.0007], a non-steroidal anti-inflammatory drug (NSAID, OR 3.18, 95% CI 1.07–9.4; P = 0.0368) or a proton-pump inhibitor (PPI, OR 2.18, 95% CI 1.42–3.34; P = 0.0004). Conclusion This study is limited by a lack of data, preventing confirmation of numerous reports therefore not included in the analysis. We are unable to draw definite pathophysiological conclusions from our data. Nonetheless, we suggest that ICIs may be a ‘second-hit’ that precipitates acute kidney injury caused by another concomitant drug (fluindione, NSAID or PPI).
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Affiliation(s)
- Alexandre O Gerard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Susana Barbosa
- Institute of Molecular and Cellular Pharmacology (IPMC), UMR 7275, CNRS, University Côte d'Azur, Valbonne, France
| | - Nadège Parassol
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Marine Andreani
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Marion Cremoni
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Audrey Laurain
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Sylvine Pinel
- Pharmacovigilance Center of Paris - Fernand Widal, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Fanny Rocher
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
| | - Vincent L M Esnault
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, University Côte d'Azur, Nice, France
| | - Antoine Sicard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
- Clinical Research Unit of University Côte d'Azur (UR2CA), University Côte d'Azur, Nice France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Centre of Nice, University Hospital Centre of Nice, Nice, France
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Billon E, Dalban C, Oudard S, Chevreau C, Laguerre B, Barthélémy P, Borchiellini D, Geoffrois L, Negrier S, Joly F, Thiery-Vuillemin A, Gross-Goupil M, Rolland F, Priou F, Mahammedi H, Tantot F, Escudier B, Chabaud S, Albiges L, Gravis G. Association of adrenal metastases with outcomes in patients with metastatic clear cell renal cell carcinoma (mccRCC) treated with nivolumab in the GETUG-AFU-26 NIVOREN phase II trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
348 Background: Glandular metastases (GMs) (adrenal, pancreas, thyroid, ovary, breast, or prostate) are rare in mccRCC. Several studies have observed significantly longer overall survival (OS) for GM patients treated with anti-angiogenic therapy. This study assesses outcomes from mccRCC treated with nivolumab with or without GMs. Methods: The GETUG-AFU 26 NIVOREN, phase II trial assessed the activity and safety of nivolumab in pts with mccRCC who failed antiangiogenic therapies (NCT03013335). Pts were stratified in two subgroups according to the presence of at least one GM. Specific analyzes were performed for pancreatic and adrenal metastases. Primary endpoint was OS, secondary endpoint were progression free survival (PFS) and overall response rate (ORR). Results: Between February 2016 and July 2017, among 720 patients treated by nivolumab 217 patients had GM (151: adrenal and 86: pancreatic metastases). Clinical characteristics were comparable between the two subgroups except for IMDC poor subgroup (19% vs 28%) and for Furhman grade IV (13.5% vs 23.4%) for GM and non GM respectively. Median time between metastatic disease and nivolumab was 3.2 years (y) vs 2 y for GM and non GM respectively and 2.8 vs 2.1 y with or without adrenal metastasis. There was no statistical difference in outcomes between pts with or without GMs. However, pts with adrenal metastases had worse OS (12-months survival: 64% vs 71.1%; HR 1.51 (1.19-1.92)); shorter PFS (6-months survival: 27.2% vs 36.6%; HR 1.29 (1.07-1.57)) and lower ORR (12.5% [7.6%; 19.0%] vs 23.2% [19.8%; 27.0%]; p = 0.005) than non-adrenal metastases. Conversely, patients with pancreatic metastases had significantly longer overall survival (12-months survival: 82.3% vs 67.9%; HR 0.59 (0.40-0.85)) in univariate analysis compared to non-pancreatic metastases. In multivariate analysis, only adrenal metastasis remained associated with dismal prognosis (Table). Conclusions: Adrenal metastasis is an independent poor prognostic factor for response and survival in the GETUG-AFU 26 NIVOREN phase II trial. Limited activity with nivolumab is observed for patients with adrenal metastases from mccRCC without difference with previous anti angiogenic therapy. Molecular characterization could help to identify the angiogenic profile of adrenal metastases. Clinical trial information: NCT03013335. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Lionnel Geoffrois
- Institut de Cancérologie de Lorraine, Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France
| | - Sylvie Negrier
- Departement of Medical Oncology, Centre Léon Bérard, University Lyon I, Lyon, France
| | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Department of Medical Oncology, Saint-Herblain, France
| | - Frank Priou
- CHD Vendee-Hopital Les Oudairies, La Roche-Sur-Yon, France
| | | | | | | | | | - Laurence Albiges
- Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Gwenaelle Gravis
- Institut Paoli-Calmettes Aix-Mareseille Université, Marseille, France
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Aldea M, Lam L, Orillard E, Llacer Perez C, Saint-Ghislain M, Gravis G, Fléchon A, Roubaud G, Barthelemy P, Ricci F, Priou F, Neviere Z, Beaufils M, Laguerre B, Hardy AC, Helissey C, Ratta R, Borchiellini D, Pobel C, Joly F, Castro E, Thiery-Vuillemin A, Baciarello G, Fizazi K. Cabazitaxel activity in men with metastatic castration-resistant prostate cancer with and without DNA damage repair defects. Eur J Cancer 2021; 159:87-97. [PMID: 34742160 DOI: 10.1016/j.ejca.2021.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cabazitaxel was shown to improve overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) after abiraterone/enzalutamine and docetaxel failure, though benefit by the presence of DNA damage repair (DDR) defects is unknown. With the advent of poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) in partially overlapping indications with cabazitaxel, we aimed to determine cabazitaxel activity in men with mCRPC according to their DDR status. METHODS This is a retrospective multicenter study that enrolled patients with mCRPC treated with cabazitaxel who had undergone DDR tumour tissue profiling. Patients with at least one deleterious germline or somatic alterations were considered DDR positive (DDR+). Each DDR + patient has been matched with a DDR negative (DDR-) from the same institution who underwent the same test. An exploratory cohort of patients found to be DDR + by liquid biopsy was also included. Prostate specific antigen (PSA) decline≥50% (PSA50), PSA progression-free survival (PFS, PSA-PFS), radiographic PFS (rPFS), clinical PFS or radiographic PFS (c/rPFS) and OS were evaluated. RESULTS Among 190 men (95 DDR+, 95 DDR-) with tissue sequencing, PSA50 was achieved with cabazitaxel in 29/92 (32%) and 33/92 (36%) in patients with DDR+ and DDR- (P = 0.64). The median rPFS was 5.33 months [95%CI 4.34-7.04] versus 5.75 months [95%CI 4.67-7.27] (P = 0.55). The median OS was 15.4 months [95%CI 12.16-26.6] and 11.5 months [95%CI 9.76-14.4] (P = 0.036), respectively. No PSA50 responses on cabazitaxel were observed in BRCA1/2 patients previously treated with PARPi (n = 10). Similar outcomes with cabazitaxel were observed in the liquid biopsy cohort (n = 63 DDR+). CONCLUSIONS Our study suggests that cabazitaxel is active in patients with mCRPC regardless of their DDR status, although its activity in men pretreated with a PARPi may be lower.
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Affiliation(s)
- Mihaela Aldea
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, 114 Edouard Vaillant Street, 94805, Villejuif, France
| | - Laurent Lam
- Department of Biostatistics and Epidemiology, Gustave Roussy, 114 Edouard Vaillant Street, 94805, Villejuif, France
| | - Emeline Orillard
- Department of Medical Oncology, Hôpital Jean Minjoz, 3 Boulevard Alexandre Fleming, 25000, Besançon, France
| | - Casilda Llacer Perez
- Department of Medical Oncology, Hospitales Virgen de La Victoria y Regional de Málaga, Campus de Teatinos, S/N, 29010, Málaga, Spain
| | - Mathilde Saint-Ghislain
- Department of Medical Oncology, Centre Francois Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg/ICANS Strasbourg, 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Francesco Ricci
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005, Paris, France
| | - Frank Priou
- Department of Medical Oncology, Centre Hospitalier Départemental Vendée, Boulevard Stéphane Moreau, 85000, La Roche-sur-Yon, France
| | - Zoe Neviere
- Department of Medical Oncology, Centre Francois Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Mathilde Beaufils
- Department of Medical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugène Marquis, Bataille Flandres-Dunkerque Avenue, 35000, Rennes, France
| | - Anne-Claire Hardy
- Department of Medical Oncology, Hôpital Privé des Côtes D'Armor, 10 François Jacob Street, 22190, Plérin, France
| | - Carole Helissey
- Department of Medical Oncology, Hôpital D'Instruction des Armées Begin, 69 Paris Avenue, 94160, Saint-Mandé, France
| | - Raffaele Ratta
- Department of Medical Oncology, Hôpital Foch, 40 Worth Street, 92150, Suresnes, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Cote D'Azur, 33 Valombrose Avenue, 06100, Nice, France
| | - Cedric Pobel
- Department of Medical Oncology, Hôpital Européen Georges-Pompidou, 20 Leblanc Street, 75015, Paris, France
| | - Florence Joly
- Department of Medical Oncology, Centre Francois Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Elena Castro
- Department of Medical Oncology, Hospitales Virgen de La Victoria y Regional de Málaga, Campus de Teatinos, S/N, 29010, Málaga, Spain
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, Hôpital Jean Minjoz, 3 Boulevard Alexandre Fleming, 25000, Besançon, France
| | - Giulia Baciarello
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, 114 Edouard Vaillant Street, 94805, Villejuif, France
| | - Karim Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Saclay, 114 Edouard Vaillant Street, 94805, Villejuif, France.
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Pignot G, Thiery-vuillemin A, Walz J, Lang H, Balssa L, Leblanc L, Borchiellini D, Parier B, Albiges L, Bensalah K, Schlurmann F, Mourey E, Bigot P, Ingels A, Bernhard J, Piechaud T, Roubaud G, Klifa D, Gravis G, Barthelemy P. Résultats oncologiques de la néphrectomie différée après réponse complète à l’immunothérapie pour cancer du rein métastatique au diagnostic. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pujalte Martin M, Borchiellini D, Thamphya B, Guillot A, Paoli JB, Besson D, Hilgers W, Priou F, El Kouri C, Hoch B, Deville JL, Schiappa R, Cheli S, Milano G, Tanti JF, Bost F, Ferrero JM. TAXOMET: A French Prospective Multicentric Randomized Phase II Study of Docetaxel Plus Metformin Versus Docetaxel Plus Placebo in Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2021; 19:501-509. [PMID: 34629300 DOI: 10.1016/j.clgc.2021.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Docetaxel (DOCE) is a standard of care in metastatic castration-resistant prostate cancer (mCRPC). Several retrospective studies suggested a decrease in Prostate Cancer incidence and mortality with metformin (MET). MET has also demonstrated anti-tumor activity in Prostate Cancer preclinical models, with increased apoptosis when added to DOCE. We aimed at exploring the role of MET in combination with DOCE in mCRPC. PATIENTS AND METHODS Non-diabetic mCRPC patients were randomly assigned to receive DOCE 75 mg/m2 every 21 days + prednisone (5 mg. BID) with either MET 850 mg BID (D+M) or placebo (D+P) up to 10 cycles. Prostate-Specific Antigen (PSA) response ≥50% from baseline was the primary end point. Secondary end points included objective response rate (ORR), progression-free survival (PFS), overall survival (OS), toxicity and quality of life (QoL). RESULTS Out of 99 patients were randomized (D+M = 50; D+P = 49) in 10 French centers. The median follow-up was 86 (IQR 73-88) months. The PSA-response rate reached 66% in the D+M arm, but was not different from that observed in the D+P arm (63%, P = 0,94). In the D+M and D+P arms, the ORR was 28% and 24%, the median PFS was 7.8 and 6.0 months and the median OS was 27 and 20 months (ns), respectively. Diarrhea grade I to II was more frequent in the MET arm (66% vs. 43%). No impairment of QoL was observed. CONCLUSION MET addition failed to improve the standard DOCE regimen in mCRPC. Further research targeting tumor cell metabolism should be performed.
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Affiliation(s)
- Marc Pujalte Martin
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Brice Thamphya
- Research Departement, Epidemiology and Bioinformatics Unit, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Aline Guillot
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - Dominique Besson
- Department of Medical Oncology, Centre Cario-HPCA, Plérin, France
| | - Werner Hilgers
- Department of Medical Oncology, Sainte Catherine Cancer Institute, Avignon Provence, France
| | - Frank Priou
- Department of Medical Oncology, CHD Vendée, La Roche sur Yon, France
| | - Claude El Kouri
- Department of Medical Oncology, Centre Catherine de Sienne, Nantes, France
| | - Benjamin Hoch
- Department of Medical Oncology, Centre Azuréen de Cancérologie, Mougins
| | | | - Renaud Schiappa
- Research Departement, Epidemiology and Bioinformatics Unit, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Sandrine Cheli
- Clinical Research and Innovation Department, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gérard Milano
- Oncopharmacology Unit, EA3836, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | | | - Frédéric Bost
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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Alves Costa Silva C, Derosa L, Dalban C, Colomba E, Negrier S, Chevreau C, Gravis G, Oudard S, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Joly F, Ladoire S, Tantot F, Escudier B, Albiges L. 697P Impact of β-blockers (BB) on outcomes of metastatic renal cell carcinoma (mRCC) patients treated with nivolumab (N). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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38
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Colomba E, Jonas S, Eymard JC, Delva R, Brachet P, Neuzillet Y, Penel N, Roubaud G, Bompas E, Mahammedi H, Longo R, Helissey C, Barthelemy P, Borchiellini D, Hasbini A, Priou F, Saldana C, Voog E, Foulon S, Fizazi K. 603P Objective computerized cognitive assessment in men with metastatic castrate-resistant prostate cancer (mCRPC) randomly receiving darolutamide or enzalutamide in the ODENZA trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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39
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Gaillard V, Lhuillier A, Bigot C, Pierard L, Trensz P, Schuster C, Malouf G, Fritsch A, Borchiellini D, Geoffrois L, Barthelemy P. CN54 Impact of the app-based and nurse-led supportive care program AKO@dom on dose-intensity of oral targeted therapies in patients with metastatic renal cell cancer: A multicentric observational retrospective study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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40
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Gafanov R, Powles T, Bedke J, Stus V, Waddell T, Nosov D, Pouliot F, Soulieres D, Melichar B, Azevedo S, McDermott R, Vynnychenko I, Borchiellini D, Markus M, Bondarenko I, Lin J, Burgents J, Molife L, Plimack E, Rini B. 669P Subsequent therapy following pembrolizumab + axitinib or sunitinib treatment for advanced renal cell carcinoma (RCC) in the phase III KEYNOTE-426 study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Derosa L, Alves Costa Silva C, Dalban C, Colomba E, Negrier S, Chevreau C, Gravis G, Oudard S, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Joly F, Ladoire S, Tantot F, Escudier B, Albiges L. 657MO Antibiotic (ATB) therapy and outcome from nivolumab (N) in metastatic renal cell carcinoma (mRCC) patients (pts): Results of the GETUG-AFU 26 NIVOREN multicentric phase II study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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42
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Vano Y, Phan L, Gravis G, Korakis I, Schlürmann F, Maillet D, Bennamoun M, Houede N, Topart D, Borchiellini D, Barthelemy P, Ratta R, Ryckewaert T, Hasbini A, Hans S, Emambux S, Cournier S, Braychenko E, Elaidi RT, Oudard S. 673P Cabozantinib-nivolumab (CN) vs. nivolumab-cabozantinib (NC) in patients (pts) with metastatic clear cell renal cell carcinoma (mRCC) following one prior VEGFR tyrosine kinase inhibitor (TKI): The CABIR multicentric matching-adjusted study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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43
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Ambrosetti D, Coutts M, Paoli C, Durand M, Borchiellini D, Montemagno C, Rastoin O, Borderie A, Grepin R, Rioux-Leclercq N, Bernhard JC, Pagès G, Dufies M. Cancer-associated fibroblasts in renal cell carcinoma: implication in prognosis and resistance to anti-angiogenic therapy. BJU Int 2021; 129:80-92. [PMID: 34107167 DOI: 10.1111/bju.15506] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the role of cancer-associated fibroblasts (CAFs) in clear cell renal cell carcinoma (ccRCC) with respect to tumour aggressiveness, metastasis development, and resistance to anti-angiogenic therapy (vascular endothelial growth factor receptor-tyrosine kinase inhibitors [VEGFR-TKI]). PATIENTS AND METHODS Our study involved tissue samples from three distinct and independent cohorts of patients with ccRCC. The presence of CAFs and tumour lymphangiogenesis was investigated, respectively, by transcriptional signatures and then correlated with tumour development and prognosis. The effect of these CAFs on tumour cell migration and VEGFR-TKI resistance was analysed on co-cultures of ccRCC cells with CAFs. RESULTS Results from our cohorts and from in silico investigations showed that VEGFR-TKI significantly increase the number of CAFs in tumours. In the same populations of patients with ccRCC, the proportion of intra-tumoral CAFs correlated to shorter disease-free and overall survival. The presence of CAFs was also correlated with lymphangiogenesis and lymph node metastasis. CAFs increased the migration and decreased the VEGFR-TKI-dependent cytotoxic effect of tumour cells. CONCLUSIONS Our results show that VEGFR-TKI promote the development of CAFs, and CAFs favour tumour aggressiveness, metastatic dissemination, and resistance to treatment in ccRCC. CAFs could represent a new therapeutic target to fight resistance to treatment of ccRCC. Targeting CAF and immunotherapies combination are emerging as efficient treatments in many types of solid tumours. Our results highlight their relevance in ccRCC.
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Affiliation(s)
- Damien Ambrosetti
- Department of Pathology, CHU Nice, Université Côte d'Azur, Nice, France.,Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284, INSERM U1081, University Côte d'Azur, Nice, France
| | - Michael Coutts
- Department of Pathology, Maidstone General Hospital, Maidstone, UK
| | - Charlotte Paoli
- Department of Pathology, CHU Nice, Université Côte d'Azur, Nice, France
| | - Matthieu Durand
- Department of Urology, CHU Nice, Université Côte d'Azur, Nice, France
| | | | - Christopher Montemagno
- Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284, INSERM U1081, University Côte d'Azur, Nice, France.,Department of Biomedical, Centre Scientifique de Monaco, Monaco, Principality of Monaco.,LIA ROPSE, Laboratoire International Associé, Université Côte d'Azur - Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Olivia Rastoin
- Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284, INSERM U1081, University Côte d'Azur, Nice, France.,LIA ROPSE, Laboratoire International Associé, Université Côte d'Azur - Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Arnaud Borderie
- Department of Pathology, CHU Nice, Université Côte d'Azur, Nice, France
| | - Renaud Grepin
- Department of Biomedical, Centre Scientifique de Monaco, Monaco, Principality of Monaco.,LIA ROPSE, Laboratoire International Associé, Université Côte d'Azur - Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | | | - Jean-Christophe Bernhard
- Department of Urology, University Hospital, Bordeaux, France.,French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Gilles Pagès
- Institute for Research on Cancer and Aging of Nice (IRCAN), CNRS UMR 7284, INSERM U1081, University Côte d'Azur, Nice, France.,Department of Biomedical, Centre Scientifique de Monaco, Monaco, Principality of Monaco.,LIA ROPSE, Laboratoire International Associé, Université Côte d'Azur - Centre Scientifique de Monaco, Monaco, Principality of Monaco
| | - Maeva Dufies
- Department of Biomedical, Centre Scientifique de Monaco, Monaco, Principality of Monaco.,LIA ROPSE, Laboratoire International Associé, Université Côte d'Azur - Centre Scientifique de Monaco, Monaco, Principality of Monaco
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Pignot G, Thiery-Vuillemin A, Walz J, Gaillard V, Lang H, Balssa L, Geoffrois L, Albiges L, Bensalah K, Schlurmann F, Ladoire S, Bigot P, Ingels A, Roubaud G, Cassuto O, Parier B, Bernhard JC, Borchiellini D, Gravis G, Barthelemy P. Nephrectomy after response to immune checkpoint inhibitors for metastatic renal cell carcinoma (mRCC): A surgical challenge allowing favorable oncological outcomes. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16557 Background: In the current era of Immune checkpoint inhibitors (ICI), the role and timing of nephrectomy is still unknown. We aimed to evaluate the oncological outcomes of patients with metastatic renal cell carcinoma (mRCC) managed with nephrectomy for residual disease after complete response (CR) or major partial response (mPR defined as > 80%) on metastatic sites following ICI. Methods: Patients who underwent nephrectomy after prior ICI between 2015 and 2020 were retrospectively included and clinicopathological data were reviewed. Perioperative data, postoperative complications, toxicities related to ICI, continuation or discontinuation of systemic treatment following surgery, and 1-year oncological outcomes were recorded. Results: Twenty-five patients without initial cytoreductive nephrectomy at diagnosis underwent delayed nephrectomy after long ICI administration because of CR (or mPR) on metastatic sites. Median age was 62 years [38-79]. 88% of patients had clear cell RCC on the initial biopsy. IMDC prognostic group was intermediate (80%) or poor (20%). ICI was administered as first-line therapy in 56.0% of cases and as second-line option after TKI in 44.0% of cases. Treatments regimens were: nivolumab + ipilimumab (n = 12), nivolumab + tivozanib (n = 2) or nivolumab alone (n = 11). The mean duration of ICI treatment was 11.8 months (range: 3-38 months) and the mean number of cycles was 19 (range: 6-75). Twelve patients had a CR on metastatic sites while 13 patients had a mPR ( > 80%). Overall, 64% of patients experienced toxicities related to ICI treatment. Median operative time was 210 minutes [90-345] and mean blood loss was 558 cc [40-4000]. In 80.0% of cases, surgeons experienced difficulties in finding dissection plans due to adhesions and/or inflammatory infiltration. The 30-day Clavien-Dindo postoperative complication rate was 36.0%, including 1 surgery-related death. Pathological report showed lymphocyte and/or macrophage infiltration in 60% of cases and complete pathological response (pT0) in 3 cases (12%). After a mean follow-up of 19.4 months, 79.2% of the patients were free from progression and 70.8% free from systemic treatment. The recurrence-free survival (RFS) and overall survival (OS) at 1 year were 79.5% and 89.8% respectively. CR on metastatic sites was significantly associated with good RFS compared to mPR (1-year RFS = 100% vs. 56.8%, median RFS = 21.6 vs. 4.25 months, p = 0.006) while the duration of IO treatment exposure was not. Conclusions: Nephrectomy following ICI for mRCC can be a difficult procedure. However, it may provide good long-term RFS, with systemic treatment discontinuation following surgery in most cases. This strategy may be offered in well-selected patients, especially in case of CR on metastatic sites before surgery.
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Affiliation(s)
| | | | | | | | - Herve Lang
- Department of Urology, CHU Strasbourg, Strasbourg University, Strasbourg, France
| | - Loic Balssa
- Urology Department, Chru Besancon, Besancon, France
| | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lés-Nancy, France
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, University of Paris Sud, Boston, MA
| | - Karim Bensalah
- University Hospital Pontchaillou Service d’urologie CHU Rennes, Université de Rennes, Rennes, France
| | | | | | - Pierre Bigot
- Service d’Urologie CHU Angers, Université d’Angers, Angers, France
| | | | - Guilhem Roubaud
- Department of Medical Oncology, Institute Bergonié, Bordeaux, France
| | | | | | - Jean-Christophe Bernhard
- Service d’Urologie CHU Bordeaux, Université De Bordeaux, French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Philippe Barthelemy
- Institut de Cancérologie Strasbourg Europe,Strasbourg, France, Strasbourg, France
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Colomba E, Jonas SF, Eymard JC, Delva R, Brachet PE, Neuzillet Y, Penel N, Roubaud G, Bompas E, Mahammedi H, Longo R, Helissey C, Barthelemy P, Borchiellini D, Hasbini A, Priou F, Saldana C, Voog E, Foulon S, Fizazi K. ODENZA: A French prospective, randomized, open-label, multicenter, cross-over phase II trial of preference between darolutamide and enzalutamide in men with asymptomatic or mildly symptomatic metastatic castrate-resistant prostate cancer (CRPC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5046 Background: Darolutamide (Daro) and enzamutamide (Enza) are both next generation androgen receptor inhibitors with demonstrated activity in men with CRPC. Although both agents are associated with survival improvement, their toxicity profiles are different. To help decipher whether this may impact on patient preference, we designed the ODENZA trial. Methods: ODENZA is a prospective, randomized, open-label, multicenter, cross-over, phase II trial of preference between Daro and Enza in men with asymptomatic or mildly symptomatic metastatic CRPC. Patients were randomized 1/1 to receive Daro 1200 mg/d for 12 weeks followed by Enza 160 mg/d for 12 weeks (Daro-Enza arm) or the reverse sequence (Enza-Daro arm). In both arms, the second treatment was given in absence of evidence of cancer progression at week 12. The primary endpoint was patient preference between the two drugs, as assessed by a questionnaire at week 24. The Prescott's test was used to determine treatment preference in patients fullfilling pre planned criteria (exposure to both treatments, no progression at week 12, and completion of the preference questionnaire). A p-value greater than 0.05 indicates that there is no difference in preference between treatments. Stratification factors were performance status and prior taxane for mCSPC. After week 24, patients went on to an extension period during which they received the chosen treatment until progression or toxicity. The main secondary objectives included reasons for preference, response at week 12, cognitive assessment, and toxicity. Results: Overall 249 pts were randomized, median age 72y (68; 79), ECOG PS 0 (56%), prior taxanes (22%). Two hundred pts fulfilled the pre-planned criteria for evaluation of the preference primary endpoint : 97 (48.5% [41.3;55.7]), 80 (40.0% [33.0;47.0]), and 23 (11.5% [6.8;16.2]) chose Daro, Enza, and had no preference, respectively (unilateral p-value of 0.92). After preference assessment, 186 patients entered the extension period: 103 (55.4%) and 83 (44.6%) received Daro and Enza respectively. The most common factors influencing patient preference all numerically favored Daro over Enza, without significant differences were: less fatigue (44% vs 29%), ease of taking the medication (37% vs 31%), better quality of life (36% vs 28%), ability to be more active (26% vs 15%), ability to concentrate (22% vs 15%) and less falls (6% vs 3%). A PSA50 response was achieved in 76.2% and 83.9% at week 12 with Daro and Enza respectively (p = 0.13). Fatigue was the most frequently reported all grade adverse event at week 12, in 21% and 36% with Daro and Enza, respectively. Conclusions: More patients with early mCRPC preferred Daro over Enza, although the difference did not reach significance, with fatigue as the key influencing factor. Clinical trial information: NCT03314324.
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Affiliation(s)
- Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, Gineco Group, France
| | - Sarah Flora Jonas
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay; U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | | | - Remy Delva
- Institut de Cancerologie de l'Ouest, Angers, France
| | | | - Yann Neuzillet
- Versailles-Saint-Quentin-en-Yvelines University, Urology Department, Foch Hospital, Suresnes, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University Hospital, Lille, France
| | | | | | | | | | - Carole Helissey
- Clinical Research Unit, Military Hospital Begin, Saint-Mandé, France
| | - Philippe Barthelemy
- Institut de Cancérologie Strasbourg Europe,Strasbourg, France, Strasbourg, France
| | | | | | - Franck Priou
- Centre Hospitalier Departemental Les Oudairies, La Roche Sur Yon, France
| | - Carolina Saldana
- Oncology Department, Hôpital Henri Mondor, APHP, Créteil, France
| | - Eric Voog
- Centre Jean Bernard Clinique Victor Hugo, Le Mans, France
| | | | - Karim Fizazi
- Institut Gustave Roussy and University of Paris Saclay, Villejuif, France
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46
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Rini BI, Plimack ER, Stus V, Waddell T, Gafanov R, Pouliot F, Nosov D, Melichar B, Soulieres D, Borchiellini D, Vynnychenko IO, McDermott RS, Azevedo SJ, Tamada S, Kryzhanivska A, Li C, Burgents JE, Molife LR, Bedke J, Powles T. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma (ccRCC): Results from 42-month follow-up of KEYNOTE-426. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4500] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4500 Background: In the first interim analysis of the randomized, multicenter, open-label, phase 3 KEYNOTE-426 study (NCT02853331), treatment with pembro + axi significantly improved OS, PFS, and ORR vs sunitinib monotherapy in treatment-naive advanced ccRCC. Extended follow-up (median, 30.6 mo) continued to demonstrate the superior efficacy of pembro + axi vs sunitinib monotherapy in this patient population. Here, we present the results of the prespecified final analysis with 42.8-mo median follow-up. Methods: Treatment-naive patients (pts) with advanced ccRCC, KPS ≥70%, and measurable disease (RECIST v1.1) were randomly assigned 1:1 to receive pembro 200 mg IV Q3W for up to 35 doses + axi 5 mg orally BID or sunitinib 50 mg orally QD on a 4-wk on/2-wk off schedule until progression, intolerable toxicity, or withdrawal. Randomization was stratified by IMDC risk (favorable vs intermediate vs poor) and geographic region (North America vs Western Europe vs Rest of World). Dual primary endpoints were OS and PFS. Secondary endpoints were ORR, DOR, and safety. The protocol-specified final analysis was based on a target of 404 OS events. No formal hypothesis testing was performed because all efficacy endpoints were met previously at the first interim analysis; nominal P values are reported. Results: Overall, 861 pts were randomly assigned to receive pembro + axi (n=432) or sunitinib (n=429). Median duration of follow-up, defined as time from randomization to the database cutoff date, was 42.8 mo (range, 35.6-50.6). At data cutoff, 418 pts had died: 193 (44.7%) of 432 pts in the pembro + axi arm vs 225 (52.4%) of 429 pts in the sunitinib arm. Compared with sunitinib, pembro + axi improved OS (median: 45.7 vs 40.1 mo; HR, 0.73 [95% CI, 0.60-0.88]; P<0.001) and PFS (median: 15.7 vs 11.1 mo; HR, 0.68 [95% CI, 0.58-0.80]; P<0.0001). The 42-mo OS rate was 57.5% with pembro + axi vs 48.5% with sunitinib; the 42-mo PFS rate was 25.1% with pembro + axi vs 10.6% with sunitinib. For pembro + axi vs sunitinib, ORR was 60.4% vs 39.6% ( P<0.0001); CR rate was 10.0% vs 3.5%; median DOR was 23.6 mo (range 1.4+ to 43.4+) vs 15.3 mo (range, 2.3-42.8+). Subsequent anticancer therapy was administered to 47.2% of pts in pembro + axi arm vs 65.5% of pts in sunitinib arm. Although a similar proportion of pts in each arm received VEGF/VEGFR inhibitors, only 10.2% of pts in the pembro + axi arm received subsequent treatment with a PD-1/L1 inhibitor compared to 48.7% of pts in the sunitinib arm. No new safety signals were observed. Conclusions: With a median follow-up of 42.8 mo, this is the longest follow-up of an anti-PD–1/L1 immunotherapy combined with a VEGF/VEGFR inhibitor for first-line RCC. These results show that pembro + axi continues to demonstrate superior efficacy over sunitinib with respect to OS, PFS, and ORR, with no new safety signals. Clinical trial information: NCT02853331.
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Affiliation(s)
| | | | - Viktor Stus
- Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, Dnipro, Ukraine
| | - Tom Waddell
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Rustem Gafanov
- Russian Scientific Center of Roentgenoradiology, Moscow, Russian Federation
| | | | - Dmitry Nosov
- Central Clinical Hospital With Outpatient Clinic, Moscow, Russian Federation
| | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Denis Soulieres
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | | | | | | | | | - Anna Kryzhanivska
- Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | | | | | - Jens Bedke
- Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trusts, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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47
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Barrière J, Audigier-Valette C, Borchiellini D, Hoch B, Castelnau O, Francois E, Gastaud L, Skaf R, Berdah JF, Marie W, Lescaut W, Peyrade F, Cluzeau T, Cassuto O, Carles M. [We must respect the anti-SARS-CoV-2 vaccine schedule without delay in cancer patients under treatment]. Bull Cancer 2021; 108:341-342. [PMID: 33741139 PMCID: PMC7934697 DOI: 10.1016/j.bulcan.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jérôme Barrière
- Polyclinique Saint-Jean, département d'oncologie médicale, 92, avenue Dr Maurice Donat, 06800 Cagnes-sur-Mer, France.
| | - Clarisse Audigier-Valette
- Centre hospitalier Toulon Sainte-Musse, département de pneumo-oncologie, 54, rue Henri-Sainte-Claire-Deville, 83056 Toulon, France
| | - Delphine Borchiellini
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Benjamin Hoch
- Centre Azuréen de cancérologie, département d'oncologie médicale, 1, place Docteur-Jean-Luc Broquerie, 06250 Mougins, France
| | - Olivier Castelnau
- Institut Arnault Tzanck, département de pneumo-oncologie, 116, rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Eric Francois
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Lauris Gastaud
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Richard Skaf
- Polyclinique Saint-George, département d'oncologie médicale, 2, avenue De Rimiez, 06100 Nice, France
| | - Jean-François Berdah
- Hôpital privé Toulon-Hyères, Sainte-Marguerite, département d'oncologie médicale, avenue Alexis-Godillot, 83400 Hyères, France
| | - Wislez Marie
- Hôpital Cochin, université de Paris, unité d'oncologie thoracique, service de pneumologie, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Willy Lescaut
- Centre hospitalier Princesse-Grace, département d'oncologie médicale, avenue Pasteur, 98000 Monaco
| | - Frédéric Peyrade
- Centre Antoine-Lacassagne, département d'oncologie médicale, 33, avenue de Valombrose, 06189 Nice, France
| | - Thomas Cluzeau
- CHU de Nice, hôpital Archet 1, département d'hématologie clinique, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - Ophélie Cassuto
- Polyclinique Saint-George, département d'oncologie médicale, 2, avenue De Rimiez, 06100 Nice, France
| | - Michel Carles
- CHU de Nice, hôpital Archet 1, département d'infectiologie, 151, route Saint-Antoine-de-Ginestière, 06200 Nice, France
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Vauchier C, Auclin E, Barthelemy P, Carril L, Ryckewaert T, Borchiellini D, Ajgal Z, Bennamoun M, Campedel L, Thiery-Vuillemin A, Coquan E, Crouzet L, Berdah JF, Chevreau C, Ratta R, Flechon A, Lefort F, Gross-Goupil M, Thibault C, Oudard S. Rechallenge of nivolumab in metastatic renal cell carcinoma, an ambispective multicenter study (RENIVO). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
330 Background: Immune checkpoint inhibitors (ICIs) in combination with another ICI or an antiangiogenic targeted therapy have been approved for frontline therapy in metastatic renal cell carcinoma (mRCC). However, progression disease (PD) often occurs and subsequent therapies are needed. Rechallenge of ICI may then be an option, but there is a lack of data regarding this strategy. Methods: This ambispective multicenter study included patients who received a rechallenge of Nivolumab (ICI-2) between January 2014 and September 2020, after a first-ICI therapy (ICI-1), regardless of the reason of the discontinuation. Patients could have either a non-ICI therapy or have a prolonged free-interval (≥ 12 weeks) between ICI regimens. Those with ongoing rechallenge at inclusion were followed prospectively. Primary endpoint was investigator-assessed best ORR. Results: 45 rechallenges were included from 16 centers. Median age was 60 years (range, 42-90), 64% were male. Most of them had clear cell histology (91%) and a Fuhrman or ISUP grade ≥ 3 (80%). Single-agent Nivolumab and Nivolumab-Ipilimumab association were used in 78% and 11% during ICI-1 and in 93% and 7% during ICI-2, respectively. Discontinuation for PD, toxicity or clinical decision occurred in 49%, 27% and 24% for ICI-1 and in 94%, 3% and 3% for ICI-2, respectively. The ORR were 51% (n = 23) at ICI-1 and 16% (n = 7) at ICI-2. One patient had a complete response during both ICI-1 and ICI-2 and two had a partial response at ICI-2 although they had PD as best ICI-1 response. After a median follow-up of 14.9 months (mo), median duration of response for ICI-2 was 5.1 mo (95% CI, 2.7-not reached [NR]). For ICI-1 and ICI-2: median progression-free survival (PFS) was 11.4 mo (95% CI, 9.8-23.5) and 3.5 mo (95% CI, 2.8-9.7); median overall survival was NR (95% CI, 37.8-NR) and 24 mo (95% CI, 9.9-NR). Poor prognostic factors for PFS at ICI-2 were Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 2, presence of liver metastases, inflammatory syndrome and PFS under ICI-1 > 6 months. Grade ≥ 3 immune-related adverse events occurred in 24% (n = 11) during ICI-1 but only in 4% (n = 2) during ICI-2. There was no treatment-related death. Conclusions: Our study suggests that resumption of ICI with Nivolumab has a moderate efficacy in mRCC and acceptable tolerance. Predictive factors of response are needed to propose this strategy to selected mRCC patients. Larger prospective cohorts are needed to confirm these results. [Table: see text]
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Affiliation(s)
| | - Edouard Auclin
- Oncology Department, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, Paris, France
| | | | | | | | | | - Zahra Ajgal
- Medical Oncology, Paris Descartes University, Cochin-Port Royal Hospital, AP-HP, Paris, France
| | - Mostefa Bennamoun
- Department of Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Luca Campedel
- Department of Medical Oncology, Groupe Hospitalier Pitie-Salpetriere, University Pierre and Marie Curie (Paris VI), Institut Universitaire de Cancerologie, Paris, France
| | | | | | | | | | | | | | - Aude Flechon
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Felix Lefort
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux Cedex, France
| | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | - Constance Thibault
- Oncology department, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, Paris, France
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Mourey L, Dalban C, Negrier S, Chevreau C, Gravis G, Thibault C, Laguerre B, Barthelemy P, Borchiellini D, Gross-Goupil M, Geoffrois L, Rolland F, Thiery-Vuillemin A, Joly F, Ladoire S, Tantot F, Escudier B, Albiges L. Safety and efficacy of nivolumab in older patients (pts) with renal cell carcinoma: Results of a sub-group analysis of the GETUG-AFU 26 NIVOREN multicenter phase II study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
331 Background: NIVOREN GETUG AFU 26 study, is a french multicenter prospective study to evaluate safety and efficacy of Nivolumab (N) in a broad “real world setting” in mRCC after failure of 1 or 2 tyrosine kinase inhibitors. Methods: Between February 2016 and July 2017, 729 pts were enrolled across 27 institutions. Primary objective of the trial was safety assessed by grade ≥ 3 treatment related adverse event (TRAE). We report here results of older patients above 70 years old ([70;75[; [75;80[; ≥ 80) compared with their younger counterparts. Results: Overall, 720 patients were treated (median age 64 (22;90)). Among them 205 pts were ≥ 70 (28.5%) divided as follow: [70-75[:107 (14.9%) / [75-80[: 68 (9,4%) / ≥ 80: 30 (4,2%). Patients’ characteristics (Table) were similar in younger and older patients except for IMDC risk groups (IMDC) classification with less poor prognostic in pts ≥ 75 and fewer brain metastasis in pts ≥ 70. Treatment duration was similar across age groups despite a rate of discontinuation for TRAE increasing with age. Regarding efficacy, there was a non-significant trend toward improved response rate and progression free survival and lower specific survival with increasing age. Conclusions: In this large “real world” setting study a significant number of old pts were included. Prognostic profile appears better in older pts included. There is no signal for an excess of toxicity in this population and efficacy is comparable to younger patients. Age alone should not prevent prescribing N in mRCC. Clinical trial information: NCT03013335 . [Table: see text]
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Affiliation(s)
- Loic Mourey
- Institut Claudius Regaud/IUCT-Oncopole, Toulouse, France
| | | | - Sylvie Negrier
- Departement of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Constance Thibault
- Oncology department, Hôpital Européen Georges Pompidou, AP-HP, University of Paris, Paris, France
| | | | | | | | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | | | - Frederic Rolland
- Institut de Cancérologie de l'Ouest, Department of Medical Oncology, St Herblain, France
| | | | - Florence Joly
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | | | | | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
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