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Saad E, Gebrael G, Semaan K, Eid M, Saliby RM, Labaki C, Sayegh N, Wells JC, Takemura K, Ernst MS, Lemelin A, Basappa NS, Wood LA, Powles T, Ernst DS, Lalani AKA, Agarwal N, Xie W, Heng DYC, Choueiri TK. Impact of smoking status on clinical outcomes in patients with metastatic renal cell carcinoma treated with first-line immune checkpoint inhibitor-based regimens. Oncologist 2024:oyae072. [PMID: 38630540 DOI: 10.1093/oncolo/oyae072] [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: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Current tobacco smoking is independently associated with decreased overall survival (OS) among patients with metastatic renal cell carcinoma (mRCC) treated with targeted monotherapy (VEGF-TKI). Herein, we assess the influence of smoking status on the outcomes of patients with mRCC treated with the current first-line standard of care of immune checkpoint inhibitor (ICI)-based regimens. MATERIALS AND METHODS Real-world data from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were collected retrospectively. Patients with mRCC who received either dual ICI therapy or ICI with VEGF-TKI in the first-line setting were included and were categorized as current, former, or nonsmokers. The primary outcomes were OS, time to treatment failure (TTF), and objective response rate (ORR). OS and TTF were compared between groups using the log-rank test and multivariable Cox regression models. ORR was assessed between the 3 groups using a multivariable logistic regression model. RESULTS A total of 989 eligible patients were included in the analysis, with 438 (44.3%) nonsmokers, 415 (42%) former, and 136 (13.7%) current smokers. Former smokers were older and included more males, while other baseline characteristics were comparable between groups. Median follow-up for OS was 21.2 months. In the univariate analysis, a significant difference between groups was observed for OS (P = .027) but not for TTF (P = .9), with current smokers having the worse 2-year OS rate (62.8% vs 70.8% and 73.1% in never and former smokers, respectively). After adjusting for potential confounders, no significant differences in OS or TTF were observed among the 3 groups. However, former smokers demonstrated a higher ORR compared to never smokers (OR 1.45, P = .02). CONCLUSION Smoking status does not appear to independently influence the clinical outcomes to first-line ICI-based regimens in patients with mRCC. Nonetheless, patient counseling on tobacco cessation remains a crucial aspect of managing patients with mRCC, as it significantly reduces all-cause mortality.
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Affiliation(s)
- Eddy Saad
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Karl Semaan
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marc Eid
- Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Nicolas Sayegh
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
- UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Kosuke Takemura
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Thomas Powles
- Experimental Cancer Medicine Centre, Barts Cancer Institute, St. Bartholomew's Hospital, Queen Mary University of London, London, United Kingdom
| | - D Scott Ernst
- Department of Oncology, Western University, London, ON, Canada
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Wanling Xie
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Takemura K, Lemelin A, Ernst MS, Wells JC, Saliby RM, El Zarif T, Labaki C, Basappa NS, Szabados B, Powles T, Davis ID, Wood LA, Lalani AKA, McKay RR, Lee JL, Meza L, Pal SK, Donskov F, Yuasa T, Beuselinck B, Gebrael G, Agarwal N, Choueiri TK, Heng DYC. Outcomes of Patients with Brain Metastases from Renal Cell Carcinoma Receiving First-line Therapies: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 2024:S0302-2838(24)00005-8. [PMID: 38290965 DOI: 10.1016/j.eururo.2024.01.006] [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: 07/27/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
Patients with brain metastases (BrM) from renal cell carcinoma and their outcomes are not well characterized owing to frequent exclusion of this population from clinical trials. We analyzed data for patients with or without BrM using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). A total of 389/4799 patients (8.1%) had BrM on initiation of systemic therapy. First-line immuno-oncology (IO)-based combination therapy was associated with longer median overall survival (OS; 32.7 mo, 95% confidence interval [CI] 22.3-not reached) versus tyrosine kinase inhibitor monotherapy (20.6 mo, 95% CI 15.7-24.5; p = 0.019), as were intensive focal therapies with stereotactic radiotherapy or neurosurgery (31.4 mo, 95% CI 22.3-37.5) versus whole-brain radiotherapy alone or no focal therapy (16.5 mo, 95% CI 10.2-21.1; p = 0.028). On multivariable analysis, IO-based regimens (HR 0.49, 95% CI 0.25-0.97; p = 0.040) and stereotactic radiotherapy or neurosurgery (HR 0.48, 95% CI 0.29-0.78; p = 0.003) were independently associated with longer OS, as was IMDC favorable or intermediate risk (HR 0.40, 95% CI 0.24-0.66; p < 0.001). Intensive systemic and focal therapies were associated with better prognosis in this population. Further studies should explore the clinical effectiveness of multimodal strategies. PATIENT SUMMARY: In a large group of patients with advanced kidney cancer, we found that 8.1% had brain metastases when starting systemic therapy. Patients with brain metastases had significantly poorer prognosis than those without brain metastases. Receipt of combination immunotherapy, stereotactic radiotherapy, or neurosurgery was associated with longer overall survival.
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Affiliation(s)
- Kosuke Takemura
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada; Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | | | - Matthew S Ernst
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | | | | | - Talal El Zarif
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Chris Labaki
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada
| | | | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Frede Donskov
- Aarhus University Hospital, Aarhus, Denmark; University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Takeshi Yuasa
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
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MacPhail C, Wood LA, Thana M. Perioperative systemic therapy in renal cell carcinoma. Curr Opin Support Palliat Care 2023; 17:301-307. [PMID: 37800628 DOI: 10.1097/spc.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW Renal cell carcinoma (RCC) is the most common kidney neoplasm. Localized RCC can be cured with nephrectomy. However, a proportion of patients will recur with incurable distant metastatic disease. There is a clear need for treatments to reduce the risk of RCC recurrence and thus improve survival. This review describes the landscape of perioperative therapy for RCC, focusing on more recent trials involving immune checkpoint inhibitors (ICIs). RECENT FINDINGS ICIs have significantly changed outcomes in advanced RCC. Four trials investigating the role of perioperative ICI for RCC are now reported. Only one trial utilizing adjuvant pembrolizumab (Keynote-564) has shown a disease-free survival benefit in resected RCC. SUMMARY Patients with resected RCC should be counselled on their risk of recurrence and the potential option of adjuvant pembrolizumab, recognizing that overall survival data are not yet available.
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Affiliation(s)
- Ceilidh MacPhail
- Division of Medical Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
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Takemura K, Ernst MS, Navani V, Wells JC, Bakouny Z, Donskov F, Basappa NS, Wood LA, Meza L, Pal SK, Szabados B, Powles T, Beuselinck B, McKay RR, Lee JL, Ernst DS, Kapoor A, Yuasa T, Choueiri TK, Heng DYC. Characterization of Patients with Metastatic Renal Cell Carcinoma Undergoing Deferred, Upfront, or No Cytoreductive Nephrectomy in the Era of Combination Immunotherapy: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol 2023:S2588-9311(23)00217-1. [PMID: 37914579 DOI: 10.1016/j.euo.2023.10.002] [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: 02/04/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The role of cytoreductive nephrectomy (CN) has not yet been well characterized in the era of combination immunotherapy. OBJECTIVE To evaluate characteristics and outcomes for patients with metastatic renal cell carcinoma (mRCC) who received immuno-oncology (IO)-based combination therapy according to CN status. DESIGN, SETTING, AND PARTICIPANTS Using the International mRCC Database Consortium (IMDC), patients with mRCC who received frontline IO-based combinations were included. Upfront CN was defined as CN up to 3 mo before diagnosis of metastatic disease but before systemic therapy initiation. Deferred CN was defined as CN after systemic therapy initiation. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival (OS) from initiation of systemic therapy was estimated via Cox proportional-hazards regression. A 12-mo landmark time and a time-varying covariate for CN status were used to mitigate potential bias. RESULTS AND LIMITATIONS Of the 385 patients eligible for landmark analysis, 24, 182, and 179 underwent deferred CN, upfront CN, and no CN, respectively. Patients in the no CN subgroup were older (63 yr vs 57 yr in the deferred CN subgroup and 60 yr in the upfront CN subgroup; p = 0.001) and a higher proportion had bone metastases (44% vs 26% in the deferred CN subgroup and 23% in the upfront CN subgroup; p < 0.001). A lower proportion of patients in the upfront CN subgroup had IMDC poor risk (23% vs 43% in the no CN subgroup and 47% in the deferred CN subgroup; p < 0.001). On multivariable analysis, CN receipt was an independent favorable prognostic factor (hazard ratio 0.45, 95% confidence interval 0.26-0.78; p = 0.005). The study is limited by the lack of randomization and its retrospective nature. CONCLUSIONS Despite changes in practice patterns with the advent of novel therapeutic agents, CN may still serve as an effective surgical intervention in carefully selected patients. PATIENT SUMMARY For patients with metastatic kidney cancer, surgery to remove the primary tumor was traditionally the treatment of choice, but immunotherapy drugs are now another option for these patients. We analyzed data for contemporary patients with metastatic kidney cancer who received combination immunotherapy as their first treatment. We found that in selected patients receiving immunotherapy, surgery to remove the primary tumor as well can result in better prognosis.
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Affiliation(s)
- Kosuke Takemura
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Matthew S Ernst
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Ziad Bakouny
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Frede Donskov
- Aarhus University Hospital, Aarhus, Denmark; University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Scott Ernst
- London Regional Cancer Program, Western University, London, ON, Canada
| | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Takeshi Yuasa
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Ernst MS, Navani V, Wells JC, Donskov F, Basappa N, Labaki C, Pal SK, Meza L, Wood LA, Ernst DS, Szabados B, McKay RR, Parnis F, Suarez C, Yuasa T, Lalani AK, Alva A, Bjarnason GA, Choueiri TK, Heng DYC. Outcomes for International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Groups in Contemporary First-line Combination Therapies for Metastatic Renal Cell Carcinoma. Eur Urol 2023; 84:109-116. [PMID: 36707357 DOI: 10.1016/j.eururo.2023.01.001] [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: 07/21/2022] [Revised: 11/24/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The combination of immuno-oncology (IO) agents ipilimumab and nivolumab (IPI-NIVO) and vascular endothelial growth factor targeted therapies (VEGF-TT) combined with IO (IO-VEGF) are current standard of care first-line treatments for metastatic renal cell carcinoma (mRCC). OBJECTIVE To establish real-world clinical benchmarks for IO combination therapies based on the International mRCC Database Consortium (IMDC) criteria. DESIGN, SETTING, AND PARTICIPANTS Patients with mRCC who received first-line IPI-NIVO, IO-VEGF, or VEGF-TT from 2002 to 2021 were identified using the IMDC database and stratified according to IMDC risk groups. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival (OS), time to next treatment (TTNT), and treatment duration (TD) were calculated using the Kaplan-Meier method and compared between IMDC risk groups within each treatment cohort by the log-rank test. The overall response rate (ORR) was calculated by physician assessment of the best overall response. The primary outcome was OS at 18 mo. RESULTS AND LIMITATIONS In total, 728 patients received IPI-NIVO, 282 IO-VEGF, and 7163 VEGF-TT. The median follow-up times for patients remaining alive were 14.3 mo for IPI-NIVO, 14.9 mo IO-VEGF, and 34.4 mo for VEGF-TT. OS at 18 mo for favorable, intermediate, and poor risk was, respectively, 90%, 78%, and 50% for those receiving IPI-NIVO; 93%, 83%, and 74% for IO-VEGF; and 84%, 64%, and 28% for VEGF-TT. ORRs in favorable-, intermediate-, and poor-risk groups were 41.3%, 40.6%, and 33.0% for those receiving IPI-NIVO; 60.3%, 56.8%, and 40.9% for IO-VEGF; and 39.3%, 33.5%, and 20.9% for VEGF-TT, respectively. The IMDC model stratified patients into statistically distinct risk groups for the three endpoints of OS, TTNT, and TD within each treatment cohort. Limitations of this study were the retrospective design and short follow-up. CONCLUSIONS This study demonstrated that the IMDC model continues to risk stratify patients with mRCC treated with contemporary first-line IO combination therapies and provided real-world survival benchmarks. PATIENT SUMMARY The International Metastatic Renal Cell Carcinoma Database Consortium model continues to stratify patients with metastatic renal cell carcinoma receiving modern combination treatments in the real-world setting.
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Affiliation(s)
- Matthew S Ernst
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Vishal Navani
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - J Connor Wells
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital & University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Naveen Basappa
- Cross Cancer Clinic, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - D Scott Ernst
- London Regional Cancer Centre, London, Ontario, Canada
| | | | - Rana R McKay
- University of California San Diego, Moores Cancer Center, San Diego, CA, USA
| | | | - Cristina Suarez
- Vall d'Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Aly-Khan Lalani
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ajjai Alva
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Y C Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
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Ernst MS, Navani V, Wells JC, Donskov F, Basappa N, Labaki C, Pal SK, Meza L, Wood LA, Ernst DS, Szabados B, McKay RR, Parnis F, Suarez C, Yuasa T, Lalani AK, Alva A, Bjarnason GA, Choueiri TK, Heng DYC. Corrigendum to "Outcomes for International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Groups in Contemporary First-line Combination Therapies for Metastatic Renal Cell Carcinoma" [Eur Urol 2023]. Eur Urol 2023; 83:e166-e167. [PMID: 36967358 DOI: 10.1016/j.eururo.2023.03.003] [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: 05/15/2023]
Affiliation(s)
- Matthew S Ernst
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Vishal Navani
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - J Connor Wells
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital & University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Naveen Basappa
- Cross Cancer Clinic, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - D Scott Ernst
- London Regional Cancer Centre, London, Ontario, Canada
| | | | - Rana R McKay
- University of California San Diego, Moores Cancer Center, San Diego, CA, USA
| | - Francis Parnis
- Icon Cancer Centre, Adelaide, South Australia, Australia
| | - Cristina Suarez
- Vall d'Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Aly-Khan Lalani
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ajjai Alva
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Y C Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
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Lalani AKA, Kapoor A, Basappa NS, Bhindi B, Bjarnason GA, Bosse D, Breau RH, Canil CM, Cardenas LM, Castonguay V, Chavez-Munoz C, Chu W, Dudani S, Graham J, Heng DYC, Kollmannsberger C, Lattouf JB, Morgan S, Reaume MN, Richard PO, Swaminath A, Tanguay S, Wood LA, Lavallée LT. Adjuvant therapy for renal cell carcinoma: 2023 Canadian Kidney Cancer Forum consensus statement. Can Urol Assoc J 2023; 17:E154-E163. [PMID: 37185210 PMCID: PMC10132379 DOI: 10.5489/cuaj.8381] [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: 05/17/2023]
Abstract
INTRODUCTION Several recent randomized trials evaluated the impact of adjuvant immune checkpoint inhibitor (ICI)-based therapy on post-surgical outcomes in renal cell carcinoma (RCC), with disparate results. The objective of this consensus statement is to provide data-driven guidance regarding the use of ICIs after complete resection of clear-cell RCC in a Canadian context. METHODS An expert panel of genitourinary medical oncologists, urologic oncologists, and radiation oncologists with expertise in RCC management was convened in a dedicated session during the 2022 Canadian Kidney Cancer Forum in Toronto, Canada. Topic statements on the management of patients after surgery for RCC, including counselling, risk stratification, indications for medical oncology referral, appropriate followup, eligibility and management for adjuvant ICIs, as well as treatment options for patients with recurrence who received adjuvant immunotherapy, were discussed. Participants were asked to vote if they agreed or disagreed with each statement. Consensus was achieved if greater than 75% of participants agreed with the topic statement. RESULTS A total of 22 RCC experts voted on 14 statements. Consensus was achieved on all topic statements. The panel felt patients with clear-cell RCC at increased risk of recurrence after surgery, as per the Keynote-564 group definitions, should be counselled about recurrence risk by a urologist, should be informed about the potential role of adjuvant ICI systemic therapy, and be offered referral to discuss risks and benefits with a medical oncologist. The panel felt that one year of pembrolizumab is currently the only regimen that should be considered if adjuvant therapy is selected. Panelists emphasized current opinions are based on disease-free survival given the available results. Significant uncertainty regarding the benefit and harms of adjuvant therapy remains, primarily due to a lack of consistent benefit observed across similar trials of adjuvant ICI-based therapies and immature overall survival (OS) data. CONCLUSIONS This consensus document provides guidance from Canadian RCC experts regarding the potential role of ICI-based adjuvant systemic therapy after surgery. This rapidly evolving field requires frequent evidence-based re-evaluation.
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Affiliation(s)
- Aly-Khan A Lalani
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster, Hamilton, ON, Canada
| | - Anil Kapoor
- St Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Georg A Bjarnason
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Dominick Bosse
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Christina M Canil
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Luisa M Cardenas
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster, Hamilton, ON, Canada
| | - Vincent Castonguay
- Centre de recherche du Centre Hospitalier Universitaire de Québec - Université Laval (CRCHUQc-UL), Centre de recherche sur le cancer (CRC) de l'Université Laval, Québec, QC, Canada
| | - Claudia Chavez-Munoz
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shaan Dudani
- Department of Oncology, William Osler Health System, Brampton, ON, Canada
| | | | - Daniel Y C Heng
- Department of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada
| | | | | | - Scott Morgan
- Department of Radiation Oncology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - M Neil Reaume
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Patrick O Richard
- Department of Urology, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Anand Swaminath
- Department of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Tanguay
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Lori A Wood
- Division of Medical Oncology, Dalhousie University, Halifax, NS, Canada
| | - Luke T Lavallée
- Division of Urology and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Holland P, Karmas E, Merrimen J, Wood LA. Accuracy of germ cell tumor histology and stage within a Canadian cancer registry. Can Urol Assoc J 2023; 17:44-48. [PMID: 36218319 PMCID: PMC9970644 DOI: 10.5489/cuaj.8030] [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: 11/19/2022]
Abstract
INTRODUCTION Cancer registries are the mainstay for Canadian population-based cancer statistics. Data are collected in provincial and territorial registries, including the Nova Scotia Cancer Registry (NS CR). The goal of this study was to determine the accuracy of NS CR data for germ cell tumors (GCT). METHODS This analysis included all NS CR patients diagnosed with GCT from 2006-2015. The date and method of diagnosis, primary site, histology, and stage were recorded from the NS CR and compared to each patient's chart. Any discrepancies between the two sources were reviewed and reasons behind the discrepancies recorded. RESULTS A total of 229 patients made up the study cohort. Using NS CR data, 57.6% had seminoma, 34.5% non-seminoma (NSG CT), and 7.9% other. Discrepancies in pathology were noted in 16 patients (7.0%). Using NS CR staging data (available in 185 cases), 71.9% had stage I, 12.4% stage II, 11.9% stage III, and 3.8% other. Discrepancies in stage were noted in 32 patients (17.3%) with NS CR data downstaging eight patients (4.3%) and upstaging 21 patients (11.4%). The site of the primary GCT was discrepant in 12 patients (5.2%). The date of diagnosis was accurate within one week for all patients except one. CONCLUSIONS Higher-level NS CR data, such as date of diagnosis and overall pathological diagnosis, appear relatively accurate; however, there are inaccuracies in histological subtype and stage. This study raises awareness of these gaps and highlights key areas for improvement in educating registry personnel who interpret and enter data about the uniqueness of GCT pathology, staging, and interpretation of tumor markers.
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Affiliation(s)
- Patrick Holland
- Department of Medicine, Dalhousie University, Halifax, NS, Canada,QEII Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada
| | | | - Jennifer Merrimen
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Lori A. Wood
- QEII Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada,Department of Urology, Dalhousie University, Halifax, NS, Canada,Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Elsharawi I, Moss P, Wang C, Wood LA. Uncommon case of metastatic prostate cancer developing cutaneous metastasis. BMJ Case Rep 2022; 15:15/12/e251661. [PMID: 36535736 PMCID: PMC9764667 DOI: 10.1136/bcr-2022-251661] [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] [Indexed: 12/23/2022] Open
Abstract
We report a case of a man in his early 70s with a known history of prostate adenocarcinoma who presented with an undiagnosed skin lesion on his right lower lateral neck 6 years after his metastatic cancer diagnosis. The painless lesion was pink, lobulated and soft. The differential diagnosis included both primary and metastatic tumours. On resection, the histology and immunohistochemical profile of the lesion were consistent with metastatic prostate cancer. He has been managed with multiple lines of therapy since then due to progressive disease. In the 18 months, since his resection, however, he has had no clinical evidence of recurrent cutaneous metastases.
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Affiliation(s)
- Ibrahim Elsharawi
- General Pathology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Phillip Moss
- Anatomical Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheng Wang
- Anatomical Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori A Wood
- Division of Medical Oncology, Victoria General Hospital, Halifax, Nova Scotia, Canada
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Rendon RA, Hotte SJ, Morgan SC, Black PC, Jiang M, Huynh MJ, Wood LA. 2022 European Society for Medical Oncology: Meeting highlights. Can Urol Assoc J 2022; 16:E590-E596. [PMID: 36656706 PMCID: PMC9851212 DOI: 10.5489/cuaj.8178] [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: 11/24/2022]
Affiliation(s)
| | - Sebastien J. Hotte
- Department of Oncology, McMaster University & Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Scott C. Morgan
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia & Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Maria Jiang
- University of Toronto & Princess Margaret Cancer Centre, UHN, Toronto, ON, Canada
| | - Melissa J. Huynh
- Division of Urology, Western University & London Health Sciences Centre, London, ON, Canada
| | - Lori A. Wood
- Department of Urology, Dalhousie University, Halifax, NS, Canada,Division of Medical Oncology, Dalhousie University, Halifax, NS, Canada
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11
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Dragomir A, Nazha S, Tanguay S, Breau RH, Bhindi B, Rendon RA, Kapoor A, Hotte SJ, Basappa N, Fairey A, So AI, Kollmannsberger C, Finelli A, Hansen A, Canil C, Heng D, Lattouf JB, Bjarnason G, Power N, Pouliot F, Wood LA. Outcomes of Cytoreductive Nephrectomy for Patients with Metastatic Renal Cell Carcinoma: Real World Data from Canadian Centers. Eur Urol Focus 2022; 8:1703-1710. [PMID: 34736870 DOI: 10.1016/j.euf.2021.10.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment options for metastatic renal cell carcinoma (mRCC) include cytoreductive nephrectomy (CN) and systemic therapy (ST). Results from the CARMENA and SURTIME trials suggest that CN before ST may not be the optimal treatment strategy for mRCC. OBJECTIVE To use real-world data to evaluate and compare outcomes for patients with mRCC who underwent CN before, after, or without ST to those patients who only received ST. DESIGN, SETTING, AND PARTICIPANTS The Canadian Kidney Cancer information system (CKCis) database was used to identify patients diagnosed with mRCC between January 2011 and April 2020. Only patients with synchronous disease, treated within 12 mo from their initial RCC diagnosis, with International Metastatic Renal Cell Carcinoma Database Consortium intermediate/high risk, and confirmed RCC histology were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were classified into four groups according to the initial treatment received for mRCC. Inverse probability of treatment weighting using propensity scores was used to balance the treatment groups. Cox proportional hazards models were used to assess the impact of CN after adjusting for potential confounding variables in the weighted cohorts. RESULTS AND LIMITATIONS A total of 788 patients were included in the study cohort. Of these 383 patients underwent CN before ST, 73 underwent CN after ST, 80 underwent CN only, and 252 patients received ST only. The median patient age was 63 yr and 73% of the cohort were men. In weighted analysis, the groups undergoing CN before ST (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52-0.82) and CN after ST (HR 0.41, 95% CI 0.28-0.60) both had better survival compared to the ST only group. No survival benefit was observed for CN only compared to ST only, or for CN before ST compared to CN after ST. CONCLUSIONS We evaluated the association between different sequences of treatment with CN and survival in patients with mRCC using CKCis real world data. The results demonstrate that the selected patients who undergo CN, whether performed before or after ST, have an associated improvement in survival. PATIENT SUMMARY Two of the treatment options for metastatic kidney cancer are surgery and systemic therapy (chemotherapy or immunotherapy). We used data from the Canadian Kidney Cancer information system to determine whether there are differences in survival according to the sequencing of these treatments. Patients who had both surgery and systemic therapy, regardless of which treatment was first, had better survival than patients who only received systemic therapy.
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Affiliation(s)
| | | | | | | | - Bimal Bhindi
- Southern Alberta Institute of Urology, Alberta, Canada
| | | | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | | | - Naveen Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Adrian Fairey
- Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Alan I So
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Hansen
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | | | - Daniel Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Jean-Baptiste Lattouf
- Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Canada
| | - Georg Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | | | - Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, University of Laval, Quebec, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
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Nguyen EK, Lalani AKA, Ghosh S, Basappa NS, Kapoor A, Hansen AR, Kollmannsberger C, Heng D, Wood LA, Castonguay V, Soulières D, Winquist E, Canil C, Graham J, Bjarnason GA, Breau RH, Pouliot F, Swaminath A. Outcomes of Radiation Therapy Plus Immunotherapy in Metastatic Renal Cell Carcinoma: Results From the Canadian Kidney Cancer Information System. Adv Radiat Oncol 2022; 7:100899. [PMID: 35814860 PMCID: PMC9260099 DOI: 10.1016/j.adro.2022.100899] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/06/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose With the integration of immunotherapy (IO) agents in the management of metastatic renal cell carcinoma (mRCC), there has been interest in the combined use with radiation therapy (RT). However, real world data are limited. The purpose of this study was to evaluate outcomes in patients with mRCC receiving both RT and IO compared with IO alone. Methods and Materials Data were collected from Canadian Kidney Cancer Information System from January 2011 to September 2019 across 14 academic centers. Patients with mRCC who received IO as first- or second-line therapy were included. RT was categorized as radical dose or palliative dose. Kaplan-Meier estimates were reported for overall survival (OS) and time to treatment failure. Cox proportional hazard models were used adjusted for age and International Metastatic RCC Database Consortium risk categories. Results In total, 505 patients were included in the study: 179 received RT + IO and 326 received IO alone. Two-year OS for the RT + IO group was 55.0% compared with 66.4% in the IO alone cohort (adjusted hazard ratio [aHR], 1.38; P = .07). At 2 years, 12.2% of the RT + IO patients remained on therapy versus 30.9% in the IO alone group (aHR, 1.30; P = .02). For patients receiving first-line therapy, 2-year OS in the RT + IO group was 56.4% versus 78.4% in the IO alone arm, though this difference was not statistically significant (aHR, 1.23; P = .56). For patients receiving radical dose and palliative dose, 2-year OS was 57.0% and 53.9%, respectively (aHR, 0.86; P = .63). Conclusions In this descriptive analysis, more than one-third of patients with mRCC received RT and demonstrated inferior outcomes compared with IO alone. Potential explanations include greater presence of adverse metastatic sites in those receiving RT. Prospective clinical trials evaluating potential benefits of RT in an IO era remain an important need.
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Affiliation(s)
| | | | - Sunita Ghosh
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Anil Kapoor
- McMaster University, Hamilton, Ontario, Canada
| | - Aaron R. Hansen
- Princess Margaret Cancer Centre-University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lori A. Wood
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | | | - Christina Canil
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georg A. Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rodney H. Breau
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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13
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Graham J, Wells JC, Dudani S, Gan CL, Donskov F, Lee JL, Kollmannsberger CK, Meza L, Beuselinck B, Hansen A, North SA, Bjarnason GA, Sayegh N, Kanesvaran R, Wood LA, Hotte SJ, McKay RR, Choueiri TK, Heng DYC. Outcomes of patients with advanced non-clear cell renal cell carcinoma treated with first-line immune checkpoint inhibitor therapy. Eur J Cancer 2022; 171:124-132. [PMID: 35717820 DOI: 10.1016/j.ejca.2022.05.002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have demonstrated impressive activity in metastatic clear-cell renal cell carcinoma (ccRCC) and have become standard treatment options for patients with advanced disease. Data supporting the effectiveness of ICI-based therapy in advanced non-clear cell RCC (nccRCC) is more limited. METHODS We performed a retrospective analysis using the International Metastatic RCC Database Consortium (IMDC) to evaluate the outcomes of patients with advanced nccRCC. Patients were classified into three groups based on first-line therapy: ICI-based therapy (monotherapy or combination), vascular endothelial growth factor (VEGF) inhibitor monotherapy, or mammalian target of rapamycin (mTOR) inhibitor monotherapy. The primary outcome was overall survival (OS). Secondary outcomes were time to treatment failure (TTF) and objective response rate (ORR). We used the Kaplan-Meier method to compare OS and TTF between treatment groups and Cox proportional hazards models to adjust for prognostic covariates. RESULTS We identified a total of 1145 patients with metastatic nccRCC. The most common subtype was papillary RCC (54.9%). For first-line therapy, 74.3% received VEGF monotherapy, 15% received mTOR monotherapy, and 10.7% received ICI-based therapy. Median OS in the ICI group was 28.6 months, versus 16.4 months in the VEGF group and 12.2 months in the mTOR group. Median TTF in the ICI group was 6.9 months, versus 5.0 months in the VEGF group and 3.9 months in the mTOR group. ORR was 27.2% in the ICI group, 14.5% in the VEGF group, and 9% in the mTOR group. After adjusting for the IMDC risk group, histological subtype, and age, the hazard ratio for OS was 0.57 (95% CI 0.42-0.78, p < 0.0001) for ICI versus VEGF and 0.50 (95% CI 0.36-0.71, p < 0.0001) for ICI versus mTOR. CONCLUSIONS In advanced nccRCC, first-line ICI-based treatment appears to be associated with improved OS compared to VEGF and mTOR targeted therapy. These results should be confirmed in prospective randomised trials.
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Affiliation(s)
- Jeffrey Graham
- University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada.
| | | | - Shaan Dudani
- Division of Oncology/Hematology, William Osler Health System, Brampton, ON, Canada
| | - Chun L Gan
- University of Calgary, Calgary, Alberta, Canada
| | | | - Jae-Lyun Lee
- Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Luis Meza
- Department of Medical Oncology and Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Benoit Beuselinck
- Leuven Cancer Institute, Universitaire Ziekenhuizen, Leuven, Belgium
| | - Aaron Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Scott A North
- University of Alberta Cross Cancer Institute, Edmonton, AB, Canada
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nicolas Sayegh
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Rana R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Navani V, Ernst M, Wells JC, Yuasa T, Takemura K, Donskov F, Basappa NS, Schmidt A, Pal SK, Meza L, Wood LA, Ernst DS, Szabados B, Powles T, McKay RR, Weickhardt A, Suarez C, Kapoor A, Lee JL, Choueiri TK, Heng DYC. Imaging Response to Contemporary Immuno-oncology Combination Therapies in Patients With Metastatic Renal Cell Carcinoma. JAMA Netw Open 2022; 5:e2216379. [PMID: 35687336 PMCID: PMC9187954 DOI: 10.1001/jamanetworkopen.2022.16379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The association between treatment with first-line immuno-oncology (IO) combination therapies and physician-assessed objective imaging response among patients with metastatic renal cell carcinoma (mRCC) remains uncharacterized. OBJECTIVE To compare the likelihood of objective imaging response (ie, complete or partial response) to first-line IO combination ipilimumab-nivolumab (IOIO) therapy vs approved IO with vascular endothelial growth factor inhibitor (IOVE) combination therapies among patients with mRCC. DESIGN, SETTING, AND PARTICIPANTS This multicenter international cohort study was nested in routine clinical practice. A data set from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) was used to identify consecutive patients with mRCC who received treatment with IO combination therapies between May 30, 2013, and September 9, 2021. A total of 899 patients with a histologically confirmed diagnosis of mRCC who received treatment with a first-line IOVE or IOIO regimen and had evaluable responses were included. EXPOSURES Best overall response to first-line IO combination therapy based on Response Evaluation Criteria in Solid Tumors, version 1.1. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in treating physician-assessed objective imaging response based on the type of first-line IO combination therapy received. Secondary outcomes included the identification of baseline characteristics positively associated with objective imaging response and the association of objective imaging response with overall survival. RESULTS Among 1085 patients with mRCC who received first-line IO combination therapies, 899 patients (median age, 62.8 years [IQR, 55.9-69.2 years]; 666 male [74.2%]) had evaluable responses. A total of 794 patients had information available on IMDC risk classification; of those, 127 patients (16.0%) had favorable risk, 442 (55.7%) had intermediate risk, and 225 (28.3%) had poor risk. With regard to best overall response among all participants, 37 patients (4.1%) had complete response, 344 (38.3%) had partial response, 315 (35.0%) had stable disease, and 203 (22.6%) had progressive disease. Corresponding median overall survival was not estimable (95% CI, 53.3 months to not estimable) among patients with complete response, 55.9 months (95% CI, 44.1 months to not estimable) among patients with partial response, 48.1 months (95% CI, 33.4 months to not estimable) among patients with stable disease, and 13.0 months (95% CI, 8.4-18.1 months) among patients with progressive disease (log rank P < .001). Treatment with IOVE therapy was found to be independently associated with an increased likelihood of obtaining response (OR, 1.89; 95% CI, 1.26-2.81; P = .002) compared with IOIO therapy. The presence of lung metastases (odds ratio [OR], 1.49; 95% CI, 1.01-2.20), receipt of cytoreductive nephrectomy (OR, 1.59; 95% CI, 1.04-2.43), and favorable IMDC risk (OR, 1.93; 95% CI, 1.10-3.39) were independently associated with an increased likelihood of response. CONCLUSIONS AND RELEVANCE In this study, treatment with IOVE therapy was associated with significantly increased odds of objective imaging response compared with IOIO therapy. The presence of lung metastases, receipt of cytoreductive nephrectomy, and favorable IMDC risk were associated with increased odds of experiencing objective imaging response. These findings may help inform treatment selection, especially in clinical contexts associated with high-volume multisite metastatic disease, in which obtaining objective imaging response is important.
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Affiliation(s)
- Vishal Navani
- Tom Baker Cancer Centre, Department of Medical Oncology, University of Calgary, Calgary, Canada
| | - Matthew Ernst
- Tom Baker Cancer Centre, Department of Medical Oncology, University of Calgary, Calgary, Canada
| | | | - Takeshi Yuasa
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kosuke Takemura
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Naveen S. Basappa
- Cross Cancer Institute, Department of Medical Oncology, University of Alberta, Edmonton, Canada
| | | | - Sumanta K. Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Lori A. Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | | | - Bernadett Szabados
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego, La Jolla
| | | | - Cristina Suarez
- Vall d’Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Jae Lyun Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | | | - Daniel Y. C. Heng
- Tom Baker Cancer Centre, Department of Medical Oncology, University of Calgary, Calgary, Canada
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Moore KJ, Snow S, Wood LA. Delivering Chemotherapy to a Metastatic Poor Risk Testicular Cancer Patient on Hemodialysis. Curr Oncol 2022; 29:1808-1812. [PMID: 35323348 PMCID: PMC8946941 DOI: 10.3390/curroncol29030148] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
A standard curative intent approach of chemotherapy treatment for metastatic testicular cancer has been well established. However, there is little guidance for patients undergoing hemodialysis (HD) who require chemotherapy for this disease. Thus, we describe our treatment approach and rationale for a patient on HD with poor risk metastatic nonseminomatous germ cell tumor involving the testicle, lymph nodes, liver, and bone. After orchiectomy, five cycles of cisplatin and modified dose etoposide were delivered and strategically timed with HD. Treatment was complicated by significant neuropathy. Surgical resection of two liver lesions was performed after chemotherapy. Ten years post-chemotherapy, he remains free of clinical, biochemical, or radiological recurrence. While our patient remains free of disease after this treatment, the optimal chemotherapy and dialysis dose and schedule to maximize cure and minimize toxicity remains unknown.
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Affiliation(s)
- Kieran J. Moore
- Department of Urology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS 6299, Canada;
| | - Stephanie Snow
- Department of Medicine, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS 6299, Canada;
| | - Lori A. Wood
- Department of Urology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS 6299, Canada;
- Department of Medicine, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS 6299, Canada;
- Correspondence: ; Tel.: +1-902-473-5469
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Thana M, Basappa NS, Ghosh S, Kollmannsberger CK, Heng DY, Hansen AR, Graham J, Soulières D, Reaume MN, Lalani AKA, Castonguay V, Bjarnason GA, Patenaude F, Breau RH, Pouliot F, Kapoor A, Wood LA. Utilization and safety of ipilimumab plus nivolumab in a real-world cohort of metastatic renal cell carcinoma patients. Clin Genitourin Cancer 2021; 20:210-218. [DOI: 10.1016/j.clgc.2021.12.003] [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] [Received: 06/15/2021] [Accepted: 12/05/2021] [Indexed: 02/08/2023]
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17
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Rini BI, Atkins MB, Plimack ER, Soulières D, McDermott RS, Bedke J, Tartas S, Alekseev B, Melichar B, Shparyk Y, Kondoh C, Langiewicz P, Wood LA, Hammers H, Silber CG, Haber B, Jensen E, Chen M, Powles T. Characterization and Management of Treatment-emergent Hepatic Toxicity in Patients with Advanced Renal Cell Carcinoma Receiving First-line Pembrolizumab plus Axitinib. Results from the KEYNOTE-426 Trial. Eur Urol Oncol 2021; 5:225-234. [PMID: 34244116 DOI: 10.1016/j.euo.2021.05.007] [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] [Received: 10/20/2020] [Revised: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pembrolizumab plus axitinib improved efficacy over sunitinib in treatment-naive advanced renal cell carcinoma in the KEYNOTE-426 (NCT02853331) study. However, a relatively high incidence of grade 3/4 aminotransferase elevations was observed. OBJECTIVE To further characterize treatment-emergent aminotransferase elevations in patients treated with pembrolizumab-axitinib. DESIGN, SETTING, AND PARTICIPANTS Patients enrolled in KEYNOTE-426 were included in this study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three Standardized MedDRA Queries for potential hepatic disorders were used to identify patients for the hepatic event analysis subpopulation (HEAS). Alanine aminotransferase events were characterized for time to onset, time to recovery, corticosteroid use, and rechallenge with study treatment(s). RESULTS AND LIMITATIONS The HEAS comprised 189/429 (44%) pembrolizumab-axitinib patients and 128/425 (30%) sunitinib patients. Grade 3/4 hepatic adverse events were more common in the combination arm: 22% (94/429) versus 7% (29/425); 3% (13/429) discontinued the combination due to hepatic adverse events. In the pembrolizumab-axitinib arm, 125/426 patients (29%) had alanine aminotransferase (ALT) ≥3× upper limit of normal (ULN), with median time to onset of 84 d (range, 7-840 d). Among patients with ALT ≥3× ULN, 120/125 (96%) recovered to <3× ULN following study treatment interruption/discontinuation, with a median time to recovery of 15 d (3-176 d): 68/120 (57%) received corticosteroids. One hundred patients were rechallenged with one or both study treatment(s): 45/100 (45%) had ALT ≥3× ULN recurrence, and all 45 recovered to ALT <3× ULN following study treatment interruption/discontinuation. No fatal hepatic events occurred. CONCLUSIONS A higher incidence of grade 3/4 aminotransferase elevations occurs with pembrolizumab-axitinib. These events should be carefully evaluated and managed with prompt study treatment interruption or discontinuation, with or without corticosteroid treatment. The decision to rechallenge with one or both drugs should be based on severity of event and thorough causality assessment. PATIENT SUMMARY Renal cell carcinoma patients receiving pembrolizumab-axitinib are at a higher risk of liver enzyme elevations, which could be reversed with appropriate management.
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Affiliation(s)
- Brian I Rini
- Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - Denis Soulières
- Centre Hospitalier de l'Universite de Montréal, Montréal, QC, Canada
| | | | - Jens Bedke
- Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Boris Alekseev
- Federal Medical Research Center n.a. P.A. Hertsen, Moscow, Russia
| | - Bohuslav Melichar
- Lekarska fakulta Univerzity Palackeho a Fakultni nemocnice Olomouc, Czech Republic
| | - Yaroslav Shparyk
- Lviv State Oncology Regional Treatment and Diagnostic Center, Lviv, Ukraine
| | | | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | - Hans Hammers
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Mei Chen
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Powles
- Barts Health and the Royal Free NHS Trusts, Barts Cancer Institute, and Queen Mary University of London, London, UK
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18
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Gan CL, Stukalin I, Meyers DE, Dudani S, Grosjean HAI, Dolter S, Ewanchuk BW, Goutam S, Sander M, Wells C, Pabani A, Cheng T, Monzon J, Morris D, Basappa NS, Pal SK, Wood LA, Donskov F, Choueiri TK, Heng DYC. Outcomes of patients with solid tumour malignancies treated with first-line immuno-oncology agents who do not meet eligibility criteria for clinical trials. Eur J Cancer 2021; 151:115-125. [PMID: 33975059 DOI: 10.1016/j.ejca.2021.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/08/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immuno-oncology (IO)-based therapies have been approved based on randomised clinical trials, yet a significant proportion of real-world patients are not represented in these trials. We sought to compare the outcomes of trial-ineligible vs. -eligible patients with advanced solid tumours treated with first-line (1L) IO therapy. PATIENTS AND METHODS Using the International Metastatic Renal Cell Carcinoma (RCC) Database Consortium and the Alberta Immunotherapy Database, patients with advanced RCC, non-small-cell lung cancer (NSCLC) or melanoma treated with 1L PD-(L)1 inhibition-based therapy were included. Trial eligibility was retrospectively determined as per commonly used exclusion criteria. The outcomes of interest were overall survival (OS), overall response rate (ORR), treatment duration (TD) and time to next treatment (TTNT). RESULTS A total of 395 of 1241 (32%) patients were deemed trial-ineligible. The main reasons for ineligibility based on preselected exclusion criteria were Karnofsky performance status <70%/Eastern Cooperative Oncology Group performance status >1 (40%, 158 of 395), brain metastases (32%, 126 of 395), haemoglobin < 9 g/dL (16%, 63 of 395) and estimated glomerular filtration rate <40 mL/min (15%, 61 of 395). Between the ineligible vs. eligible groups, the median OS, ORR, median TD and median TTNT were 10.2 vs. 39.7 months (p < 0.01), 36% vs. 47% (p < 0.01), 2.7 vs. 6.9 months (p < 0.01) and 6.0 vs. 16.8 months (p < 0.01), respectively. Subgroup analyses showed statistically significant inferior OS, TD and TTNT for trial-ineligible vs. -eligible patients across all tumour types. Adjusted hazard ratios for death in RCC, NSCLC and melanoma were 1.84 (95% confidence interval [CI] 1.22-2.77), 2.21 (95% CI 1.58-3.11) and 1.82 (95% CI 1.21-2.74), respectively.. CONCLUSIONS Thirty-two percent of real-world patients treated with contemporary 1L IO-based therapies were ineligible for clinical trials. Although one-third of the trial-ineligible patients responded to treatment, the overall trial-ineligible population had inferior outcomes than trial-eligible patients. These data may guide patient counselling and temper expectations of benefit.
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Affiliation(s)
- Chun L Gan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Igor Stukalin
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Daniel E Meyers
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Samantha Dolter
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | | | | | - Michael Sander
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Jose Monzon
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Don Morris
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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19
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Annala M, Fu S, Bacon JVW, Sipola J, Iqbal N, Ferrario C, Ong M, Wadhwa D, Hotte SJ, Lo G, Tran B, Wood LA, Gingerich JR, North SA, Pezaro CJ, Ruether JD, Sridhar SS, Kallio HML, Khalaf DJ, Wong A, Beja K, Schönlau E, Taavitsainen S, Nykter M, Vandekerkhove G, Azad AA, Wyatt AW, Chi KN. Cabazitaxel versus abiraterone or enzalutamide in poor prognosis metastatic castration-resistant prostate cancer: a multicentre, randomised, open-label, phase II trial. Ann Oncol 2021; 32:896-905. [PMID: 33836265 DOI: 10.1016/j.annonc.2021.03.205] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/09/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Treatment of poor prognosis metastatic castration-resistant prostate cancer (mCRPC) includes taxane chemotherapy and androgen receptor pathway inhibitors (ARPI). We sought to determine optimal treatment in this setting. PATIENTS AND METHODS This multicentre, randomised, open-label, phase II trial recruited patients with ARPI-naive mCRPC and poor prognosis features (presence of liver metastases, progression to mCRPC after <12 months of androgen deprivation therapy, or ≥4 of 6 clinical criteria). Patients were randomly assigned 1 : 1 to receive cabazitaxel plus prednisone (group A) or physician's choice of enzalutamide or abiraterone plus prednisone (group B) at standard doses. Patients could cross over at progression. The primary endpoint was clinical benefit rate for first-line treatment (defined as prostate-specific antigen response ≥50%, radiographic response, or stable disease ≥12 weeks). RESULTS Ninety-five patients were accrued (median follow-up 21.9 months). First-line clinical benefit rate was greater in group A versus group B (80% versus 62%, P = 0.039). Overall survival was not different between groups A and B (median 37.0 versus 15.5 months, hazard ratio (HR) = 0.58, P = 0.073) nor was time to progression (median 5.3 versus 2.8 months, HR = 0.87, P = 0.52). The most common first-line treatment-related grade ≥3 adverse events were neutropenia (cabazitaxel 32% versus ARPI 0%), diarrhoea (9% versus 0%), infection (9% versus 0%), and fatigue (7% versus 5%). Baseline circulating tumour DNA (ctDNA) fraction above the cohort median and on-treatment ctDNA increase were associated with shorter time to progression (HR = 2.38, P < 0.001; HR = 4.03, P < 0.001). Patients with >30% ctDNA fraction at baseline had markedly shorter overall survival than those with undetectable ctDNA (HR = 38.22, P < 0.001). CONCLUSIONS Cabazitaxel was associated with a higher clinical benefit rate in patients with ARPI-naive poor prognosis mCRPC. ctDNA abundance was prognostic independent of clinical features, and holds promise as a stratification biomarker.
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Affiliation(s)
- M Annala
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - S Fu
- Department of Medical Oncology, BC Cancer, Vancouver, Canada; Oncology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - J V W Bacon
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - J Sipola
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - N Iqbal
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, Canada
| | - C Ferrario
- Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - M Ong
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Canada
| | - D Wadhwa
- BC Cancer - Kelowna Centre, Kelowna, Canada
| | - S J Hotte
- Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - G Lo
- Department of Medical Oncology, R. S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Canada
| | - B Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L A Wood
- QEII Health Sciences Centre, Halifax, Canada
| | - J R Gingerich
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Canada
| | - S A North
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - C J Pezaro
- Eastern Health Clinical School, Monash University, Australia; Department of Oncology, Eastern Health, Australia
| | | | - S S Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - H M L Kallio
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - D J Khalaf
- Department of Medical Oncology, BC Cancer, Vancouver, Canada
| | - A Wong
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - K Beja
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - E Schönlau
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - S Taavitsainen
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - M Nykter
- Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - G Vandekerkhove
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - A A Azad
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A W Wyatt
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada.
| | - K N Chi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Department of Medical Oncology, BC Cancer, Vancouver, Canada.
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20
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Canil C, Kapoor A, Basappa NS, Bjarnason G, Bossé D, Dudani S, Graham J, Gray S, Hansen AR, Heng DY, Karakiewicz PI, Kollmannsberger C, Lalani AKA, North SA, Patenaude F, Soulières D, Thana M, Winquist E, Wood LA, Reaume MN, Maloni R, Hotte SJ. Management of advanced kidney cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2021. Can Urol Assoc J 2021; 15:84-97. [PMID: 33830005 PMCID: PMC8021420 DOI: 10.5489/cuaj.7245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Christina Canil
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Naveen S. Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Georg Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Dominick Bossé
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Shaan Dudani
- William Osler Health System, Brampton, ON, Canada
| | | | - Samantha Gray
- Department of Oncology, Dalhousie University, Saint John Regional Hospital, St. John, NB, Canada
| | - Aaron R. Hansen
- Department of Oncology, Princess Margaret Cancer Centre, Toronto ON, Canada
| | - Daniel Y.C. Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary AB, Canada
| | - Pierre I. Karakiewicz
- Department of Surgery, Le Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and the University of British Columbia, Vancouver, BC, Canada
| | | | - Scott A. North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - François Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Myuran Thana
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Lori A. Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - M. Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON, Canada
| | - Ranjena Maloni
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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21
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Nason GJ, Wood LA, Huddart RA, Albers P, Rendon RA, Einhorn LH, Nichols CR, Kollmannsberger C, Anson-Cartwright L, Sweet J, Warde P, Jewett MA, Chung P, Bedard PL, Hansen AR, Hamilton RJ. A Canadian approach to the regionalization of testis cancer: A review. Can Urol Assoc J 2020; 14:346-351. [PMID: 32432537 PMCID: PMC7716843 DOI: 10.5489/cuaj.6268] [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: 11/19/2022]
Abstract
At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups.This review summarizes the discussion and recommendations of one of the central topics of the workshop - the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18-30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required.Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a "networks of excellence" model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine.
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Affiliation(s)
- Gregory J. Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lori A. Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert A. Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | | | - Lawrence H. Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig R. Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Center, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael A.S. Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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22
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Sun R, Breau RH, Mallick R, Tanguay S, Pouliot F, Kapoor A, Lavallée LT, Finelli A, So AI, Rendon RA, Fairey AS, Lattouf JB, Kawakami J, Bhindi B, Basappa NS, Wood LA, Bjarnason GA, Heng DYC, Bansal RK. Prognostic impact of paraneoplastic syndromes on patients with non-metastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system. Can Urol Assoc J 2020; 15:132-137. [PMID: 33007184 DOI: 10.5489/cuaj.6833] [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: 11/19/2022]
Abstract
INTRODUCTION The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell carcinoma (RCC) is uncertain. This study was conducted to analyze the association of PNS with recurrence and survival of patients with non-metastatic RCC undergoing nephrectomy. METHODS The Canadian Kidney Cancer information system is a multi-institutional cohort of patients started in January 2011. Patients with nephrectomy for non-metastatic RCC were identified. PNS included anemia, polycythemia, hypercalcemia, and weight loss. Associations between PNS and recurrence or death were assessed using Kaplan-Meier curves and multivariable analysis. RESULTS Of 4337 patients, 1314 (30.3%) had evidence of one or more PNS. Patients with PNS were older, had higher comorbidity, and had more advanced clinical and pathological tumor characteristics as compared to patients without PNS (all p<0.05). Kaplan-Meier five-year estimated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were significantly worse in patients with PNS (63.7%, 84.3%, and 79.6%, respectively, for patients with PNS vs. 73.9%, 90.8%, and 90.1%, respectively, for patients without PNS, all p<0.005). On univariable analysis, presence of PNS increased risk of recurrence (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.48-1.90, p<0.0001) and cancer-related death (HR 1.85, 95% CI 1.34-2.54, p=0.0002). Adjusting for known prognostic factors, PNS was not associated with recurrence or survival. CONCLUSIONS In non-metastatic RCC patients undergoing surgery, presence of PNS is associated with older age, higher Charlson comorbidity index score, advanced tumor stage, and aggressive tumor histology. Following surgery, baseline PNS is not strongly independently associated with recurrence or death.
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Affiliation(s)
- Ryan Sun
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | | | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ricardo A Rendon
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | | | - Jun Kawakami
- Southern Alberta Institute of Urology, Calgary, AB, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, Calgary, AB, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Lori A Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Rahul K Bansal
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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23
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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24
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Dragomir A, Nazha S, Wood LA, Rendon RA, Finelli A, Hansen A, So AI, Kollmannsberger C, Basappa NS, Pouliot F, Soulières D, Heng DYC, Kapoor A, Tanguay S. Outcomes of complete metastasectomy in metastatic renal cell carcinoma patients: The Canadian Kidney Cancer information system experience. Urol Oncol 2020; 38:799.e1-799.e10. [PMID: 32778475 DOI: 10.1016/j.urolonc.2020.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/31/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical resection of metastasis can be integrated in the management of metastatic renal cell carcinoma (mRCC) as it can contribute to delay disease progression and improve survival. OBJECTIVE This study assessed the impact of complete metastasectomy in mRCC patients using real-world pan-Canadian data. DESIGN, SETTING AND PARTICIPANTS The Canadian Kidney Cancer information system (CKCis) database was used to select patients who were diagnosed with mRCC between January 2011 and April 2019. To minimize selection bias, each patient having received a complete metastasectomy was matched with up to 4 patients not treated with metastasectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival (OS) was calculated from the date of metastasectomy or selection, to death from any cause. A Cox proportional hazards model was used to assess the impact of the metastasectomy while adjusting for potential confounding variables. RESULTS A total of 229 patients undergoing complete metastasectomy were matched with 803 patients not treated with metastasectomy. After matching, baseline characteristics were well balanced between groups. After 12 months, the proportion of patients that were still alive was 96.0% and 89.8% in the complete metastasectomy and its matched group, respectively; the 5-year OS were 63.2% and 51.4%, respectively. Multivariate analysis performed in the matched cohort revealed that patients who underwent complete metastasectomy had a lower risk of mortality compared to patients who did not undergo metastasectomy (hazard ratio: 0.41, 95% confidence interval:0.27-0.63). CONCLUSION Our study found that patients who underwent complete metastasectomy have a longer overall survival and a longer time to initiation of targeted therapy compared to patients not receiving metastasectomy. These findings should support aggressive resection of metastasis in selected patients.
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Affiliation(s)
- Alice Dragomir
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Sara Nazha
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, NS, Canada
| | - Ricardo A Rendon
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, NS, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Aaron Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alan I So
- BC Cancer Agency Vancouver Cancer Centre, BC Cancer Agency, Vancouver, BC, Canada
| | | | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Frédéric Pouliot
- Centre Hospitalier Universitaire de Québec, University of Laval, Quebec, QC, Canada
| | - Denis Soulières
- Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, QC, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Simon Tanguay
- Faculty of Medicine, McGill University, Montreal, QC, Canada
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Tajzler C, Tanguay S, Mallick R, Ahrens B, Ly TL, Breau RH, Basappa NS, Kapoor A, Heng DYC, Pouliot F, Finelli A, Lavallée LT, So AI, Drachenberg DE, Soulières D, Bjarnason GA, Richard PO, Maloni R, Power NE, Haan M, Wood LA. Determining generalizability of the Canadian Kidney Cancer information system (CKCis) to the entire Canadian kidney cancer population. Can Urol Assoc J 2020; 14:E499-E506. [PMID: 33275557 DOI: 10.5489/cuaj.6716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Canadian Kidney Cancer information system (CKCis) has prospectively collected data on patients with renal tumors since January 1, 2011 from 16 sites within 14 academic centers in six provinces. Canadian kidney cancer experts have used CKCis data to address several research questions. The goal of this study was to determine if the CKCis cohort is representative of the entire Canadian kidney cancer population, specifically regarding demographic and geographic distributions. METHODS The CKCis prospective cohort was analyzed up to December 31, 2018. Baseline demographics and tumor characteristics were analyzed, including location of patients' residence at the time of CKCis entry. Geographic data is presented by province, rural vs. urban via postal code information (2nd digit=0) and by Canadian urban boundary files. To determine the proportion of renal cell carcinoma (RCC) patients that CKCis captures, CKCis accruals were compared to projected Canadian Cancer Society RCC incidence in 2016-2017 and the incidence from the 2016 Canadian Cancer Registry. To determine if the CKCis baseline data is representative, it was compared to registry data and other published data when registry data was not available. RESULTS This CKCis cohort includes 10 298 eligible patients: 66.6% male, median age 62.6 years; 14.6% had metastatic disease at the time of diagnosis and 70.4% had clear-cell carcinomas. The CKCis cohort captures about 1250 patients per year, which represents approximately 20% of the total kidney cancer incidence. The proportion of patients captured per province did vary from 13-43%. Rural patients make up 17% of patients, with some baseline differences between rural and urban patients. There appears to be no major differences between CKCis patient demographics and disease characteristics compared to national data sources. Canadian heat maps detailing patient location are presented. CONCLUSIONS CKCis contains prospective data on >10 000 Canadian kidney cancer patients, making it a valuable resource for kidney cancer research. The baseline demographic and geographic data do appear to include a broad cross-section of patients and seem to be highly representative of the Canadian kidney cancer population. Moving forward, future projects will include determining if CKCis cancer outcomes are also representative of the entire Canadian kidney cancer population and studying variations across provinces and within rural vs. urban areas.
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Affiliation(s)
- Camilla Tajzler
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Beau Ahrens
- Department of Graduate Studies, Dalhousie University, Halifax, NS, Canada
| | - Tina Luu Ly
- University of Western, Research Data Centre, London, ON, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Anil Kapoor
- Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Frédéric Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
| | | | - Denis Soulières
- Department of Medicine, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Patrick O Richard
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Michael Haan
- University of Western, Research Data Centre, London, ON, Canada
| | - Lori A Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Lalani AKA, Chi KN, Heng DY, Kollmannsberger CK, Sridhar SS, Blais N, Canil C, Czaykowski P, Hotte SJ, Iqbal N, Soulières D, Bossé D, Alimohamed NS, Basappa NS, Mukherjee SD, Winquist E, Wood LA, North SA. Prioritizing systemic therapies for genitourinary malignancies: Canadian recommendations during the COVID-19 pandemic. Can Urol Assoc J 2020; 14:E154-E158. [PMID: 32267828 PMCID: PMC7197961 DOI: 10.5489/cuaj.6595] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Kim N. Chi
- BC Cancer Agency, Vancouver Cancer Center, Vancouver, BC, Canada
| | - Daniel Y.C. Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Srikala S. Sridhar
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Normand Blais
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Christina Canil
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czaykowski
- Cancer Care Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | | | - Nayyer Iqbal
- Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis Soulières
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Dominick Bossé
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Som D. Mukherjee
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Eric Winquist
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Lori A. Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Scott A. North
- Cross Cancer Institute, University of Alberta, Edmonton AB, Canada
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Holland P, Merrimen J, Pringle C, Wood LA. Renal medullary carcinoma and its association with sickle cell trait: a case report and literature review. ACTA ACUST UNITED AC 2020; 27:e53-e56. [PMID: 32218668 DOI: 10.3747/co.27.5043] [Citation(s) in RCA: 4] [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] [Indexed: 12/25/2022]
Abstract
Renal medullary carcinoma (rmc) is a rare and aggressive renal malignancy that usually presents at an advanced stage, has a poor prognosis, and is associated with sickle cell trait. We present a case of rmc including radiologic and pathology findings, treatment, and outcome. A review of the literature is also presented, with an emphasis on the association of rmc with sickle cell trait, which was an unknown diagnosis in our patient preoperatively.
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Affiliation(s)
| | - J Merrimen
- Department of Pathology, Faculty of Medicine
| | - C Pringle
- Department of Diagnostic Radiology, Faculty of Medicine
| | - L A Wood
- Department of Urology, Faculty of Medicine.,Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS
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29
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Dudani S, Graham J, Wells JC, Bakouny Z, Pal SK, Dizman N, Donskov F, Porta C, de Velasco G, Hansen A, Iafolla M, Beuselinck B, Vaishampayan UN, Wood LA, Liow E, Yan F, Yuasa T, Bjarnason GA, Choueiri TK, Heng DYC. First-line Immuno-Oncology Combination Therapies in Metastatic Renal-cell Carcinoma: Results from the International Metastatic Renal-cell Carcinoma Database Consortium. Eur Urol 2019; 76:861-867. [PMID: 31445844 PMCID: PMC6858928 DOI: 10.1016/j.eururo.2019.07.048] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 05/19/2019] [Accepted: 07/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND In metastatic renal-cell carcinoma (mRCC), recent data have shown efficacy of first-line ipilimumab and nivolumab (ipi-nivo) as well as immuno-oncology (IO)/vascular endothelial growth factor (VEGF) inhibitor combinations. Comparative data between these strategies are limited. OBJECTIVE To compare the efficacy of ipi-nivo versus IO-VEGF (IOVE) combinations in mRCC, and describe practice patterns and effectiveness of second-line therapies. DESIGN, SETTING, AND PARTICIPANTS Using the International Metastatic Renal-cell Carcinoma Database Consortium (IMDC) dataset, patients treated with any first-line IOVE combination were compared with those treated with ipi-nivo. INTERVENTION All patients received first-line IO combination therapies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS First- and second-line response rates, time to treatment failure (TTF), time to next treatment (TNT), and overall survival (OS) were analysed. Hazard ratios were adjusted for IMDC risk factors. RESULTS AND LIMITATIONS In total, 113 patients received IOVE combinations and 75 received ipi-nivo. For IOVE combinations versus ipi-nivo, first-line response rates were 33% versus 40% (between-group difference 7%, 95% confidence interval [CI] -8% to 22%, p = 0.4), TTF was 14.3 versus 10.2 mo (p = 0.2), TNT was 19.7 versus 17.9 mo (p = 0.4), and median OS was immature but not statistically different (p = 0.17). Adjusted hazard ratios for TTF, TNT, and OS were 0.71 (95% CI 0.46-1.12, p = 0.14), 0.65 (95% CI 0.38-1.11, p = 0.11), and 1.74 (95% CI 0.82-3.68, p = 0.14), respectively. Sixty-four (34%) patients received second-line treatment. In patients receiving subsequent VEGF-based therapy, second-line response rates were lower in the IOVE cohort than in the ipi-nivo cohort (15% vs 45%; between-group difference 30%, 95% CI 3-57%, p = 0.04; n = 40), though second-line TTF was not significantly different (3.7 vs 5.4 mo; p = 0.4; n = 55). Limitations include the study's retrospective design and sample size. CONCLUSIONS There were no significant differences in first-line outcomes between IOVE combinations and ipi-nivo. Most patients received VEGF-based therapy in the second line. In this group, second-line response rate was greater in patients who received ipi-nivo initially. PATIENT SUMMARY There were no significant differences in key first-line outcomes for patients with metastatic renal-cell carcinoma receiving immuno-oncology/vascular endothelial growth factor inhibitor combinations versus ipilimumab and nivolumab.
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Affiliation(s)
- Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Ziad Bakouny
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Camillo Porta
- Department of Internal Medicine, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Aaron Hansen
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marco Iafolla
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Flora Yan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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30
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Hotte SJ, Kapoor A, Basappa NS, Bjarnason G, Canil C, Conter HJ, Czaykowski P, Graham J, Gray S, Heng DYC, Karakiewicz PI, Kollmannsberger C, Lalani AKA, North SA, Patenaude F, Soulières D, Violette P, Winquist E, Wood LA, Dudani S, Maloni R, Reaume MN. Management of Advanced Kidney Cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2019. Can Urol Assoc J 2019; 13:343-354. [PMID: 31603413 DOI: 10.5489/cuaj.6256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Anil Kapoor
- Urologic Research Center for Research & Innovation, McMaster University, Hamilton, ON, Canada.,The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Naveen S Basappa
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - Georg Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, The Ottawa Hospital Cancer Center and the University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Samantha Gray
- Department of Oncology, Dalhousie University, Saint John Regional Hospital, St. John, NB, Canada
| | - Daniel Y C Heng
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Center, Calgary AB, Canada
| | - Pierre I Karakiewicz
- Department of Surgery, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Center, and the University of British Columbia, Vancouver, BC, Canada
| | | | - Scott A North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | - François Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Phillippe Violette
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Shaan Dudani
- Department of Medical Oncology, University of Calgary and Tom Baker Cancer Center, Calgary AB, Canada
| | - Ranjena Maloni
- The Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Center and the University of Ottawa, Ottawa, ON, Canada
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31
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Thana M, Wood LA. Followup imaging studies in metastatic castration-resistant prostate cancer: An individualized approach. Can Urol Assoc J 2019; 13:201-202. [PMID: 31199238 DOI: 10.5489/cuaj.6033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Myuran Thana
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
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Graham J, Wells JC, Donskov F, Lee JL, Fraccon A, Pasini F, Porta C, Bowman IA, Bjarnason GA, Ernst DS, Rha SY, Beuselinck B, Hansen A, North SA, Kollmannsberger CK, Wood LA, Vaishampayan UN, Pal SK, Choueiri TK, Heng DYC. Cytoreductive Nephrectomy in Metastatic Papillary Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol Oncol 2019; 2:643-648. [PMID: 31411994 DOI: 10.1016/j.euo.2019.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/06/2019] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is evidence that cytoreductive nephrectomy (CN) may be beneficial in metastatic renal cell carcinoma (mRCC). This has been studied predominantly in clear-cell RCC, with more limited data on the role of CN in patients with papillary histology. OBJECTIVE To determine the benefit of CN in synchronous metastatic papillary RCC. DESIGN, SETTING, AND PARTICIPANTS Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) database, a retrospective analysis was performed for patients with papillary mRCC treated with or without CN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Median overall survival (OS) and progression-free survival (PFS) were determined for both patient groups. Cox regression analysis was performed to control for imbalances in individual IMDC risk factors. RESULTS AND LIMITATIONS In total, 647 patients with papillary mRCC were identified, of whom 353 had synchronous metastatic disease. Of these, 109 patients were treated with CN and 244 were not. The median follow-up was 57.1mo (95% confidence interval [CI] 32.9-77.8) and the OS from the start of first-line targeted therapy for the entire cohort was 13.2mo (95% CI 12.0-16.1). Median OS for patients with CN was 16.3mo, compared to 8.6mo (p<0.0001) in the no-CN group. When adjusted for individual IMDC risk factors, the hazard ratio (HR) of death for CN was 0.62 (95% CI 0.45-0.85; p=0.0031). Limitations include the retrospective nature of the analysis. CONCLUSIONS The use of CN in patients with mRCC and papillary histology appears to be associated with better survival compared to no CN after adjustment for risk criteria. Selection of appropriate candidates for CN is crucial. A clinical trial in this rare population may not be possible. PATIENT SUMMARY In a population of patients with advanced papillary kidney cancer, we found that surgical removal of the primary kidney tumor was associated with better overall survival.
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Affiliation(s)
- Jeffrey Graham
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | | | - Jae Lyun Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | | | - Felice Pasini
- Oncologia Medica Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | | | | | | | - Sun Young Rha
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Aaron Hansen
- Princess Margaret Cancer Centre, Toronto, Canada
| | - Scott A North
- University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | | | - Lori A Wood
- QEII Health Sciences Centre, Halifax, Canada
| | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada.
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Stukalin I, Wells JC, Graham J, Yuasa T, Beuselinck B, Kollmansberger C, Ernst DS, Agarwal N, Le T, Donskov F, Hansen AR, Bjarnason GA, Srinivas S, Wood LA, Alva AS, Kanesvaran R, Fu SYF, Davis ID, Choueiri TK, Heng DYC. Real-world outcomes of nivolumab and cabozantinib in metastatic renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. ACTA ACUST UNITED AC 2019; 26:e175-e179. [PMID: 31043824 DOI: 10.3747/co.26.4595] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/01/2023]
Abstract
Objectives In the present study, we explored the real-world efficacy of the immuno-oncology checkpoint inhibitor nivolumab and the tyrosine kinase inhibitor cabozantinib in the second-line setting. Methods Using the International Metastatic Renal Cell Carcinoma Database Consortium (imdc) dataset, a retrospective analysis of patients with metastatic renal cell carcinoma (mrcc) treated with nivolumab or cabozantinib in the second line after prior therapy targeted to the vascular endothelial growth factor receptor (vegfr) was performed. Baseline characteristics and imdc risk factors were collected. Overall survival (os) and time to treatment failure (ttf) were calculated using Kaplan-Meier curves. Overall response rates (orrs) were determined for each therapy. Multivariable Cox regression analysis was performed to determine survival differences between cabozantinib and nivolumab treatment. Results The analysis included 225 patients treated with nivolumab and 53 treated with cabozantinib. No significant difference in median os was observed: 22.10 months [95% confidence interval (ci): 17.18 months to not reached] with nivolumab and 23.70 months (95% ci: 15.52 months to not reached) with cabozantinib (p = 0.61). The ttf was also similar at 6.90 months (95% ci: 4.60 months to 9.20 months) with nivolumab and 7.39 months (95% ci: 5.52 months to 12.85 months) with cabozantinib (p = 0.20). The adjusted hazard ratio (hr) for nivolumab compared with cabozantinib was 1.30 (95% ci: 0.73 to 2.3), p = 0.38. When adjusted by imdc criteria and age, the hr was 1.32 (95% ci: 0.74 to 2.38), p = 0.35. Conclusions Real-world imdc data indicate comparable os and ttf for nivolumab and cabozantinib. Both agents are reasonable therapeutic options for patients progressing after initial first-line vegfr-targeted therapy.
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Affiliation(s)
- I Stukalin
- Alberta: Tom Baker Cancer Center, University of Calgary, Calgary (Stukalin, Wells, Heng)
| | - J C Wells
- Alberta: Tom Baker Cancer Center, University of Calgary, Calgary (Stukalin, Wells, Heng).,Ontario: Queen's University, Kingston (Wells); London Health Sciences Centre, London (Ernst); Princess Margaret Cancer Centre, University Health Network, Toronto (Hansen); Sunnybrook Odette Cancer Centre, Toronto (Bjarnason)
| | - J Graham
- Alberta: Tom Baker Cancer Center, University of Calgary, Calgary (Stukalin, Wells, Heng)
| | - T Yuasa
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | - B Beuselinck
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | | | - D S Ernst
- Ontario: Queen's University, Kingston (Wells); London Health Sciences Centre, London (Ernst); Princess Margaret Cancer Centre, University Health Network, Toronto (Hansen); Sunnybrook Odette Cancer Centre, Toronto (Bjarnason)
| | - N Agarwal
- United States: University of Utah Huntsman Cancer Institute, Salt Lake City, UT (Agarwal); University of Texas Southwestern Medical Center, Dallas, TX (Le); Stanford Medical Center, Stanford, CA (Srinivas); University of Michigan, Ann Arbor, MI (Alva); Dana-Farber Cancer Institute, Boston, MA (Choueiri)
| | - T Le
- United States: University of Utah Huntsman Cancer Institute, Salt Lake City, UT (Agarwal); University of Texas Southwestern Medical Center, Dallas, TX (Le); Stanford Medical Center, Stanford, CA (Srinivas); University of Michigan, Ann Arbor, MI (Alva); Dana-Farber Cancer Institute, Boston, MA (Choueiri)
| | - F Donskov
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | - A R Hansen
- Ontario: Queen's University, Kingston (Wells); London Health Sciences Centre, London (Ernst); Princess Margaret Cancer Centre, University Health Network, Toronto (Hansen); Sunnybrook Odette Cancer Centre, Toronto (Bjarnason)
| | - G A Bjarnason
- Ontario: Queen's University, Kingston (Wells); London Health Sciences Centre, London (Ernst); Princess Margaret Cancer Centre, University Health Network, Toronto (Hansen); Sunnybrook Odette Cancer Centre, Toronto (Bjarnason)
| | - S Srinivas
- United States: University of Utah Huntsman Cancer Institute, Salt Lake City, UT (Agarwal); University of Texas Southwestern Medical Center, Dallas, TX (Le); Stanford Medical Center, Stanford, CA (Srinivas); University of Michigan, Ann Arbor, MI (Alva); Dana-Farber Cancer Institute, Boston, MA (Choueiri)
| | - L A Wood
- Nova Scotia: Queen Elizabeth II Health Sciences Centre, Halifax (Wood)
| | - A S Alva
- United States: University of Utah Huntsman Cancer Institute, Salt Lake City, UT (Agarwal); University of Texas Southwestern Medical Center, Dallas, TX (Le); Stanford Medical Center, Stanford, CA (Srinivas); University of Michigan, Ann Arbor, MI (Alva); Dana-Farber Cancer Institute, Boston, MA (Choueiri)
| | - R Kanesvaran
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | - S Y F Fu
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | - I D Davis
- non-United States international: Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan (Yuasa); University Hospitals Leuven, Leuven, Belgium (Beuselinck); Aarhus University Hospital, Aarhus, Denmark (Donskov); National Cancer Centre Singapore, Singapore (Kanesvaran); Auckland City Hospital, Auckland, New Zealand (Fu); Monash University Eastern Health Clinical School, Melbourne, Australia (Davis)
| | - T K Choueiri
- United States: University of Utah Huntsman Cancer Institute, Salt Lake City, UT (Agarwal); University of Texas Southwestern Medical Center, Dallas, TX (Le); Stanford Medical Center, Stanford, CA (Srinivas); University of Michigan, Ann Arbor, MI (Alva); Dana-Farber Cancer Institute, Boston, MA (Choueiri)
| | - D Y C Heng
- Alberta: Tom Baker Cancer Center, University of Calgary, Calgary (Stukalin, Wells, Heng)
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Lavallée LT, Fitzpatrick R, Wood LA, Basiuk J, Knee C, Cnossen S, Mallick R, Witiuk K, Vanhuyse M, Tanguay S, Finelli A, Jewett MAS, Basappa N, Lattouf JB, Gotto GT, Al-Asaaed S, Bjarnason GA, Moore R, North S, Canil C, Pouliot F, Soulières D, Castonguay V, Kassouf W, Cagiannos I, Morash C, Breau RH. Development and Implementation of a Continuing Medical Education Program in Canada: Knowledge Translation for Renal Cell Carcinoma (KT4RCC). J Cancer Educ 2019; 34:14-18. [PMID: 28779441 DOI: 10.1007/s13187-017-1259-7] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p = 0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Ryan Fitzpatrick
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Lori A Wood
- QEII Health Sciences Centre, Halifax, Canada
- Dalhousie University, Halifax, Canada
| | | | | | | | | | | | | | | | - Antonio Finelli
- University Health Network, Toronto, Canada
- Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Naveen Basappa
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Jean-Baptiste Lattouf
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Université de Montréal, Montreal, Canada
| | | | | | | | - Ronald Moore
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Scott North
- Cross Cancer Institute, Edmonton, Canada
- University of Alberta, Edmonton, Canada
| | - Christina Canil
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | | | - Denis Soulières
- Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Chris Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- University of Ottawa, Ottawa, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
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35
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Yip SM, Wells C, Moreira R, Wong A, Srinivas S, Beuselinck B, Porta C, Sim HW, Ernst DS, Rini BI, Yuasa T, Basappa NS, Kanesvaran R, Wood LA, Canil C, Kapoor A, Fu SY, Choueiri TK, Heng DY. Checkpoint inhibitors in patients with metastatic renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Cancer 2018; 124:3677-3683. [DOI: 10.1002/cncr.31595] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Steven M. Yip
- Department of Medical Oncology; Tom Baker Cancer Center; Calgary Alberta Canada
| | - Connor Wells
- Department of Medical Oncology; Tom Baker Cancer Center; Calgary Alberta Canada
| | - Raphael Moreira
- Department of Oncology; Américas Medical Service/Brazil, United Health Group; Sao Paulo Brazil
| | - Alex Wong
- Department of Medical Oncology, Cross Cancer Institute; University of Alberta; Edmonton Alberta Canada
| | - Sandy Srinivas
- Department of Medical Oncology; Stanford University; Stanford California
| | - Benoit Beuselinck
- Department of General Medical Oncology; University Hospitals Leuven; Leuven Belgium
| | - Camillo Porta
- Department of Medical Oncology; IRCCS San Matteo University Hospital Foundation; Pavia Italy
| | - Hao-Wen Sim
- Department of Medical Oncology; Princess Margaret Hospital; Toronto Ontario Canada
| | - D. Scott Ernst
- Department of Medical Oncology; London Health Sciences Centre; London Ontario Canada
| | - Brian I. Rini
- Department of Oncology; Cleveland Clinic Taussig Cancer Institute; Cleveland Ohio
| | - Takeshi Yuasa
- Department of Urology; Cancer Institute Hospital of Japanese Foundation for Cancer Research; Tokyo Japan
| | - Naveen S. Basappa
- Department of Medical Oncology, Cross Cancer Institute; University of Alberta; Edmonton Alberta Canada
| | - Ravindran Kanesvaran
- Department of Medical Oncology; National Cancer Centre Singapore; Singapore Singapore
| | - Lori A. Wood
- Division of Medical Oncology; QEII Health Sciences Centre; Halifax Nova Scotia Canada
| | - Christina Canil
- Division of Medical Oncology; University of Ottawa; Ottawa Ontario Canada
| | - Anil Kapoor
- Division of Urology, Juravinski Cancer Centre; McMaster University; Hamilton Ontario Canada
| | - Simon Y.F. Fu
- Department of Medicine; Auckland City Hospital; Auckland New Zealand
| | - Toni K. Choueiri
- Department of Medical Oncology; Dana-Farber Cancer Center; Boston Massachusetts
| | - Daniel Y.C. Heng
- Department of Medical Oncology; Tom Baker Cancer Center; Calgary Alberta Canada
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36
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Motzer RJ, Haas NB, Donskov F, Gross-Goupil M, Varlamov S, Kopyltsov E, Lee JL, Melichar B, Rini BI, Choueiri TK, Zemanova M, Wood LA, Reaume MN, Stenzl A, Chowdhury S, Lim HY, McDermott R, Michael A, Bao W, Carrasco-Alfonso MJ, Aimone P, Voi M, Doehn C, Russo P, Sternberg CN. Randomized Phase III Trial of Adjuvant Pazopanib Versus Placebo After Nephrectomy in Patients With Localized or Locally Advanced Renal Cell Carcinoma. J Clin Oncol 2017; 35:3916-3923. [PMID: 28902533 DOI: 10.1200/jco.2017.73.5324] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose This phase III trial evaluated the efficacy and safety of pazopanib versus placebo in patients with locally advanced renal cell carcinoma (RCC) at high risk for relapse after nephrectomy. Patients and Methods A total of 1,538 patients with resected pT2 (high grade) or ≥ pT3, including N1, clear cell RCC were randomly assigned to pazopanib or placebo for 1 year; 403 patients received a starting dose of 800 mg or placebo. To address toxicity attrition, the 800-mg starting dose was lowered to 600 mg, and the primary end point analysis was changed to disease-free survival (DFS) for pazopanib 600 mg versus placebo (n = 1,135). Primary analysis was performed after 350 DFS events in the intent-to-treat (ITT) pazopanib 600 mg group (ITT600mg), and DFS follow-up analysis was performed 12 months later. Secondary end point analyses included DFS with ITT pazopanib 800 mg (ITT800mg) and safety. Results The primary analysis results of DFS ITT600mg favored pazopanib but did not show a significant improvement over placebo (hazard ratio [HR], 0.86; 95% CI, 0.70 to 1.06; P = .165). The secondary analysis of DFS in ITT800mg (n = 403) yielded an HR of 0.69 (95% CI, 0.51 to 0.94). Follow-up analysis in ITT600mg yielded an HR of 0.94 (95% CI, 0.77 to 1.14). Increased ALT and AST were common adverse events leading to treatment discontinuation in the pazopanib 600 mg (ALT, 16%; AST, 5%) and 800 mg (ALT, 18%; AST, 7%) groups. Conclusion The results of the primary DFS analysis of pazopanib 600 mg showed no benefit over placebo in the adjuvant setting.
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Affiliation(s)
- Robert J Motzer
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Naomi B Haas
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Frede Donskov
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Marine Gross-Goupil
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Sergei Varlamov
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Evgeny Kopyltsov
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Jae Lyun Lee
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Bohuslav Melichar
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Brian I Rini
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Toni K Choueiri
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Milada Zemanova
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Lori A Wood
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - M Neil Reaume
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Arnulf Stenzl
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Simon Chowdhury
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Ho Yeong Lim
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Ray McDermott
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Agnieszka Michael
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Weichao Bao
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Marlene J Carrasco-Alfonso
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Paola Aimone
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Voi
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Christian Doehn
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Paul Russo
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
| | - Cora N Sternberg
- Robert J. Motzer and Paul Russo, Memorial Sloan Kettering Cancer Center, New York, NY; Naomi B. Haas, University of Pennsylvania, Philadelphia, PA; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Marine Gross-Goupil, Bordeaux University Hospital, Bordeaux, France; Sergei Varlamov, Altai Regional Cancer Center, Barnaul; Evgeny Kopyltsov, State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia; Jae Lyun Lee, University of Ulsan College of Medicine; Ho Yeong Lim, Sungkyunkwan University, Seoul, Republic of Korea; Bohuslav Melichar, Palacky University Medical School and Teaching Hospital, Olomouc; Milada Zemanova, Charles University and General University Hospital, Prague, Czech Republic; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; Lori A. Wood, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia; M. Neil Reaume, Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Arnulf Stenzl, University Hospital Tübingen, Tübingen; Christian Doehn, University of Lübeck Medical School and Urologikum Lübeck, Lübeck, Germany; Simon Chowdhury, Guy's and St Thomas' National Health Service Foundation/St Thomas' Hospital, London; Ray McDermott, Tallaght University Hospital and Cancer Trials Ireland, Dublin; Agnieszka Michael, University of Surrey, Guildford, United Kingdom; Weichao Bao, Marlene J. Carrasco-Alfonso, and Maurizio Voi, Novartis Oncology, East Hanover, NJ; Paola Aimone, Novartis Pharma AG, Basel, Switzerland; and Cora N. Sternberg, San Camillo Forlanini Hospital, Rome, Italy
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Himmelman JG, Merrimen J, Matheson K, Theriault C, Wood LA. Accuracy of kidney cancer diagnosis and histological subtype within Canadian cancer registry data. Can Urol Assoc J 2017; 11:E326-E329. [PMID: 29382453 PMCID: PMC5798435 DOI: 10.5489/cuaj.4269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Provincial/territorial cancer registries (PTCRs) are the mainstay for Canadian population-based cancer statistics. Each jurisdiction captures this data in a population-based registry, including the Nova Scotia Cancer Registry (NSCR). The goal of this study was to describe data from the NSCR regarding renal cell carcinoma (RCC) pathology subtype and method of diagnosis and compare it to the actual pathology reports to determine the accuracy of diagnosis and histological subtype assignment. METHODS This retrospective analysis included patients diagnosed with RCC in the NSCR from 2006-2010 with an ICD-O-3 code C64.9 seen or treated in the largest NS health district. From the NSCR, method of diagnosis and pathological diagnosis was recorded. All diagnoses of non-clear-cell RCC (nonccRCC) from NSCR were compared to the actual pathology report for descriptive comparison and reasons for discordance. RESULTS 723 patients make up the study cohort. 81.3% of patients were diagnosed by nephrectomy, 11.1% radiography, 6.9 % biopsy, and 0.7% autopsy. By NSCR data, 52.8% had clear-cell (ccRCC), 20.5% RCC not otherwise specified (NOS), 12.7% papillary, 4% chromophobe, and the rest had other nonccRCC subtypes. By pathology reports, 69.5% had clear-cell, 15% papillary, 5% chromophobe, only 2.7% RCC NOS. There was a discordance rate of 15.4% between NSCR data and diagnosis from pathology report. Reasons for discordance were not enough information by the pathologist in 45.5%, misinterpretation of report by data coder in 22.2%, and true coding error in 32.3%. CONCLUSIONS When using PTCR for RCC incidence data, it is important to understand how the diagnosis is made, as not all are based on pathological confirmation; in this cohort 11% were based on radiology. One must also be aware that clear-cell and non-clear-cell subtypes may differ between the PTCR data and pathology reports. In this study, ccRCC made up 52.8% of the registry diagnoses, but increased to 69.6% on pathology report review. Use of synoptic reporting and ongoing education may improve accuracy of registry data.
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Affiliation(s)
| | - Jennifer Merrimen
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS; Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS; Canada
| | - Chris Theriault
- Research Methods Unit, Nova Scotia Health Authority, Halifax, NS; Canada
| | - Lori A. Wood
- Department of Urology, Dalhousie University, Halifax, NS; Canada
- Department of Medicine, Dalhousie University, Halifax, NS; Canada
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Davis ID, Xie W, Pezaro C, Donskov F, Wells JC, Agarwal N, Srinivas S, Yuasa T, Beuselinck B, Wood LA, Ernst DS, Kanesvaran R, Knox JJ, Pantuck A, Saleem S, Alva A, Rini BI, Lee JL, Choueiri TK, Heng DY. Efficacy of Second-line Targeted Therapy for Renal Cell Carcinoma According to Change from Baseline in International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Category. Eur Urol 2017; 71:970-978. [DOI: 10.1016/j.eururo.2016.09.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
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Motzer RJ, Haas NB, Donskov F, Gross-Goupil M, Varlamov S, Kopyltsov E, Lee JL, Melichar B, Rini BI, Choueiri TK, Zemanova M, Wood LA, Fahlenkamp D, Reaume MN, Stenzl A, Bao W, Aimone P, Doehn C, Russo P, Sternberg CN. Randomized phase III trial of adjuvant pazopanib versus placebo after nephrectomy in patients with locally advanced renal cell carcinoma (RCC) (PROTECT). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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
4507 Background: PROTECT (NCT01235962) evaluated the efficacy and safety of pazopanib (PAZ) versus placebo in patients (pts) with locally advanced renal cell carcinoma (RCC) post nephrectomy. Methods: 1538 pts with resected pT2 (high grade), pT3 or greater clear cell RCC were randomly assigned to PAZ or placebo for 1 year. The starting dose (800 mg) following treatment of 403 pts was lowered to 600 mg to improve tolerability and primary endpoint was changed to disease-free survival (DFS) with PAZ 600 (N = 1135). Primary analysis was performed after 350 DFS events in intent-to-treat (ITT) PAZ 600, and DFS follow-up analysis was performed after an additional 12 months. Secondary endpoints included DFS with ITT PAZ 800 and ITT ALL, and safety. Results: Disease characteristics were similar between arms. The primary analysis results of DFS ITT 600 were not significant [HR: 0.862; 95% CI, 0.699, 1.063; p = 0.165] (Table). The secondary endpoint of DFS in ITT PAZ 800 and ITT ALL yielded 31% and 20% risk reduction, respectively. Updated DFS analysis in ITT 600 showed a higher HR with longer follow up. Increased ALT and AST were the most common adverse events leading to treatment discontinuation in the PAZ 600 (ALT 16% and AST 5%) and PAZ 800 (ALT 18% and AST 7%) groups. Conclusions: The study did not meet the primary DFS endpoint in ITT 600; however, a 31% decrease in the risk of recurrence was observed in ITT 800. The safety profiles in the 600 mg and 800 mg groups were similar and consistent with PAZ prior experience. Clinical trial information: NCT01235962. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bohuslav Melichar
- Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Brian I. Rini
- Cleveland Clinic Taussig Cancer Insitute, Cleveland, OH
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Milada Zemanova
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | | | | | | | | | | | - Paul Russo
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Abstract
Spermatocytic tumor, formerly known as spermatocytic seminoma, is an uncommon testicular neoplasm which is a distinct clinicopathologic entity from classic seminoma. These tumors are not associated with germ cell neoplasia in situ, other germ cell tumors, or isochromosome 12p. Although typically, these tumors have an excellent prognosis occasional cases are associated with sarcoma and have a very poor prognosis. We present a case of spermatocytic tumor with sarcoma showing a chondrosarcomatous component, discuss the pathologic findings and differential diagnosis and provide follow-up information.
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Affiliation(s)
- Ashley E. Stueck
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - John E. Grantmyre
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lori A. Wood
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Cheng Wang
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jennifer Merrimen
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Connor Wells J, Donskov F, Fraccon AP, Pasini F, Bjarnason GA, Beuselinck B, Knox JJ, Rha SY, Agarwal N, Bowman IA, Lee JL, Pal SK, Srinivas S, Scott Ernst D, Vaishampayan UN, Wood LA, Simpson R, De Velasco G, Choueiri TK, Heng DYC. Characterizing the outcomes of metastatic papillary renal cell carcinoma. Cancer Med 2017; 6:902-909. [PMID: 28414866 PMCID: PMC5430092 DOI: 10.1002/cam4.1048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/22/2016] [Revised: 01/21/2017] [Accepted: 02/02/2017] [Indexed: 12/19/2022] Open
Abstract
Outcomes of metastatic papillary renal cell carcinoma (pRCC) patients are poorly characterized in the era of targeted therapy. A total of 5474 patients with metastatic renal cell carcinoma (mRCC) in the International mRCC Database Consortium (IMDC) were retrospectively analyzed. Outcomes were compared between clear cell (ccRCC; n = 5008) and papillary patients (n = 466), and recorded type I and type II papillary patients (n = 30 and n = 165, respectively). Overall survival (OS), progression‐free survival (PFS), and overall response rate (ORR) favored ccRCC over pRCC. OS was 8 months longer in ccRCC patients and the hazard ratio of death was 0.71 for ccRCC patients. No differences in PFS or ORR were detected between type I and II PRCC in this limited dataset. The median OS for type I pRCC was 20.0 months while the median OS for type II was 12.6 months (P = 0.096). The IMDC prognostic model was able to stratify pRCC patients into favorable risk (OS = 34.1 months), intermediate risk (OS = 17.0 months), and poor‐risk groups (OS = 6.0 months). pRCC patient outcomes were inferior to ccRCC, even after controlling for IMDC prognostic factors. The IMDC prognostic model was able to effectively stratify pRCC patients.
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Affiliation(s)
- John Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.,Queen's University, Kingston, Ontario, Canada
| | | | | | - Felice Pasini
- Medical Oncology Department, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | | | | | - Sun Young Rha
- Yonsei University College of Medicine, Seoul, South Korea
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Jae-Lyun Lee
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | | | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Robin Simpson
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Albiges L, Hakimi AA, Xie W, McKay RR, Simantov R, Lin X, Lee JL, Rini BI, Srinivas S, Bjarnason GA, Ernst S, Wood LA, Vaishamayan UN, Rha SY, Agarwal N, Yuasa T, Pal SK, Bamias A, Zabor EC, Skanderup AJ, Furberg H, Fay AP, de Velasco G, Preston MA, Wilson KM, Cho E, McDermott DF, Signoretti S, Heng DYC, Choueiri TK. Body Mass Index and Metastatic Renal Cell Carcinoma: Clinical and Biological Correlations. J Clin Oncol 2016; 34:3655-3663. [PMID: 27601543 DOI: 10.1200/jco.2016.66.7311] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Obesity is an established risk factor for clear cell renal cell carcinoma (RCC); however, some reports suggest that RCC developing in obese patients may be more indolent. We investigated the clinical and biologic effect of body mass index (BMI) on treatment outcomes in patients with metastatic RCC. METHODS The impact of BMI (high BMI: ≥ 25 kg/m2 v low BMI: < 25 kg/m2) on overall survival (OS) and treatment outcome with targeted therapy was investigated in 1,975 patients from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and in an external validation cohort of 4,657 patients. Gene expression profiling focusing on fatty acid metabolism pathway, in The Cancer Genome Atlas data set, and immunohistochemistry staining for fatty acid synthase (FASN) were also investigated. Cox regression was undertaken to estimate the association of BMI with OS, adjusted for the IMDC prognostic factors. RESULTS In the IMDC cohort, median OS was 25.6 months (95% CI, 23.2 to 28.6) in patients with high BMI versus 17.1 months (95% CI, 15.5 to 18.5) in patients with low BMI (adjusted hazard ratio, 0.84; 95% CI, 0.73 to 0.95). In the validation cohort, high BMI was associated with improved OS (adjusted hazard ratio, 0.83; 95% CI, 0.74 to 0.93; medians: 23.4 months [95% CI, 21.9 to 25.3 months] v 14.5 months [95% CI, 13.8 to 15.9 months], respectively). In The Cancer Genome Atlas data set (n = 61), FASN gene expression inversely correlated with BMI (P = .034), and OS was longer in the low FASN expression group (medians: 36.8 v 15.0 months; P = .002). FASN immunohistochemistry positivity was more frequently detected in IMDC poor (48%) and intermediate (34%) risk groups than in the favorable risk group (17%; P-trend = .015). CONCLUSION High BMI is a prognostic factor for improved survival and progression-free survival in patients with metastatic RCC treated with targeted therapy. Underlying biology suggests a role for the FASN pathway.
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Affiliation(s)
- Laurence Albiges
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - A Ari Hakimi
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Wanling Xie
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Rana R McKay
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Ronit Simantov
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Xun Lin
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Jae-Lyun Lee
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Brian I Rini
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Sandy Srinivas
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Georg A Bjarnason
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Scott Ernst
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Lori A Wood
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Ulka N Vaishamayan
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Sun-Young Rha
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Neeraj Agarwal
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Takeshi Yuasa
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Sumanta K Pal
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Aristotelis Bamias
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Emily C Zabor
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Anders J Skanderup
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Helena Furberg
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Andre P Fay
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Guillermo de Velasco
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Mark A Preston
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Kathryn M Wilson
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Eunyoung Cho
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - David F McDermott
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Sabina Signoretti
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Daniel Y C Heng
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
| | - Toni K Choueiri
- Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Sabina Signoretti, and Toni K. Choueiri, Dana-Farber Cancer Institute; Wanling Xie, Rana R. McKay, Mark A. Preston, Eunyoung Cho, Sabina Signoretti, and Toni K. Choueiri, Brigham and Women's Hospital; Laurence Albiges, Wanling Xie, Rana R. McKay, Andre P. Fay, Guillermo de Velasco, Eunyoung Cho, David F. McDermott, Sabina Signoretti, and Toni K. Choueiri, Harvard Medical School; Mark A. Preston and Kathryn M. Wilson, Harvard School of Public Health; David F. McDermott, Beth Israel Deaconess Medical Center, Boston, MA; Laurence Albiges, Gustave Roussy, Université Paris-Saclay, Villejuif, France; A. Ari Hakimi, Emily C. Zabor, Anders J. Skanderup, and Helena Furberg, Memorial Sloan Kettering Cancer Center, New York; Ronit Simantov and Xun Lin, Pfizer Oncology, New York, NY; Jae-Lyun Lee, University of Ulsan College of Medicine, Asan; Sun-Young Rha, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; Sandy Srinivas, Stanford Cancer Institute, Stanford; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Georg A. Bjarnason, Sunnybrook Odette Cancer Center, Toronto; Scott Ernst, London Health Sciences Center, London, Ontario; Lori A. Wood, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Daniel Y.C. Heng, Tom Baker Cancer Center; University of Calgary, Calgary, Alberta, Canada; Ulka N. Vaishamayan, Karmanos Cancer Center, Detroit, MI; Neeraj Agarwal, University of Utah Huntsman Cancer Institute, Salt Lake City, UT; Takeshi Yuasa, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Aristotelis Bamias, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; and Eunyoung Cho, The Warren Alpert Medical School of Brown University; Brown University School of Public Health, Providence, RI
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Ruiz-Morales JM, Swierkowski M, Wells JC, Fraccon AP, Pasini F, Donskov F, Bjarnason GA, Lee JL, Sim HW, Sliwczynsk A, Ptak-Chmielewska A, Teter Z, Beuselinck B, Wood LA, Yuasa T, Pezaro C, Rini BI, Szczylik C, Choueiri TK, Heng DYC. First-line sunitinib versus pazopanib in metastatic renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur J Cancer 2016; 65:102-8. [PMID: 27487293 DOI: 10.1016/j.ejca.2016.06.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 05/16/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sunitinib (SU) and pazopanib (PZ) are standards of care for first-line treatment of metastatic renal cell carcinoma (mRCC). However, how the efficacy of these drugs translates into effectiveness on a population-based level is unknown. PATIENTS AND METHODS We used the International mRCC Database Consortium (IMDC) to assess overall survival (OS), progression-free survival (PFS), response rate (RR) and performed proportional hazard regression adjusting for IMDC prognostic groups. Second-line OS (OS2) and second-line PFS (PFS2) were also evaluated. RESULTS We obtained data from 7438 patients with mRCC treated with either first-line SU (n = 6519) or PZ (n = 919) with an overall median follow-up of 40.4 months (95% confidence interval [CI] 39.2-42.1). There were no significant differences in IMDC prognostic groups (p = 0.36). There was no OS difference between SU and PZ (22.3 versus 22.6 months, respectively, p = 0.65). When adjusted for IMDC criteria, the hazard ratio (HR) of death for PZ versus SU was 1.03 (95% CI 0.92-1.17, p = 0.58). There was no PFS difference between SU and PZ (8.4 versus 8.3 months, respectively, p = 0.17). When adjusted for IMDC criteria, the HR for PFS for PZ versus SU was 1.08 (95% CI 0.981-1.19, p = 0.12). There was no difference in RR between SU and PZ (30% versus 28%, respectively, p = 0.15). We also found no difference in any second-line treatment between either post-SU or post-PZ groups for OS2 (13.1 versus 11 months, p = 0.27) and PFS2 (3.7 versus 5.0 months, p = 0.07). CONCLUSIONS We confirmed in real-world practice that SU and PZ have similar efficacy in the first-line setting for mRCC and do not affect outcomes with subsequent second-line treatment.
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Affiliation(s)
- Jose Manuel Ruiz-Morales
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada; Hospital Medica Sur, Mexico City, Mexico
| | | | - J Connor Wells
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Anna Paola Fraccon
- Department of Oncology, Casa di Cura Pederzoli, Peschiera Del Garda, Italy
| | - Felice Pasini
- Department of Medical Oncology, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hao-Wen Sim
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Carmel Pezaro
- Monash University Eastern Health Clinical School, Australia
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Cezary Szczylik
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | | | - Daniel Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada.
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Kyriakopoulos CE, Chittoria N, Choueiri TK, Kroeger N, Lee JL, Srinivas S, Knox JJ, Bjarnason GA, Ernst SD, Wood LA, Vaishampayan UN, Agarwal N, Pal SK, Kanesvaran R, Rha SY, Yuasa T, Donskov F, North SA, Heng DY, Rini BI. Outcome of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: Results From the International Metastatic Renal Cell Carcinoma Database Consortium. Clin Genitourin Cancer 2015; 13:e79-85. [DOI: 10.1016/j.clgc.2014.08.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/11/2014] [Indexed: 12/22/2022]
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Kroeger N, Pantuck AJ, Wells JC, Lawrence N, Broom R, Kim JJ, Srinivas S, Yim J, Bjarnason GA, Templeton A, Knox J, Bernstein E, Smoragiewicz M, Lee J, Rini BI, Vaishampayan UN, Wood LA, Beuselinck B, Donskov F, Choueiri TK, Heng DY. Characterizing the impact of lymph node metastases on the survival outcome for metastatic renal cell carcinoma patients treated with targeted therapies. Eur Urol 2014; 68:506-15. [PMID: 25524810 DOI: 10.1016/j.eururo.2014.11.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 09/19/2014] [Accepted: 11/28/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND It is unknown whether lymph node metastases (LNM) and their localization negatively affect clinical outcome in metastatic renal cell carcinoma (mRCC) patients. OBJECTIVE To evaluate the clinicopathological features, survival outcome, and treatment response in mRCC patients with LNM versus those without LNM after treatment with targeted therapies (TT). DESIGN, SETTING, AND PARTICIPANTS Patients (n=2996) were first analyzed without consideration of lymph node (LN) localization or histologic subtype. Additional analyses (n=1536) were performed in subgroups of patients with supradiaphragmatic (SPD) LNM, subdiaphragmatic (SBD) LNM, and patients with LNM in both locations (SPD+/SBD+) without histologic considerations, and then separately in clear cell RCC (ccRCC) and non-clear cell RCC (nccRCC) patients, respectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was overall survival (OS) and the secondary outcome was progression-free survival (PFS). RESULTS AND LIMITATIONS All patients with LNM had worse PFS (p=0.001) and OS (p<0.001) compared to those without LNM. Compared to patients without LNM (PFS 8.8 mo; OS 25.1 mo), any SBD LNM involvement was associated with worse PFS (SBD, 6.8 mo; p=0.003; SPD+/SBD+, 5.5 mo; p<0.001) and OS (SBD, 16.2 mo; p<0.001; SPD+/SBD+, 11.5 mo; p<0.001). Both SBD and SPD+/SBD+ LNM were retained as independent prognostic factors in multivariate analyses (MVA) for PFS (p=0.006 and p=0.022, respectively) and OS (both p<0.001), while SPD LNM was not an independent risk factor. Likewise, in ccRCC, SBD LNM (19.8 mo) and SPD+/SBD+ LNM (12.85 mo) patients had the worst OS. SPD+/SBD+ LNM (p=0.006) and SBD LNM (p=0.028) were independent prognostic factors for OS in MVA, while SPD LNM was not significant (p=0.301). The study is limited by its retrospective design and the lack of pathologic evaluation of LNM in all cases. CONCLUSIONS The metastatic spread of RCC to SBD lymph nodes is associated with poor prognosis in mRCC patients treated with TT. PATIENT SUMMARY The presence of lymph node metastases below the diaphragm is associated with shorter survival outcome when metastatic renal cell carcinoma (mRCC) patients are treated with targeted therapies. Clinical trials should evaluate whether surgical removal of regional lymph nodes at the time of nephrectomy may improve outcomes in high-risk RCC patients.
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Affiliation(s)
- Nils Kroeger
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Department of Urology, University Medicine, Greifswald, Germany; Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California Los Angeles, CA, USA
| | - Allan J Pantuck
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California Los Angeles, CA, USA
| | - J Connor Wells
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Nicola Lawrence
- Auckland City Hospital, Auckland, New Zealand, Auckland, New Zealand
| | - Reuben Broom
- Auckland City Hospital, Auckland, New Zealand, Auckland, New Zealand
| | - Jenny J Kim
- Department of Medical Oncology Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sandy Srinivas
- Division of Oncology, Stanford Medical Center, Stanford, CA, USA
| | - Jessica Yim
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Arnoud Templeton
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jennifer Knox
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ezra Bernstein
- Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine at the University of California Los Angeles, CA, USA
| | - Martin Smoragiewicz
- Department of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Jae Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Brian I Rini
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | | | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Benoit Beuselinck
- Department of General Medical Oncology and Laboratory for Experimental Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel Y Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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Heng DYC, Choueiri TK, Rini BI, Lee J, Yuasa T, Pal SK, Srinivas S, Bjarnason GA, Knox JJ, Mackenzie M, Vaishampayan UN, Tan MH, Rha SY, Donskov F, Agarwal N, Kollmannsberger C, North S, Wood LA. Outcomes of patients with metastatic renal cell carcinoma that do not meet eligibility criteria for clinical trials. Ann Oncol 2014; 25:149-54. [PMID: 24356626 DOI: 10.1093/annonc/mdt492] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [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: 01/03/2023] Open
Abstract
BACKGROUND Targeted therapies in metastatic renal cell carcinoma (mRCC) have been approved based on registration clinical trials that have strict eligibility criteria. The clinical outcomes of patients treated with targeted agents but are ineligible for trials are unknown. PATIENTS AND METHODS mRCC patients treated with vascular endothelial growth factor-targeted therapy were retrospectively deemed ineligible for clinical trials (according to commonly used inclusion/exclusion criteria) if they had a Karnofsky performance status (KPS) <70%, nonclear-cell histology, brain metastases, hemoglobin ≤9 g/dl, creatinine >2× the upper limit of normal, corrected calcium ≥12 mg/dl, platelet count of <100 × 10(3)/uL, or neutrophil count <1500/mm(3). RESULTS Overall, 768 of 2210 (35%) patients in the International Metastatic RCC Database Consortium (IMDC) were deemed ineligible for clinical trials by the above criteria. Between ineligible versus eligible patients, the response rate, median progression-free survival (PFS) and median overall survival of first-line targeted therapy were 22% versus 29% (P = 0.0005), 5.2 versus 8.6 months, and 12.5 versus 28.4 months (both P < 0.0001), respectively. Second-line PFS (if applicable) was 2.8 months in the trial ineligible versus 4.3 months in the trial eligible patients (P = 0.0039). When adjusted by the IMDC prognostic categories, the HR for death between trial ineligible and trial eligible patients was 1.55 (95% confidence interval 1.378-1.751, P < 0.0001). CONCLUSIONS The number of patients that are ineligible for clinical trials is substantial and their outcomes are inferior. Specific trials addressing the unmet needs of protocol ineligible patients are warranted.
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Affiliation(s)
- D Y C Heng
- Tom Baker Cancer Center, Calgary, AB, Canada
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Heng DYC, Wells JC, Rini BI, Beuselinck B, Lee JL, Knox JJ, Bjarnason GA, Pal SK, Kollmannsberger CK, Yuasa T, Srinivas S, Donskov F, Bamias A, Wood LA, Ernst DS, Agarwal N, Vaishampayan UN, Rha SY, Kim JJ, Choueiri TK. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 2014; 66:704-10. [PMID: 24931622 DOI: 10.1016/j.eururo.2014.05.034] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [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: 03/31/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. OBJECTIVE To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. DESIGN, SETTING, AND PARTICIPANTS Retrospective data from patients with synchronous mRCC (n=1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were used to compare 982 mRCC patients who had a CN with 676 mRCC patients who did not. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS OS was compared and hazard ratios (HRs) adjusted for IMDC poor prognostic criteria. RESULTS AND LIMITATIONS Patients who had CN had better IMDC prognostic profiles versus those without (favorable, intermediate, or poor in 9%, 63%, and 28% vs 1%, 45%, and 54%, respectively). The median OS of patients with CN versus without CN was 20.6 versus 9.5 mo (p<0.0001). When adjusted for IMDC criteria to correct for imbalances, the HR of death was 0.60 (95% confidence interval, 0.52-0.69; p<0.0001). Patients estimated to survive <12 mo may receive marginal benefit from CN. Patients who have four or more of the IMDC prognostic criteria did not benefit from CN. Data were collected retrospectively. CONCLUSIONS CN is beneficial in synchronous mRCC patients treated with targeted therapy, even after adjusting for prognostic factors. Patients with estimated survival times <12 mo or four or more IMDC prognostic factors may not benefit from CN. This information may aid in patient selection as we await results from randomized controlled trials. PATIENT SUMMARY We looked at the survival outcomes of metastatic renal cell carcinoma patients who did or did not have the primary tumor removed. We found that most patients benefited from tumor removal, except for those with four or more IMDC risk factors.
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Affiliation(s)
| | | | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | | | | | | | | | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Aristotelis Bamias
- Department of Clinical Therapeutics, National & Kapodistrian University, Athens, Greece
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - D Scott Ernst
- London Regional Cancer Centre, London, Ontario, Canada
| | - Neeraj Agarwal
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Sun Young Rha
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jenny J Kim
- Sidney Kimmel Comprehensive Cancer Center at John Hopkins University, Baltimore, MD, USA
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Schutz FAB, Xie W, Donskov F, Sircar M, McDermott DF, Rini BI, Agarwal N, Pal SK, Srinivas S, Kollmannsberger C, North SA, Wood LA, Vaishampayan U, Tan MH, Mackenzie MJ, Lee JL, Rha SY, Yuasa T, Heng DYC, Choueiri TK. The impact of low serum sodium on treatment outcome of targeted therapy in metastatic renal cell carcinoma: results from the International Metastatic Renal Cell Cancer Database Consortium. Eur Urol 2013; 65:723-30. [PMID: 24184025 DOI: 10.1016/j.eururo.2013.10.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [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: 09/10/2013] [Accepted: 10/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hyponatremia has been associated with poor survival in many solid tumors and more recently found to be of prognostic and predictive value in metastatic renal cell cancer (mRCC) patients treated with immunotherapy. OBJECTIVE To investigate the influence of baseline hyponatremia in mRCC patients treated with targeted therapy in the International Metastatic Renal Cell Carcinoma Database Consortium. DESIGN, SETTING, AND PARTICIPANTS Data on 1661 patients treated with first-line vascular endothelial growth factor (VEGF) or mammalian target of rapamycin (mTOR) targeted therapy for mRCC were available from 18 cancer centers to study the impact of hyponatremia (serum sodium level <135 mmol/l) on clinical outcomes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary objective was overall survival (OS) and secondary end points included time to treatment failure (TTF) and the disease control rate (DCR). The chi-square test was used to compare the DCR in patients with and without hyponatremia. OS and TTF were estimated with the Kaplan-Meier method and differences between groups were examined by the log-rank test. Multivariable logistic regression (for DCR) and Cox regression (for OS and TTF) were undertaken adjusted for prognostic risk factors. RESULTS AND LIMITATIONS Median OS after treatment initiation was 18.5 mo (95% confidence interval [CI], 17.5-19.8 mo), with 552 (33.2%) of patients remaining alive on a median follow-up of 22.1 mo. Median baseline serum sodium was 138 mmol/l (range: 122-159 mmol/l), and hyponatremia was found in 14.6% of patients. On univariate analysis, hyponatremia was associated with shorter OS (7.0 vs 20.9 mo), shorter TTF (2.9 vs 7.4 mo), and lower DCR rate (54.9% vs 78.8%) (p<0.0001 for all comparisons). In multivariate analysis, these effects remain significant (hazard ratios: 1.51 [95% CI, 1.26-1.80] for OS, and 1.57 [95% CI, 1.34-1.83] for TTF; odds ratio: 0.50 [95% CI, 34-0.72] for DCR; adjusted p<0.001). Results were similar if sodium was analyzed as a continuous variable (adjusted p<0.0001 for OS, TTF, and DCR). CONCLUSIONS This is the largest multi-institutional report to show that hyponatremia is independently associated with a worse outcome in mRCC patients treated with VEGF- and mTOR-targeted agents.
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Affiliation(s)
- Fabio A B Schutz
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Wanling Xie
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Monica Sircar
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David F McDermott
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Brian I Rini
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun-Young Rha
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Takeshi Yuasa
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
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49
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Wood LA, Jewett MA. Collaborations in renal cell carcinoma research. Can Urol Assoc J 2012. [DOI: 10.5489/cuaj.61] [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: 11/19/2022]
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50
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Affiliation(s)
- N Lavens
- Urology Department, QEII Health Sciences Centre, Halifax, NS
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