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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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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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Lemelin A, Takemura K, Heng DYC, Ernst MS. Prognostic Models in Metastatic Renal Cell Carcinoma. Hematol Oncol Clin North Am 2023; 37:925-935. [PMID: 37270385 DOI: 10.1016/j.hoc.2023.04.016] [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] [Indexed: 06/05/2023]
Abstract
As many new systemic therapy options have recently emerged, the standard of care for patients with metastatic renal cell carcinoma (mRCC) is gradually changing. The increasing complexity of treatment options requires more personalized treatment strategies. This evolution in the systemic therapy landscape comes with a need for validated stratification models that facilitate decision making and patient counseling for clinicians through a risk-adapted approach. This article summarizes the available evidence on risk stratification and prognostic models for mRCC, including the International mRCC Database Consortium and Memorial Sloan Kettering Cancer Center models, as well as their association with clinical outcomes.
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Affiliation(s)
- Audreylie Lemelin
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, cc 110, 1331 - 29th Street Southwest, Calgary, Alberta T2N 4N2, Canada
| | - Kosuke Takemura
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, cc 110, 1331 - 29th Street Southwest, Calgary, Alberta T2N 4N2, Canada
| | - Daniel Y C Heng
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, cc 110, 1331 - 29th Street Southwest, Calgary, Alberta T2N 4N2, Canada.
| | - Matthew S Ernst
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, cc 110, 1331 - 29th Street Southwest, Calgary, Alberta T2N 4N2, 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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Kranawetter B, Hernández S, Mielke D, Ernst MS, Malinova V, Rohde V. Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05596-5. [PMID: 37178247 DOI: 10.1007/s00701-023-05596-5] [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: 02/22/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. METHODS A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. RESULTS Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. CONCLUSIONS Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.
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Affiliation(s)
- B Kranawetter
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany.
| | - S Hernández
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - D Mielke
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - M S Ernst
- Department of Neuroradiology, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Malinova
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
| | - V Rohde
- Department of Neurosurgery, University Medical Center, Georg-August University Göttingen, Göttingen, Germany
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Ernst MS, Heng DYC. Reply to Binghao Zhao, Hao Xing, and Wenbin Ma's Letter to the Editor re: Matthew S. Ernst, Vishal Navani, J. Connor Wells, et al. Outcomes for International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Groups in Contemporary First-line Combination Therapies for Metastatic Renal Cell Carcinoma. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2023.01.001. Eur Urol 2023:S0302-2838(23)02711-2. [PMID: 37080894 DOI: 10.1016/j.eururo.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Matthew S Ernst
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada.
| | - Daniel Y C Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
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Takemura K, Navani V, Ernst MS, Wells JC, Meza L, Pal SK, Lee JL, Li H, Agarwal N, Alva AS, Hansen AR, Basappa NS, Szabados B, Powles T, Tran B, Hocking CM, Beuselinck B, Yuasa T, Choueiri TK, Heng DYC. Characterization of Patients With Metastatic Renal Cell Carcinoma Experiencing Complete Response to First-line Therapies: Results From the International Metastatic Renal Cell Carcinoma Database Consortium. J Urol 2023; 209:701-709. [PMID: 36573926 DOI: 10.1097/ju.0000000000003132] [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] [Indexed: 12/29/2022]
Abstract
PURPOSE Clinical trials have demonstrated higher complete response rates in the immuno-oncology-based combination arms than in the tyrosine kinase inhibitor arms in patients with metastatic renal cell carcinoma. We aimed to characterize real-world patients who experienced complete response to the contemporary first-line therapies. MATERIALS AND METHODS Using the International Metastatic Renal Cell Carcinoma Database Consortium, response-evaluable patients who received frontline immuno-oncology-based combination therapy or tyrosine kinase inhibitor monotherapy were analyzed. Baseline characteristics of patients and post-landmark overall survival were compared based on best overall response, as per RECIST 1.1. RESULTS A total of 52 (4.6%) of 1,126 and 223 (3.0%) of 7,557 patients experienced complete response to immuno-oncology-based and tyrosine kinase inhibitor therapies, respectively (P = .005). An adjusted odds ratio for complete response achieved by immuno-oncology-based combination therapy (vs tyrosine kinase inhibitor monotherapy) was 1.56 (95% CI 1.11-2.17; P = .009). Among patients who experienced complete response, the immuno-oncology-based cohort had a higher proportion of non-clear cell histology (15.9% and 4.7%; P = .016), sarcomatoid dedifferentiation (29.8% and 13.5%; P = .014), and multiple sites of metastases (80.4% and 50.0%; P < .001) than the tyrosine kinase inhibitor cohort. Complete response was independently associated with post-landmark overall survival benefit in both the immuno-oncology-based and tyrosine kinase inhibitor cohorts, giving respective adjusted hazard ratios of 0.17 (95% CI 0.04-0.72; P = .016) and 0.28 (95% CI 0.21-0.38; P < .001). CONCLUSIONS The complete response rate was not as high in the real-world population as in the clinical trial population. Among those who experienced complete response, several adverse clinicopathological features were more frequently observed in the immuno-oncology-based cohort than in the tyrosine kinase inhibitor cohort. Complete response was an indicator of favorable overall survival.
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Affiliation(s)
- Kosuke Takemura
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew S Ernst
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Luis Meza
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haoran Li
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ajjai S Alva
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, 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
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Takeshi Yuasa
- Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Ernst MS, Lysack JT, Hyrcza MD, Chandarana SP, Hao D. TRK Inhibition with Entrectinib in Metastatic Salivary Secretory Carcinoma (SC): A Case Report. Curr Oncol 2022; 29:3933-3939. [PMID: 35735423 PMCID: PMC9222047 DOI: 10.3390/curroncol29060314] [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: 04/14/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022] Open
Abstract
NTRK gene fusions are rare oncogenic driver mutations that can be found in a broad range of neoplasms. In secretory carcinoma (SC), ETV6-NTRK3 gene fusion is seen in a majority of the cases and represents a druggable target for patients with advanced disease in the absence of a currently accepted standard of care. In our case, we describe a patient with recurrent, metastatic SC treated with first line entrectinib with clinically meaningful, durable ongoing response after 49 months. The patient experienced grade 1 fatigue, dysgeusia, skin sensitivity, arthralgias, an increase in serum creatinine, and weight-gain as well as grade 2 hypotension which resolved after a dose reduction. Entrectinib is a well-tolerated treatment with the potential for durable responses and TRK inhibition should be considered the standard of care in SC and other NTRK gene fusion-positive advanced neoplasms without acceptable alternative treatment options.
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Affiliation(s)
- Matthew S. Ernst
- Tom Baker Cancer Center, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada;
| | - John T. Lysack
- Division of Head and Neck Imaging, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Martin D. Hyrcza
- Department of Pathology and Laboratory Medicine, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB T2N 2T9, Canada;
| | - Shamir P. Chandarana
- Section of Otolaryngology, Department of Surgery, University of Calgary, Calgary, AB T2N 2T9, Canada;
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Desiree Hao
- Tom Baker Cancer Center, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada;
- Correspondence:
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