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Ogata Y, Akatsuka J, Endo Y, Mikami H, Yanagi M, Takeda H, Toyama Y, Yamamoto Y, Kimura G, Kondo Y. Index tumor location affected early biochemical recurrence after radical prostatectomy in patients with negative surgical margin: a retrospective study. BMC Urol 2024; 24:108. [PMID: 38762458 PMCID: PMC11102263 DOI: 10.1186/s12894-024-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 05/13/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Index tumors are the most aggressive tumors of the prostate. However, their clinical significance remains unclear. This study aimed to assess the incidence of index tumor location according to the zonal origin and whether these locations affect the prognosis after radical prostatectomy in patients with negative surgical margins. METHODS This single-centered, retrospective study evaluated 1,109 consecutive patients who underwent radical prostatectomies. An index tumor was defined as the largest tumor in the prostate gland. We detected these locations based on McNeal's zonal origin using whole-mount sections. Biochemical recurrence (BCR) free survival curves were generated using the Kaplan-Meier method. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine the predictive factors for early BCR (within 1-year). RESULTS A total of 621 patients with negative surgical margins who did not receive adjuvant therapy were included in this study. The index tumor were located in the transitional zone in 191 patients (30.8%), the peripheral zone in 399 patients (64.3%), and the central zone in 31 patients (5.0%). In total, 22 of 621 patients (3.5%) experienced early BCR and 70 patients (11.2%) experienced overall BCR at a median follow-up of 61.7 months. According to the index tumor location, the early BCR-free rates were 99.5%, 95.7 %, and 83.3% in the transitional, peripheral, and central zones, respectively. On multivariate analysis, the index tumor in the central zone was an independent predictor of early BCR with negative surgical margins following radical prostatectomy, followed by prostatectomy pathological grade, index tumor in the peripheral zone, and high prostate-specific antigen level. CONCLUSIONS We assessed the significance of index tumor location in patients with negative surgical margins following radical prostatectomy. Index tumors located in the central zone, although infrequent, were the strongest predictive factors for early BCR. Our results may allow urologists and patients to reconsider the therapeutic strategies for prostate cancer.
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Affiliation(s)
- Yoshihiko Ogata
- Department of Urology, Nippon Medical School Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yoichiro Yamamoto
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan
- Mathematical Intelligence for Medicine, Graduate School of Medicine, Tohoku University, Miyagi, 980-8574, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Mikami H, Noguchi S, Akatsuka J, Hasegawa H, Obayashi K, Takeda H, Endo Y, Toyama Y, Takei H, Kimura G, Kondo Y, Takizawa T. snRNAs from Radical Prostatectomy Specimens Have the Potential to Serve as Prognostic Factors for Clinical Recurrence after Biochemical Recurrence in Patients with High-Risk Prostate Cancer. Cancers (Basel) 2024; 16:1757. [PMID: 38730709 PMCID: PMC11083327 DOI: 10.3390/cancers16091757] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
In patients with high-risk prostate cancer (HRPC) after radical prostatectomy (RP), biochemical recurrence (BCR) increases the risk of distant metastasis. Accordingly, additional prognostic biomarkers are required to identify the subpopulation of patients with HRPC who develop clinical recurrence (CR) after BCR. The objective of this study was to identify biomarkers in formalin-fixed paraffin-embedded (FFPE) RP samples that are prognostic for CR in patients with HRPC who experience BCR after RP (post-RP BCR). First, we performed a preliminary RNA sequencing analysis to comprehensively profile RNA expression in FFPE RP samples obtained from patients with HRPC who developed CR after post-RP BCR and found that many snRNAs were very abundant in preserved FFPE samples. Subsequently, we used quantitative polymerase chain reaction (qPCR) to compare the expression levels of highly abundant snRNAs in FFPE RP samples from patients with HRPC with and without CR after post-RP BCR (21 CR patients and 46 non-CR patients who had more than 5 years of follow-up after BCR). The qPCR analysis revealed that the expression levels of snRNA RNU1-1/1-2 and RNU4-1 were significantly higher in patients with CR than in patients without CR. These snRNAs were significantly correlated with clinical recurrence-free survival (RFS) in patients with HRPC who experienced post-RP BCR. Furthermore, snRNA RNU1-1/1-2 could serve as an independent prognostic factor for clinical RFS in post-RP BCR of HRPC cases where known prognostic factors (e.g., Gleason score) cannot distinguish between CR and non-CR patients. Our findings provide new insights into the involvement of snRNAs in prostate cancer progression.
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Affiliation(s)
- Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Syunya Noguchi
- Department of Molecular Medicine and Anatomy, Nippon Medical School, Tokyo 113-8602, Japan;
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Hiroya Hasegawa
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Kotaro Obayashi
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Yuka Toyama
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Hiroyuki Takei
- Department of Breast Surgical Oncology, Nippon Medical School, Tokyo 113-8602, Japan;
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; (H.M.); (J.A.); (H.H.); (K.O.); (H.T.); (Y.E.); (Y.T.); (G.K.); (Y.K.)
| | - Toshihiro Takizawa
- Department of Molecular Medicine and Anatomy, Nippon Medical School, Tokyo 113-8602, Japan;
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Ikuma S, Akatsuka J, Takeda H, Endo Y, Kiriyama T, Hamasaki T, Kimura G, Kondo Y. Determining the clinicopathological significance of the VI-RADS ≧4 group: a retrospective study. BMC Urol 2024; 24:63. [PMID: 38509503 PMCID: PMC10953073 DOI: 10.1186/s12894-024-01452-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The Vesical Imaging Reporting and Data System (VI-RADS) is widely used for predicting muscle-invasive bladder cancer (MIBC). This study aimed to determine the clinicopathological significance of the VI-RADS ≧4 (VI≧4) group. METHODS Patients who underwent transurethral resections of bladder tumors during the study period and preoperative magnetic resonance imaging were considered. The patients were pathologically diagnosed with urothelial carcinoma (UC). We first compared the results of patients with VI-RADS scores of 3 and 4 to determine the cut-off score for MIBC; thereafter, the patients were divided into the VI≧4 and VI-RADS ≦3 (VI≦3) groups using VI-RADS. The clinicopathological significance of the VI≧4 group was examined retrospectively by comparing the characteristics of each group. RESULTS In total, 121 cases were examined, of which 28 were pathologically diagnosed with MIBC. Of the 28 MIBC cases, three (10.7%) had a VI-RADS score of ≦3, and 25 (89.3%) had a VI-RADS score of ≧4. Of the 93 NMIBC cases, 86 (92.5%) had a VI-RADS score of ≦3, and seven (7.5%) had a VI-RADS score of ≧4. The diagnostic performance of the VI-RADS with a cut-off score of 4 was 89.3% for sensitivity, 92.5% for specificity, and an area under the curve (AUC) of 0.91. Contrastingly, for a cut-off score of 3, the sensitivity was 89.3%, specificity was 62.0%, and AUC was 0.72. A VI-RADS score of ≥ 4 could predict MIBC. In the VI≧4 group, 30 of 32 (93.8%) patients had high-grade tumors. The VI≧4 group had significantly more high-grade bladder cancers than the VI≦3 group (p < 0.001 OR = 31.77 95%CI:8.47-1119.07). In addition, the VI≧4 group had more tumor necrosis (VI≧4 vs VI≦3, p < 0.001 OR = 7.46 95%CI:2.61-21.34) and more UC variant cases (VI≧4 vs VI≦3, p = 0.034 OR = 3.28 95%CI:1.05-10.25) than the VI≦3 group. CONCLUSIONS This study suggests that VI-RADS has a high diagnostic performance in predicting MIBC and that VI-RADS could diagnose high-grade tumors, necrosis, and UC variants.
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Affiliation(s)
- Shunsuke Ikuma
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
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Choueiri TK, Tomczak P, Park SH, Venugopal B, Symeonides S, Hajek J, Ferguson T, Chang YH, Lee JL, Haas N, Sawrycki P, Sarwar N, Gross-Goupil M, Thiery-Vuillemin A, Mahave M, Kimura G, Perini RF, Saretsky TL, Bhattacharya R, Xu L, Powles T. Patient-Reported Outcomes in KEYNOTE-564: Adjuvant Pembrolizumab Versus Placebo for Renal Cell Carcinoma. Oncologist 2024; 29:142-150. [PMID: 37589219 PMCID: PMC10836324 DOI: 10.1093/oncolo/oyad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND In patients with renal cell carcinoma (RCC) enrolled in the phase III KEYNOTE-564 trial (NCT03142334), disease-free survival (DFS) following nephrectomy was prolonged with use of adjuvant pembrolizumab therapy versus placebo. Patient-reported outcomes (PROs) provide an important measure of health-related quality of life (HRQoL) and can complement efficacy and safety results. PATIENTS AND METHODS In KEYNOTE-564, 994 patients were randomly assigned to receive pembrolizumab 200 mg (n = 496) or placebo (n = 498) intravenously every 3 weeks for ≤17 cycles. Patients who received ≥1 dose of treatment and completed ≥1 HRQoL assessment were included in this analysis. HRQoL end points were assessed using the EORTC QLQ-C30, FKSI-DRS, and EQ VAS. Prespecified and exploratory PRO end points were mean change from baseline in EORTC QLQ-C30 GHS/QoL score, EORTC QLQ-C30 physical function subscale score, and FKSI-DRS score. RESULTS No clinically meaningful difference in least squares mean scores for pembrolizumab versus placebo were observed at week 52 for EORTC QLQ-C30 GHS/QoL (-2.5; 95% CI -5.2 to 0.1), EORTC QLQ-C30 physical functioning (-0.87; 95% CI -2.7 to 1.0), and FKSI-DRS (-0.7; 95% CI -1.2 to -0.1). Most PRO scores remained stable or improved for the EORTC QLQ-C30 GHS/QoL (pembrolizumab, 54.3%; placebo, 67.5%), EORTC QLQ-C30 physical functioning (pembrolizumab, 64.7%; placebo, 68.8%), and FKSI-DRS (pembrolizumab, 58.2%; placebo, 66.3%). CONCLUSIONS Adjuvant treatment with pembrolizumab did not result in deterioration of HRQoL. These findings together with the safety and efficacy findings support adjuvant pembrolizumab treatment following nephrectomy. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03142334.
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Affiliation(s)
- Toni K Choueiri
- Department of Medical Oncology, Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Piotr Tomczak
- Department of Medical Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Se Hoon Park
- Department of Hematology and Oncology, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea
| | - Balaji Venugopal
- Department of Medical Oncology, The Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, UK
| | - Stefan Symeonides
- Department of Medical Oncology, Edinburgh Cancer Centre, NHS Lothian, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jaroslav Hajek
- Department of Medical Oncology, Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Thomas Ferguson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jae Lyun Lee
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | - Naomi Haas
- Division of Hematology and Oncology, Abramson Cancer Center, Philadelphia, PA, USA
| | - Piotr Sawrycki
- Chemotherapy Department, Wojewódzki Szpital Zespolony im. L. Rydygiera, Torun, Poland
| | - Naveed Sarwar
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Marine Gross-Goupil
- Department of Medical Oncology, University Hospital Bordeaux–Hôpital Saint-André, Bordeaux, France
| | | | - Mauricio Mahave
- Department of Oncology, Fundación Arturo López Pérez FALP, Santiago, Chile
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | - Lei Xu
- Merck & Co., Inc., Rahway, NJ, USA
| | - Thomas Powles
- Department of Oncology, Royal Free Hospital NHS Trust, University College London, London, UK
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Endo Y, Akatsuka J, Takeda H, Hasegawa H, Yanagi M, Toyama Y, Mikami H, Shibasaki M, Kimura G, Kondo Y. Real-World Insights into Efficacy and Safety of Enfortumab Vedotin in Japanese Patients with Metastatic Urothelial Carcinoma: Findings, Considerations, and Future Directions. Curr Oncol 2024; 31:759-768. [PMID: 38392050 PMCID: PMC10887831 DOI: 10.3390/curroncol31020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
This study presents the enfortumab vedotin (EV) treatment analysis at our institution. We retrospectively analyzed patients with metastatic urothelial cancer (mUC) treated with EV between January 2021 and October 2023. EV was administered at 1.25 mg/kg on days 1, 8, and 15 in a 28-day cycle. Whole-body computed tomography scans were performed to assess the treatment response. Patient characteristics, treatment histories, response rates, progression-free survival, and adverse events were evaluated. Response rates were determined, and adverse events were recorded. Among the 20 patients, 70% were male and 65% had bladder tumors. Most patients had lung (65%) or lymph node (65%) metastases. The median follow-up was 11.2 months, with 45% of the patients succumbing to the disease. The overall response rate was 55%. The median progression-free and median overall survivals were 10.5 and 12.9 months, respectively. Severe adverse events occurred in 35% of patients. In this real-world study, EV demonstrated promising efficacy and manageable safety profiles in Japanese patients with mUC. The study's results were consistent with previous clinical trials, although a longer follow-up was required. Our findings support EV use as a treatment option for patients with mUC who exhibit disease progression after platinum-based chemotherapy and immune-checkpoint inhibitor therapy.
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Affiliation(s)
- Yuki Endo
- Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan; (J.A.); (H.T.); (H.H.); (M.Y.); (Y.T.); (H.M.); (M.S.); (G.K.); (Y.K.)
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Saito Y, Terasaki Y, Kashiwada T, Tanaka T, Takei H, Kimura G, Kondo Y, Kawagoe T, Matsushita A, Noro R, Minegishi Y, Kamio K, Seike M, Gemma A. Clinicopathological characteristics of everolimus-associated interstitial lung disease: A single-center consecutive analysis. J NIPPON MED SCH 2024:JNMS.2024_91-211. [PMID: 38233124 DOI: 10.1272/jnms.jnms.2024_91-211] [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: 01/19/2024]
Abstract
BACKGROUND Everolimus, a mammalian target of rapamycin inhibitor used as an antineoplastic drug, is associated with a remarkably high incidence of interstitial lung disease (ILD). The clinical and pathological characteristics of ILD caused by everolimus have not been thoroughly investigated; therefore, we aimed to elucidate the features of everolimus-associated ILD. METHODS We retrospectively reviewed the medical records of patients who received everolimus for cancer treatment at our hospital. Patient backgrounds were compared between the ILD and non-ILD groups. Chest computed tomography (CT), changes in biomarkers, and lung histopathological features were analyzed for ILD cases. RESULTS Sixty-six patients were reviewed, and ILD developed in 19. There were no differences in patient demographics between the ILD and non-ILD groups. The severity of ILD was grade 1 (G1) in 9 and grade 2 (G2) in 10 cases. Chest CT showed organizing pneumonia (OP) or a hypersensitive pneumonia pattern. The levels of lactate dehydrogenase, C-reactive protein, Krebs von den lungen-6, and surfactant protein-D (SP-D) at the onset of ILD were significantly higher than those at baseline. Analysis of G1 and G2 ILD subgroups showed a higher SP-D levels in the G2 subgroup. Five patients underwent lung biopsies; all specimens demonstrated alveolitis with lymphocytic infiltration and granulomatous lesions, and some had OP findings. CONCLUSIONS Everolimus-associated ILD is mild and has a favorable prognosis. Patients with symptomatic ILD were more likely to have higher SP-D levels than those with asymptomatic ILD. Granulomatous lesions are an important pathological feature of everolimus-associated ILD.
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Affiliation(s)
- Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | | | - Takeru Kashiwada
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Toru Tanaka
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School
| | - Go Kimura
- Department of Urology, Nippon Medical School
| | | | | | - Akira Matsushita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Koichiro Kamio
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Nippon Medical School
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Gomi M, Mizutani N, Senoo R, Matsubara N, Watanabe A, Maruyama M, Kimura G, Higaki K. Development of Sustained Release System Based on High Water-Absorbable Gel Formation Using Croscarmellose Sodium, Alkaline Excipients and HPMC (ACSH SR System); Novel Application of Croscarmellose Sodium as a Gel Former. Pharm Res 2023; 40:3073-3086. [PMID: 37964084 DOI: 10.1007/s11095-023-03630-w] [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: 06/29/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Croscarmellose sodium, generally used as a superdisintegrant in pharmaceutical formulations, is hydrolyzed to form the gel structure under basic pH conditions. Utilizing this property of croscarmellose sodium, we developed a novel sustained release (SR) system. METHODS Immediate release (IR) and SR tablets containing croscarmellose sodium, alkaline excipients and/or hydroxypropyl methylcellulose (HPMC) were prepared and examined for wet strength and in vitro drug release behavior. In vivo oral drug absorption was evaluated for IR tablets, HPMC tablets and our novel SR tablets in fasted Beagle dogs. RESULTS To form the gel structure even under the physiological condition, alkaline excipients were added into the formulation containing croscarmellose sodium. Furthermore, HPMC was used to make the gel structure strong enough against mechanical destructive forces. The novel alkalized croscarmellose sodium-HPMC (ACSH) SR tablet, consisting of croscarmellose sodium, alkaline excipients, and HPMC, successfully sustained the release of acetaminophen, ibuprofen, or nicardipine hydrochloride, compared with the IR tablets. The ACSH SR system provided a better release of acetaminophen than the HPMC tablet without croscarmellose sodium in the release study using a small volume of liquid, suggesting that substantial release and subsequent absorption would be expected in the distal intestinal segments after oral dosing. The in vivo oral absorption study revealed that the ACSH SR system successfully suppressed and prolonged the plasma concentrations of acetaminophen. CONCLUSION This novel ACSH SR system prepared with croscarmellose sodium, alkaline excipients, and HPMC, would be a promising SR formulation for enabling substantial drug absorption in the distal intestinal segments.
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Affiliation(s)
- Masato Gomi
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-Naka, Kita-Ku, Okayama, 700-8530, Japan.
- Formulation R&D Laboratory, Research Division, Shionogi & Co., Ltd., 2-1-3 Kuise Terajima, Amagasaki, Hyogo, 660-0813, Japan.
| | - Naoya Mizutani
- Formulation R&D Laboratory, Research Division, Shionogi & Co., Ltd., 2-1-3 Kuise Terajima, Amagasaki, Hyogo, 660-0813, Japan
| | - Ryotaro Senoo
- Formulation R&D Laboratory, Research Division, Shionogi & Co., Ltd., 2-1-3 Kuise Terajima, Amagasaki, Hyogo, 660-0813, Japan
| | - Noriaki Matsubara
- Formulation R&D Laboratory, Research Division, Shionogi & Co., Ltd., 2-1-3 Kuise Terajima, Amagasaki, Hyogo, 660-0813, Japan
| | - Ayahisa Watanabe
- Laboratory for Medicinal Chemistry Research, Research Division, Shionogi & Co., Ltd., 3-1-1, Futaba-Cho, Toyonaka, Osaka, 561-0825, Japan
| | - Masato Maruyama
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-Naka, Kita-Ku, Okayama, 700-8530, Japan
| | - Go Kimura
- Formulation R&D Laboratory, Research Division, Shionogi & Co., Ltd., 2-1-3 Kuise Terajima, Amagasaki, Hyogo, 660-0813, Japan
| | - Kazutaka Higaki
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-Naka, Kita-Ku, Okayama, 700-8530, Japan
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Akatsuka J, Kimura G, Katsu A, Hasegawa H, Mikami H, Yanagi M, Endo Y, Takeda H, Toyama Y, Kondo Y. A case of marked rectal stenosis due to Douglas' pouch metastasis of renal pelvic carcinoma successfully treated with salvage enfortumab vedotin: correlation between serum KL-6 levels and tumor response. IJU Case Rep 2023; 6:449-453. [PMID: 37928289 PMCID: PMC10622197 DOI: 10.1002/iju5.12645] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction We report a rare case of marked rectal stenosis due to Douglas' pouch metastasis of renal pelvic urothelial carcinoma successfully treated with enfortumab vedotin. Case presentation A 77-year-old female presented with difficulty in defecation and abdominal distension. She had received two courses of cisplatin plus gemcitabine followed by four courses of maintenance avelumab for postoperative lymph node metastasis of renal pelvic urothelial carcinoma. KL-6 levels were elevated, and a computed tomography scan revealed an irregularly shaped large mass occupying Douglas' pouch, with marked rectal stenosis. Metastatic urothelial carcinoma was pathologically diagnosed, and enfortumab vedotin was initiated after colostomy. After 12 courses of enfortumab vedotin, metastatic lesions showed marked shrinkage and KL-6 levels decreased. Conclusion Enfortumab vedotin elicited a remarkable response in treating rectal stenosis due to metastasis of renal pelvic urothelial carcinoma in Douglas' pouch. Furthermore, serum KL-6 levels were correlated with the severity of metastatic urothelial carcinoma.
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Affiliation(s)
- Jun Akatsuka
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Go Kimura
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Akifumi Katsu
- Department of UrologyNippon Medical SchoolTokyoJapan
| | | | - Hikaru Mikami
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Masato Yanagi
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuki Endo
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Hayato Takeda
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuka Toyama
- Department of UrologyNippon Medical SchoolTokyoJapan
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9
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Kimura G, Matsuyama T, Mizuno Y. Stop posterior wall puncture of the arteriovenous graft (AVG). New findings of cannulation techniques from a prospective observational study with an AVG model and plastic cannula for dialysis. J Vasc Access 2023; 24:1299-1304. [PMID: 35302410 DOI: 10.1177/11297298221081650] [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: 11/16/2022] Open
Abstract
BACKGROUND Posterior wall puncture of the AVG causes serious vascular access complications, but there is no concrete technical recommendation for AVG cannulation with plastic cannula. The purpose of this study is to identify cannulation techniques to reduce posterior wall puncture of the AVG using plastic cannula. METHODS Sixty-three hemodialysis nurses' cannulations on experimental models were recorded and included in this study. Cannulations were conducted on AVG and AVF models with a plastic cannulation needle. We analyzed the angle of the needle, the motion of the needle, and the location of the needle in the graft lumen. RESULTS The occurrence of posterior wall puncture of the AVG model was 22.2%. The cannulation angles in the AVG model were greater than those in the AVF model (p < 0.05). In the posterior wall puncture group of the AVG model, after the tip of the needle had reached into the graft lumen, the angle of the needle was not flattened (p < 0.05) and the outer sleeve of the needle was not inserted into the graft (p < 0.05). Furthermore, posterior wall puncture of the AVG model were observed in the group with less than 5 years of dialysis nursing experience (p < 0.05). CONCLUSIONS From this study, after the tip of the needle had reached into the graft lumen, flattening the angle of the needle and inserting the outer sleeve of the needle into the graft were suggested as specific cannulation techniques to reduce posterior wall puncture of the AVG. Furthermore, this study also suggests the importance of cannulation technique education for new dialysis nurses to reduce cannulation-caused complications.
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Affiliation(s)
- Go Kimura
- Dialysis Center, Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Matsuyama
- Medical Products Division, W. L. Gore & Associates G.K., Minato City, Tokyo, Japan
| | - Yuki Mizuno
- Medical Products Division, W. L. Gore & Associates G.K., Minato City, Tokyo, Japan
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Yonese J, Hinata N, Masui S, Nakai Y, Shirotake S, Takeuchi A, Inamoto T, Nozawa M, Ueda K, Etsunaga T, Osawa T, Uemura M, Kimura G, Numakura K, Yamana K, Miyake H, Fukasawa S, Morishima N, Ito H, Uemura H. Real-world effectiveness of nivolumab and subsequent therapy in Japanese patients with metastatic renal cell carcinoma (POST-NIVO study): 36-month follow-up results of a clinical chart review. Int J Urol 2023; 30:762-771. [PMID: 37248753 DOI: 10.1111/iju.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/07/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To examine the long-term effectiveness of nivolumab monotherapy and following subsequent therapies for metastatic renal cell carcinoma (mRCC) in Japanese real-world settings. METHODS This was a multicenter, retrospective, observational study, with a 36-month follow-up, and conducted in Japanese patients with mRCC who initiated nivolumab monotherapy between 1 Feb 2017 and 31 Oct 2017. Endpoints included overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). RESULTS Of the 208 patients, 36.5% received nivolumab monotherapy as second-line, 30.8% as third-line, and 31.7% as fourth- or later-line therapy. By 36 months, 12.0% of patients continued nivolumab monotherapy; 88.0% discontinued, mainly because of disease progression (66.7%). The median (m) OS was not reached irrespective of treatment line, with a 36-month OS rate of 54.3% (second-line, 57.4%; third-line, 52.6%; fourth- or later-line, 52.9%). The ORR was 24.2% and five patients achieved complete response. The OS from first-line therapy was 8.9 years. In the 95 patients receiving therapy after nivolumab, 87.4% received vascular endothelial growth factor receptor-tyrosine kinase inhibitors, with mOS and mPFS of 27.4 and 8.1 months, respectively. Irrespective of treatment line, the mOS was not reached in patients with International Metastatic RCC Database Consortium (IMDC) favorable or intermediate risk at mRCC diagnosis. CONCLUSIONS This 36-month real-world follow-up analysis showed a survival benefit of nivolumab monotherapy for patients with mRCC. The long-term effectiveness of sequential therapy from first-line therapy to therapy after nivolumab was also demonstrated. Additionally, nivolumab monotherapy was beneficial for patients with favorable IMDC risk at the time of mRCC diagnosis.
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Affiliation(s)
- Junji Yonese
- Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Nobuyuki Hinata
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Masui
- Division of Reparative and Regenerative Medicine, Nephro-Urologic Surgery and Andrology, Institute of Medical Life Science, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Suguru Shirotake
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Masahiro Nozawa
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Fukuoka, Japan
| | - Toru Etsunaga
- Department of Urology, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazutoshi Yamana
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Naoto Morishima
- Oncology Medical Affairs, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Hiroaki Ito
- Oncology Medical, Bristol-Myers Squibb K.K., Chiyoda-ku, Tokyo, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
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Osawa T, Fujii Y, Kimura G, Kitamura H, Nagashima Y, Iizumi S, Osaka T, Tsubouchi R, Shinohara N. Electronic patient-reported outcome (e-PRO) monitoring for adverse event management during cabozantinib treatment in patients with advanced renal cell carcinoma: protocol for a three-arm, randomised, multicentre phase II trial (e-PRO vs paper-PRO or usual care). BMJ Open 2023; 13:e070275. [PMID: 37495393 PMCID: PMC10373669 DOI: 10.1136/bmjopen-2022-070275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Cabozantinib monotherapy is an option for treatment of advanced renal cell carcinoma (RCC). However, cabozantinib dose modification and discontinuation due to symptomatic adverse events (AEs) remains a challenge. The use of patient-reported outcomes (PROs) may help manage symptomatic AEs, which is reported to lead to improved quality of life (QOL), avoidance of drug discontinuation and better survival. This study aims to investigate the clinical benefits of PROs in patients with RCC receiving cabozantinib and the most appropriate medium for PRO monitoring (electronic [e]-PRO or paper-PRO). METHODS AND ANALYSIS This study is being conducted at about 35 sites in Japan. Patients aged ≥18 years with unresectable or metastatic RCC initiating treatment with cabozantinib monotherapy are eligible and will be randomised to: (1) e-PRO monitoring, (2) paper-PRO monitoring or (3) usual care without PRO monitoring. Recruitment began in December 2021 (target sample size, 105). Patients start treatment with cabozantinib 60 mg once daily, and in the PRO groups, will record daily medication intake, weight, temperature, blood pressure and AEs. Endpoints include the proportion of patients with a ≥5-point deterioration on the Functional Assessment of Cancer Therapy-Kidney Cancer Symptom Index (FKSI-19; primary endpoint), progression-free survival, QOL, dose adjustments, relative dose intensity, treatment-emergent AEs and frequency of interventions for AEs outside of the scheduled visits. Patient and physician opinions of the PRO monitoring systems and patient compliance with e-PRO/paper-PRO input are also being measured. ETHICS AND DISSEMINATION The study is being conducted in compliance with the Declaration of Helsinki, the International Council for Harmonisation guidelines for Good Clinical Practice and the Clinical Trials Act. Written informed consent is being obtained from all patients, and the protocol has been approved by the Hokkaido University Hospital Certified Review Board (approval number, CRB021-005). The results will be presented at conferences and submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCTs011210055.
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Affiliation(s)
- Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Sakura Iizumi
- Japan Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Tsuyoshi Osaka
- Japan Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Ryoichi Tsubouchi
- Japan Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Takeda H, Akatsuka J, Yuki E, Matsuzawa I, Suzuki Y, Hamasaki T, Kimura G, Kondo Y. Long-Term Oncological Outcomes of High-Risk Prostate Cancer defined by Histopathological Examination. J NIPPON MED SCH 2023. [PMID: 36823126 DOI: 10.1272/jnms.jnms.2023_90-210] [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: 02/22/2023]
Abstract
BACKGROUND The optimal treatment modality for locally advanced prostate cancer has not been established. Radiotherapy, hormonal therapy, and combinations of treatments are the main strategies, although the feasibility of radical prostatectomy as a first-line therapy needs to be considered. This retrospective study evaluated the long-term oncological outcome of high-risk prostate cancer treated surgically, using pathological results of the extracted specimen. The relationship between the number of risk factors and the long-term outcome was specifically analyzed. METHODS High-risk prostate cancer patients who underwent laparoscopic radical prostatectomy at Nippon Medical School from 2000 to 2012 without neoadjuvant therapy of any kind were identified. Risk factors were prostate-specific antigen (PSA) ≥20 ng/ml, pathological ≥T3, and pathological Gleason Score ≥8. Biological failure was defined as PSA ≥0.2 ng/ml. RESULTS A total of 222 men were identified. One patient had positive lymph node status, and there was a significant difference in surgical margin positivity (52 men, 68.4% vs 56 men 38.4%) between patients with and without biochemical failure. For patients meeting the high risk criteria with a follow-up of up to 133 months, the biochemical recurrence (BCR) -free survival rates at 5 and 10 years were 62.8% and 58.4%, respectively, with a mean time to BCR of 14.0 months. BCR-free survival rates at 5 and 10-year were 73.6% and 71.4%, respectively, with 1 risk factor, 48.7% and 34.6%, respectively, with 2 factors, and 34.5% and 34.5%, respectively, with 3 factors. A single risk factor group had a significantly better outcome than the group with multiple risk factors. The overall survival rate at 5 and 10 years were 94.6% and 93.7%, and the cancer-specific survival rate was 100% at both 5 and 10 years. CONCLUSIONS Reasonable long-term oncological outcomes can be achieved by surgical treatment for high-risk prostate cancer. The group with 1 risk factor had a significantly better BCR-free rate than the multiple risk factor group.
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Affiliation(s)
| | | | - Endo Yuki
- Department of Urology, Nippon Medical School
| | | | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School.,Department of Urology, Nippon Medical School Chiba Hokusoh Hospital
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Musashi Kosugi Hospital
| | - Go Kimura
- Department of Urology, Nippon Medical School
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Takeda H, Kimura G, Akatsuka J, Endo Y, Yanagi M, Mikami H, Hasegawa H, Katsu A, Funato R, Taniuchi M, Toyama Y, Kondo Y. Association of serum lactate dehydrogenase (LDH) isozyme with prognosis of patients with metastatic clear cell renal cell carcinoma (mCRCC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
709 Background: LDH isozyme is a tetramer of two subunits, H chain and M chain, and is present in all living tissue. Five types of molecular forms characterize the LDH pattern, and tumor tissues relatively consist LDH-4 and LDH-5, composed with a high ratio of the M chain, compared to normal tissues. This study analyzed the association between LDH isozyme and prognosis of mCRCC after nephrectomy. Methods: Clinical records of mCRCC patients those who were initially diagnosed M0 disease at Nippon Medical School between 2012 and 2016 were retrospectively reviewed. LDH isozyme values before operation and at time of metastasis were checked. Isozyme patterns were classified into 6 types, LDH 1-5 dominant and common type, according to the most composed molecular form. Results: Out of 38 patients, 33 patients (87%) were male, 5 patients (13%) were female. Median age was 65 years old (36-87). pT1 was seen in 3 cases, pT2 in 4, pT3 in 27, and pT4 in 4. Pathological grade 2 were 9 cases, G3 in 21, and G4 in 8. As for the IMDC risk, favourable was 2 cases (5%), intermediate in 26 (68%) and poor in 10 (26%). Median LDH was 163 IU/L (113-317), and isozyme dominant pattern were as follows: LDH-2 in 9 cases (24%), LDH-3 in 6 (16%), LDH-4 in 4, LDH-5 in 11. 8 cases were common type, and no cases showed LDH-1 dominant. Median time from surgery to recurrence was 10 months (1-104), median follow-up period after recurrence was 18 months (4-72). 16 deaths occurred. No significant correlation was seen between pre-operative LDH isozyme pattern and pathological grade or pT stage. Pre-operative LDH isozyme did not correlate with the time to recurrence (p=0.7420). The median OS for LDH-4 dominant at the time of metastasis was 10.9 months, significantly shorter than other isozyme types (P=0.0134). Conclusions: LDH-4 dominant isozyme pattern at the time of recurrence has a short OS, proposing as a prognostic predictor in mRCC.
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Affiliation(s)
- Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | | | | | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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14
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Endo Y, Kimura G, Akatsuka J, Takeda H, Yanagi M, Mikami H, Hasegawa H, Taniuchi M, Katsu A, Funato R, Toyama Y, Kondo Y. Early switching to pembrolizumab (Pe) during first-line platinum-based chemotherapy (PCT) in patients (pts) with metastatic urothelial carcinoma (mUC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
452 Background: With the results of the Javelin bladder 100 trial, PCT followed by ICI has become the standard of care for pts with mUC. While more than half of the pts have progressive disease (PD) by the 4th cycle of PCT, in general, most these pts will receive ICI after 4th cycle of PCT. However, for pts who have PD before 4 cycles, additional PCT will not only be effective, but will also cause side effects and worsen immune environment. However, the outcome of early switching to ICI during 1st-line PCT has not been reported. Here, we investigated whether early switching to Pe may improve prognosis. We also examined the usefulness of serum CYFRA (sCY) as a prognostic marker of 2nd-line Pe in this study. Methods: Seventy pts with mUC received PCT followed by Pe from February 2018 to July 2022 at our institution. Among them 56 pts who had received PCT 3 cycles or less because of PD or unacceptable side effects were included in this study. During PCT, computed tomography (CT) was performed at the end of each cycle and PCT was continued until PD. If PD on CT was confirmed, 2nd-line Pe was initiated. Performance status, metastasis site, neutrophil-lymphocyte ratio, hemoglobin, and serum alkaline phosphatase, C-reactive protein, total protein, albumin, corrected calcium (Ca) and sCY before Pe were examined as possible prognostic factors for overall survival (OS). OS was analyzed by Kaplan-Meier curves and log-rank test. Multivariate analysis on prognostic factors was carried out using the Cox hazards model. Results: Median age was 73 (31-86). Twenty-seven pts (49%) received gemcitabine-cisplatin and 29 (51%) received gemcitabine-carboplatin for PCT. Twelve pts (21%) received 1 cycle of PCT, 2 cycles in 26 (46%) and 3 cycles in 18 (32%). During the median follow-up period of 14.6 (6.2-44.6) months (M), 30 pts (53.5%) had died. The median OS was 15.5M and the 1-year OS rate was 60%. The median PFS was 10.2M and the 1-year PFS rate was 46%. Objective response rate was 25% and 18 pts showed stable disease (32%) and 24 pts (43%) showed PD. On univariate analysis, sCY (p=0.001) and Ca (p=0.003) were the significant factors for OS. On multivariate analysis, sCY (HR 3.2, 95%CI [1.33-7.82], p=0.009) and Ca (HR2.3, (95%CI [1.02-5.22], p=0.046) were the significant factors for OS. Conclusions: Early switching to Pe during 1st-line PCT resulted in PFS of 10.2M and OS of 15.5M, which were longer than those of the KEYNOTE-045 trial (PFS 2M, OS 10M). Early introduction of Pe may be effective in the pts with mUC who are resistant to chemotherapy. sCY and Ca were suggested to be the useful prognostic factors for OS.
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Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroya Hasegawa
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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Osawa T, Kimura G, Fujii Y, Uchitomi Y, Honda K, Otani A, Kondo M, Wako T, Mitsuda Y, Kawai D, Sugawara M, Kitano H, Shinohara N. Cross-sectional study of patients' (pts) and physicians' needs and the financial toxicity of systemic treatment for metastatic renal cell carcinoma (mRCC) in Japan. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
702 Background: There is an increasing awareness of the importance of pt-centricity in cancer treatments. To achieve pt-centricity in mRCC treatment, it is important to clarify the differences of preferences between pts and physicians in terms of efficacy, safety, quality of life, and healthcare economics. However, these data are currently lacking for Japanese pts with RCC. This study aims to identify any differences in preferences for drug treatments between pts with mRCC and physicians in Japan, as well as assess the financial toxicity of mRCC and its influencing factors among pts. Methods: This cross-sectional observational study collected data via a web survey of pts with mRCC and physicians. The primary endpoint was to identify the differences in drug-treatment preferences between pts and physicians. The secondary endpoints included identification of the side effects that were most distressing to the pts and those that were most difficult to communicate to the physicians, and the reasons for this. We also evaluated the financial toxicity using the “COST” tool as an exploratory endpoint. Fisher's exact test was used in the evaluation of differences between pts and physicians. Background factors for financial toxicity were evaluated using univariate and multivariate regression analyses. Pearson’s correlation was used to assess the correlation between COST score and FACT-G score. Results: 83 Pts and 165 physicians were included in the analysis. For pts, “eliminating all evidence of disease” ( P < 0.001) was the most important drug-treatment outcome, while for physicians, it was “longer survival” ( P < 0.001). The item of most concern about drug treatment was “disturbing daily activities due to the side effect” for both pts and physicians; while pts were more concerned than physicians about “financial burden” ( P < 0.01) and “lack of the knowledge for the treatment” ( P < 0.001). Diarrhea, fatigue, and vomiting were the most distressing side effects for pts; 51% of pts had difficulty in telling their physicians about side effects such as fatigue, anxiety, and depression. The median COST score was 19 (range, 3–36) and multivariate analysis showed that age and private insurance were independent factors in financial toxicity. In addition, the COST score was positively correlated with the FACT-G total score ( r = 0.40, P < 0.001). Conclusions: There is a gap between pts with mRCC and physicians in their preferences and concerns about drug treatment. Japanese pts with mRCC suffer from side effects, some of which are not shared with physicians, and experience adverse financial impacts even under the universal health insurance coverage system available in Japan. This study highlights the importance of communicating well with pts in clinical practice to achieve pt-centricity in systemic treatment for mRCC.
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Affiliation(s)
- Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Ariko Otani
- Outpatient Treatment Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Miki Kondo
- Department of Nursing, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tetsuya Wako
- Department of Pharmacy, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | | | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Tomita Y, Kobayashi K, Kimura G, Oya M, Uemura H, Nishiyama H, Galsky MD, Nasroulah F, Collette S, Broughton E, Ünsal-Kaçmaz K, Kamisuki Y, Bajorin DF. Adjuvant nivolumab versus placebo following radical surgery for high-risk muscle-invasive urothelial carcinoma: a subgroup analysis of Japanese patients enrolled in the phase 3 CheckMate 274 trial. Jpn J Clin Oncol 2023; 53:16-25. [PMID: 36300304 PMCID: PMC9825712 DOI: 10.1093/jjco/hyac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The phase 3 CheckMate 274 trial demonstrated superiority of adjuvant nivolumab over placebo after radical surgery in patients with high-risk muscle-invasive urothelial carcinoma. However, the efficacy and safety of adjuvant nivolumab in Japanese patients with muscle-invasive urothelial carcinoma have not been clarified. METHODS Patients with muscle-invasive urothelial carcinoma were randomized to adjuvant nivolumab 240 mg or placebo (every 2 weeks via intravenous infusion) up to 120 days after radical surgery in CheckMate 274. RESULTS Of 49 patients in the Japanese subgroup, 27 and 22 patients were randomized to nivolumab and placebo, respectively. Eleven and 8 patients, respectively, had tumor PD-L1 expression level of 1% or more. The median disease-free survival times in the nivolumab and placebo groups were 29.67 months (95% confidence interval 7.79-not reached) and 9.72 months (95% confidence interval 4.73-not reached), respectively (hazard ratio 0.77, 95% confidence interval 0.35-1.69). The corresponding values in patients with tumor PD-L1 expression level of 1% or more were 29.67 months (95% confidence interval 2.63-not reached) and 25.95 months (95% confidence interval 5.59-not reached) (hazard ratio 1.10, 95% confidence interval 0.31-3.92), respectively. Treatment-related adverse events of Grade 3-4 occurred in 25.9 and 13.6% of patients in the nivolumab and placebo groups, respectively. The most common treatment-related adverse events in the nivolumab group were lipase increased, amylase increased and diarrhea. The changes in quality of life scores from baseline over time were similar in both groups. CONCLUSIONS The efficacy and safety results in the Japanese subgroup were consistent with the overall population of CheckMate 274.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ko Kobayashi
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Hospital, Faculty of Medicine, Osaka, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | | | | | | | | | | | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Tamada S, Nozawa M, Ohba K, Mizuno R, Takamoto A, Ohe C, Yoshimoto T, Nakagawa Y, Fukuyama T, Matsubara N, Kimura G, Tomita Y, Nonomura N, Eto M. Prognostic value of PD-L1 expression in recurrent renal cell carcinoma after nephrectomy: a secondary analysis of the ARCHERY study. Int J Clin Oncol 2023; 28:289-298. [PMID: 36534263 PMCID: PMC9889451 DOI: 10.1007/s10147-022-02256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nephrectomy is a curative treatment for localized renal cell carcinoma (RCC), but patients with poor prognostic features may experience relapse. Understanding the prognostic impact of programmed death-ligand 1 (PD-L1) expression in patients who underwent nephrectomy for RCC may aid in future development of adjuvant therapy. METHODS Of 770 surgical specimens collected from Japanese patients enrolled in the ARCHERY study, only samples obtained from patients with recurrent RCC after nephrectomy were examined for this secondary analysis. Patients were categorized into low- and high-risk groups based on clinical stage and Fuhrman grade. Time to recurrence (TTR) and overall survival (OS) were analyzed. RESULTS Both TTR and OS were shorter in patients with PD-L1-positive than -negative tumors (median TTR 12.1 vs. 21.9 months [HR 1.46, 95% CI 1.17, 1.81]; median OS, 75.8 vs. 97.7 months [HR 1.32, 95% CI 1.00, 1.75]). TTR and OS were shorter in high-risk patients with PD-L1-positive than -negative tumors (median TTR 7.6 vs. 15.3 months [HR 1.49, 95% CI 1.11, 2.00]; median OS, 55.2 vs. 83.5 months [HR 1.53, 95% CI 1.06, 2.21]) but not in low-risk patients. CONCLUSIONS This ARCHERY secondary analysis suggests that PD-L1 expression may play a role in predicting OS and risk of recurrence in high-risk patients with localized RCC. CLINICAL TRIAL REGISTRATION UMIN000034131.
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Affiliation(s)
- Satoshi Tamada
- Department of Urology, Bell Land General Hospital, Higashiyama 500-3, Naka-Ku, Sakai City, Osaka 599-8247 Japan
| | - Masahiro Nozawa
- Department of Urology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 Japan
| | - Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582 Japan
| | - Atsushi Takamoto
- Department of Urology, Fukuyama City Hospital, 5-23-1 Zao-Cho, Fukuyama, Hiroshima 721-8511 Japan
| | - Chisato Ohe
- Department of Pathology, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191 Japan
| | - Takuya Yoshimoto
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, 1-1 Nihonbashi-Muromachi, 2-Chome Chuo-Ku, Tokyo, 103-8324 Japan
| | - Yuki Nakagawa
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, 1-1 Nihonbashi-Muromachi, 2-Chome Chuo-Ku, Tokyo, 103-8324 Japan
| | - Tamaki Fukuyama
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, 1-1 Nihonbashi-Muromachi, 2-Chome Chuo-Ku, Tokyo, 103-8324 Japan
| | - Nobuaki Matsubara
- Department of Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-Shi, Chiba, 277-8577 Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603 Japan
| | - Yoshihiko Tomita
- Departments of Urology and Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata, 951-8510 Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
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18
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Shinotsuka H, Mizutani N, Aikawa S, Kimura G. Palatability Evaluation of Sulfamethoxazole/Trimethoprim with Sweetener Using the Two-Bottle Choice Test. Chem Pharm Bull (Tokyo) 2023; 71:906-908. [PMID: 38044143 DOI: 10.1248/cpb.c23-00428] [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: 12/05/2023]
Abstract
Drug taste, which affects palatability, influences drug adherence. Sensory masking may be used to confound bitter tastes in drugs with other tastes and flavors; however, evaluation of sensory masking is difficult because of the existence of multiple tastes. In this study, a new two-bottle choice test was performed in rats to evaluate bitterness masking and determine the drug-to-sweetener ratio that significantly improves palatability. Sulfamethoxazole and trimethoprim were used as model bitter drugs, and sucralose was used as sweetener. The addition of sucralose and trimethoprim at a 0.13 : 1 ratio resulted in the greatest improvement in preference. This method is a useful new technique for evaluating the palatability of drug formulations.
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Affiliation(s)
- Haruka Shinotsuka
- Formulation R&D Laboratory, Shionogi CMC Research Innovation Center, Shionogi & Co., Ltd
| | - Naoya Mizutani
- Formulation R&D Laboratory, Shionogi CMC Research Innovation Center, Shionogi & Co., Ltd
| | - Shohei Aikawa
- Formulation R&D Laboratory, Shionogi CMC Research Innovation Center, Shionogi & Co., Ltd
| | - Go Kimura
- Formulation R&D Laboratory, Shionogi CMC Research Innovation Center, Shionogi & Co., Ltd
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19
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Taniuchi M, Yanagi M, Kiriyama T, Akatsuka J, Hasegawa H, Mikami H, Endo Y, Takeda H, Toyama Y, Kimura G, Kondo Y. Primary leiomyoma of the bladder radiologically mimicking a retroperitoneal tumor - a case report. J Med Invest 2023; 70:513-515. [PMID: 37940541 DOI: 10.2152/jmi.70.513] [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: 11/10/2023]
Abstract
The case presented is of a 47-year-old patient with an extravesical pedunculated bladder leiomyoma, which was difficult to distinguish from a retroperitoneal tumor. Preoperatively, it was suspected to be a retroperitoneal tumor and a laparotomy with tumor resection was performed. lntraoperatively, the bladder and tumor were connected by a cord-like tissue. A retrospective review of preoperative images revealed that cord-like tissue, identified intraoperatively, was also present. Bladder leiomyomas can grow as extravesical pedunculated tumors. Therefore, when the continuity between the bladder and tumor is only a cord-like object, the finding ofcontinuity is useful to diagnose with bladder leiomyoma. J. Med. Invest. 70 : 513-515, August, 2023.
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Affiliation(s)
- Mami Taniuchi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroya Hasegawa
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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20
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Eto M, Takagi T, Kimura G, Fukasawa S, Tamada S, Miura Y, Oya M, Sassa N, Anai S, Nozawa M, Sakai H, Perini R, Yusa W, Ikezawa H, Narita T, Tomita Y. Lenvatinib plus pembrolizumab versus sunitinib for advanced renal cell carcinoma: Japanese patients from the
CLEAR
study. Cancer Med 2022; 12:6902-6912. [PMID: 36457273 PMCID: PMC10067092 DOI: 10.1002/cam4.5483] [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] [Received: 08/15/2022] [Revised: 11/08/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The phase 3 CLEAR study demonstrated statistically significantly improved efficacy with lenvatinib plus pembrolizumab versus sunitinib, including progression-free survival and overall survival, in patients with previously untreated advanced renal cell carcinoma. This subset analysis investigated efficacy and safety in Japanese patients randomized to lenvatinib plus pembrolizumab or sunitinib in the CLEAR study. METHODS Progression-free survival, overall survival, tumor response, and safety were assessed in Japanese patients with previously untreated advanced renal cell carcinoma randomized to receive lenvatinib plus pembrolizumab (n = 42) or sunitinib (n = 31). Efficacy outcomes were analyzed by independent imaging review per Response Evaluation Criteria in Solid Tumors, version 1.1. RESULTS Progression-free survival was longer with lenvatinib plus pembrolizumab than with sunitinib (median, 22.1 vs. 10.9 months; hazard ratio, 0.39; 95% CI, 0.20-0.74). Median overall survival was not estimable in the lenvatinib plus pembrolizumab arm and 30.6 months in the sunitinib arm (HR, 1.20; 95% CI, 0.39-3.66). Overall survival adjusted for the imbalance of Memorial Sloan-Kettering Cancer Center prognostic risk group favored lenvatinib plus pembrolizumab (hazard ratio, 0.67; 95% CI, 0.18-2.39). Objective response rate (69.0% vs. 45.2%; odds ratio, 2.71; 95% CI, 1.03-7.10) was higher and median duration of response (20.3 vs. 9.1 months) was longer with lenvatinib plus pembrolizumab versus sunitinib. Grade ≥ 3 treatment-emergent adverse events occurred in 95.2% versus 87.1% of patients in the lenvatinib plus pembrolizumab versus sunitinib arms. CONCLUSIONS These findings support lenvatinib plus pembrolizumab as a potential first-line treatment for Japanese patients with advanced renal cell carcinoma.
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Affiliation(s)
- Masatoshi Eto
- Department of Urology Kyushu University Hospital Fukuoka Japan
| | - Toshio Takagi
- Department of Urology Tokyo Women's Medical University Hospital Tokyo Japan
| | - Go Kimura
- Department of Urology Nippon Medical School Hospital Tokyo Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology Chiba Cancer Center Chiba Japan
| | - Satoshi Tamada
- Department of Urology Bell‐land General Hospital Osaka Japan
| | - Yuji Miura
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | - Mototsugu Oya
- Department of Urology Keio University Hospital Tokyo Japan
| | - Naoto Sassa
- Department of Urology Aichi Medical University Aichi Japan
| | - Satoshi Anai
- Department of Urology Nara Medical University Nara Japan
| | - Masahiro Nozawa
- Department of Urology Kindai University Hospital Osaka Japan
| | - Hideki Sakai
- Department of Urology Nagasaki University Hospital Nagasaki Japan
| | | | - Wataru Yusa
- Japan and Asia Clinical Development Department Oncology Business Group, Eisai Co., Ltd. Tokyo Japan
| | - Hiroki Ikezawa
- Clinical Data Science Department, Medicine Development Center Eisai Co., Ltd. Tokyo Japan
| | | | - Yoshihiko Tomita
- Department of Urology, Department of Molecular Oncology Niigata University Graduate School of Medicine Niigata Japan
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21
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Mikami H, Kimura G, Taniuchi M, Katsu A, Hasegawa H, Yanagi M, Endo Y, Takeda H, Akatsuka J, Toyama Y, Kondo Y. 154P Can urine cytology predict variants of bladder cancer? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.189] [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: 12/07/2022] Open
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22
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Akatsuka J, Suzuki K, Ikuma S, Yanagi M, Endo Y, Takeda H, Toyama Y, Dohi T, Kimura G, Kondo Y. Vesicocutaneous fistula due to vesical diverticulitis with stones: A case report and literature review. IJU Case Rep 2022; 6:46-50. [PMID: 36605677 PMCID: PMC9807334 DOI: 10.1002/iju5.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction We encountered an extremely rare case of a vesicocutaneous fistula due to vesical diverticulitis with stones. Case presentation A 78-year-old male patient presented to our department with complaints of suppurative discharge in the suprapubic area. Computed tomography revealed an enlarged prostate, a vesical diverticulum with stones located on the ventral side, and an aberrant connection between the anterior bladder wall and the external surface of the skin. The patient was diagnosed with a vesicocutaneous fistula due to vesical diverticulitis and was successfully treated with a multidisciplinary approach including vesical diverticulectomy with stone removal and nonviable tissue debridement. The patient continues to receive regular outpatient follow-ups with urinary catheter changes. Conclusion Vesicocutaneous fistulas due to vesical diverticulitis with stones are extremely rare. We should be aware that a vesical diverticulum with stones located on the ventral side might pose a high-risk factor for the formation of a vesicocutaneous fistula in elderly patients.
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Affiliation(s)
- Jun Akatsuka
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Kyota Suzuki
- Department of UrologyNippon Medical SchoolTokyoJapan
| | | | - Masato Yanagi
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuki Endo
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Hayato Takeda
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Yuka Toyama
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Teruyuki Dohi
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | - Go Kimura
- Department of UrologyNippon Medical SchoolTokyoJapan
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23
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Powles T, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, Hajek J, Gurney H, Chang YH, Lee JL, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Mahave M, Haas NB, Sawrycki P, Burgents JE, Xu L, Imai K, Quinn DI, Choueiri TK, Choueiri T, Park SH, Venugopal B, Ferguson TR, Hajek J, Lin TP, Symeonides SN, Lee JL, Sawrycki P, Haas NB, Gurney HP, Mahave M, Sarwar N, Thiery-Vuillemin A, Gross-Goupil M, Chevreau C, Burke JM, Doshi G, Melichar B, Topart D, Oudard S, Kopyltsov E, Hammers HJ, Quinn DI, Alva A, Menezes JDJ, Silva AGE, Winquist EW, Hamzaj A, Procopio G, Karaszewska B, Nowakowska-Zajdel EM, Alekseev BY, Gafanov RA, Izmailov A, Semenov A, Afanasyev SG, Lipatov ON, Powles TB, Srinivas S, McDermott D, Kochuparambil ST, Davis ID, Peltola K, Sabbatini R, Chung J, Shkolnik MI, Matveev VB, Gajate Borau P, McCune S, Hutson TE, Dri A, Sales SC, Yeung C, Alcala Castro CM, Bostrom P, Laguerre B, Buttigliero C, de Giorgi U, Fomin EA, Zakharia Y, Hwang C, Singer EA, Yorio JT, Waterhouse D, Kowalyszyn RD, Alfie MS, Yanez Ruiz E, Buchler T, Kankaanranta K, Ferretti G, Kimura G, Nishimura K, Masumori N, Tamada S, Kato H, Kitamura H, Danielewicz I, Wojcik-Tomaszewska J, Sala Gonzalez N, Chiu KY, Atkins MB, Heath E, Rojas-Uribe GA, Gonzalez Fernandez ME, Feyerabend S, Pignata S, Numakura K, Cybulska Stopa B, Zukov R, Climent Duran MA, Maroto Rey PJ, Montesa Pino A, Chang CH, Vengalil S, Waddell TS, Cobb PW, Hauke R, Anderson DM, Sarantopoulos J, Gourdin T, Zhang T, Jayram G, Fein LE, Harris C, Beato PMM, Flores F, Estay A, Rubiano JA, Bedke J, Hauser S, Neisius A, Busch J, Anai S, Tsunemori H, Sawka D, Sikora-Kupis B, Arranz JA, Delgado I, Chen CH, Gunderson E, Tykodi S, Koletsky A, Chen K, Agrawal M, Kaen DL, Sade JP, Tatangelo MD, Parnis F, Barbosa FM, Faucher G, Iqbal N, Marceau D, Paradis JB, Hanna N, Acevedo A, Ibanez C, Villanueva L, Galaz PP, Durango IC, Manneh R, Kral Z, Holeckova P, Hakkarainen H, Ronkainen H, Abadie-Lacourtoisie S, Tartas S, Goebell PJ, Grimm MO, Hoefner T, Wirth M, Panic A, Schultze-Seemann W, Yokomizo A, Mizuno R, Uemura H, Eto M, Tsujihata M, Matsukawa Y, Murakami Y, Kim M, Hamberg P, Marczewska-Skrodzka M, Szczylik C, Humphreys AC, Jiang P, Kumar B, Lu G, Desai A, Karam JA, Keogh G, Fleming M, Zarba JJ, Leiva VE, Mendez GA, Harris SJ, Brown SJ, Antonio Junior JN, Costamilan RDC, Rocha RO, Muniz D, Brust L, Lalani AK, Graham J, Levesque M, Orlandi F, Kotasek R, Deville JL, Borchiellini D, Merseburger A, Rink M, Roos F, McDermott R, Oyama M, Yamamoto Y, Tomita Y, Miura Y, Ioritani N, Westgeest H, Kubiatowski T, Bal W, Girones Sarrio R, Rowe J, Prow DM, Senecal F, Hashemi-Sadraei N, Cole SW, Kendall SD, Richards DA, Schnadig ID, Gupta M. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022; 23:1133-1144. [PMID: 36055304 DOI: 10.1016/s1470-2045(22)00487-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The first interim analysis of the KEYNOTE-564 study showed improved disease-free survival with adjuvant pembrolizumab compared with placebo after surgery in patients with clear cell renal cell carcinoma at an increased risk of recurrence. The analysis reported here, with an additional 6 months of follow-up, was designed to assess longer-term efficacy and safety of pembrolizumab versus placebo, as well as additional secondary and exploratory endpoints. METHODS In the multicentre, randomised, double-blind, placebo-controlled, phase 3 KEYNOTE-564 trial, adults aged 18 years or older with clear cell renal cell carcinoma with an increased risk of recurrence were enrolled at 213 hospitals and cancer centres in North America, South America, Europe, Asia, and Australia. Eligible participants had an Eastern Cooperative Oncology Group performance status of 0 or 1, had undergone nephrectomy 12 weeks or less before randomisation, and had not received previous systemic therapy for advanced renal cell carcinoma. Participants were randomly assigned (1:1) via central permuted block randomisation (block size of four) to receive pembrolizumab 200 mg or placebo intravenously every 3 weeks for up to 17 cycles. Randomisation was stratified by metastatic disease status (M0 vs M1), and the M0 group was further stratified by ECOG performance status and geographical region. All participants and investigators involved in study treatment administration were masked to the treatment group assignment. The primary endpoint was disease-free survival by investigator assessment in the intention-to-treat population (all participants randomly assigned to a treatment). Safety was assessed in the safety population, comprising all participants who received at least one dose of pembrolizumab or placebo. As the primary endpoint was met at the first interim analysis, updated data are reported without p values. This study is ongoing, but no longer recruiting, and is registered with ClinicalTrials.gov, NCT03142334. FINDINGS Between June 30, 2017, and Sept 20, 2019, 994 participants were assigned to receive pembrolizumab (n=496) or placebo (n=498). Median follow-up, defined as the time from randomisation to data cutoff (June 14, 2021), was 30·1 months (IQR 25·7-36·7). Disease-free survival was better with pembrolizumab compared with placebo (HR 0·63 [95% CI 0·50-0·80]). Median disease-free survival was not reached in either group. The most common all-cause grade 3-4 adverse events were hypertension (in 14 [3%] of 496 participants) and increased alanine aminotransferase (in 11 [2%]) in the pembrolizumab group, and hypertension (in 13 [3%] of 498 participants) in the placebo group. Serious adverse events attributed to study treatment occurred in 59 (12%) participants in the pembrolizumab group and one (<1%) participant in the placebo group. No deaths were attributed to pembrolizumab. INTERPRETATION Updated results from KEYNOTE-564 support the use of adjuvant pembrolizumab monotherapy as a standard of care for participants with renal cell carcinoma with an increased risk of recurrence after nephrectomy. FUNDING Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc, Rahway, NJ, USA.
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Affiliation(s)
- Thomas Powles
- Royal Free Hospital NHS Foundation Trust, University College London, London, UK; Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK.
| | - Piotr Tomczak
- Poznań University of Medical Sciences, Poznań, Poland
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Balaji Venugopal
- Beatson West of Scotland Cancer Centre, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Stefan N Symeonides
- Cancer Research UK Edinburgh Centre, Edinburgh, UK; Edinburgh Cancer Centre, Edinburgh, UK; Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | | | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | - Piotr Sawrycki
- Wojewódzki Szpital Zespolony im L Rydygiera w Toruniu, Torun, Poland
| | | | - Lei Xu
- Merck & Co, Inc, Rahway, NJ, USA
| | | | - David I Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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24
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Yanagi M, Kiriyama T, Akatsuka J, Endo Y, Takeda H, Katsu A, Honda Y, Suzuki K, Nishikawa Y, Ikuma S, Mikami H, Toyama Y, Kimura G, Kondo Y. Differential diagnosis and prognosis of small renal masses: association with collateral vessels detected using contrast-enhanced computed tomography. BMC Cancer 2022; 22:856. [PMID: 35932010 PMCID: PMC9354334 DOI: 10.1186/s12885-022-09971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/09/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Active surveillance (AS) is one of the treatment methods for patients with small renal masses (SRMs; < 4 cm), including renal cell carcinomas (RCCs). However, some small RCCs may exhibit aggressive neoplastic behaviors and metastasize. Little is known about imaging biomarkers capable of identifying potentially aggressive small RCCs. Contrast-enhanced computed tomography (CECT) often detects collateral vessels arising from neoplastic angiogenesis in RCCs. Therefore, this study aimed to evaluate the association between SRM differential diagnoses and prognoses, and the detection of collateral vessels using CECT. Methods A total of 130 consecutive patients with pathologically confirmed non-metastatic SRMs (fat-poor angiomyolipomas [fpAMLs; n = 7] and RCCs [n = 123]) were retrospectively enrolled. Between 2011 and 2019, SRM diagnoses in these patients were confirmed after biopsy or surgical resection. All RCCs were surgically resected. Regardless of diameter, a collateral vessel (CV) was defined as any blood vessel connecting the tumor from around the kidney using CECT. First, we analyzed the role of CV-detection in differentiating between fpAML and RCC. Then, we evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RCC diagnosis based on CV-detection using CECT. We also assessed the prognostic value of CV-detection using the Fisher exact test, and Kaplan-Meier method and the log-rank test. Results The sensitivity, specificity, PPV, NPV, and accuracy of CV-detection for the diagnosis of small RCCs was 48.5, 45.5, 100, 100, and 9.5% respectively. Five of 123 (4.1%) patients with RCC experienced recurrence. CV-detection using CECT was the only significant factor associated with recurrence (p = 0.0177). Recurrence-free survival (RFS) was significantly lower in patients with CV compared with in those without CV (5-year RFS 92.4% versus 100%, respectively; p = 0.005). In addition, critical review of the CT images revealed the CVs to be continuous with the venous vessels around the kidney. Conclusions The detection of CVs using CECT is useful for differentiating between small fpAMLs and RCCs. CV-detection may also be applied as a predictive parameter for small RCCs prone to recurrence after surgical resection. Moreover, AS could be suitable for small RCCs without CVs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09971-w.
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Affiliation(s)
- Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Akifumi Katsu
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuichiro Honda
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kyota Suzuki
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yoshihiro Nishikawa
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shunsuke Ikuma
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Ikuma S, Kimura G, Mikami H, Yanagi M, Endo Y, Takeda H, Akatsuka J, Toyama Y, Kondo Y. Vesical Imaging-Reporting and Data System (VI-RADS). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
453 Background: The VI-RADS has been widely used as diagnostic criteria for MRI to predict muscle-invasive of bladder cancer (MIBC). The aim of this study is to evaluate the diagnostic performance of VI-RADS in our hospital and the clinicopathological features of true positive (TP), false positive (FP), true negative (TN), and false negative (FN) cases to identify possible factors for misdiagnosis. Methods: Of the 286 patients who underwent TURBT at our hospital from January 2019 to October 2020, we selected 129 consecutive cases who had performed preoperative enhanced mpMRI and diagnosed as urothelial carcinoma pathologically. We defined VI-RADS score ≥4 as positive for MIBC. The clinicopathological features of TP, FP, TN, and FN groups were retrospectively analyzed and compared. Chi-square test and Mann–Whitney U test were used for the test between the two groups. Results: VI-RADS score in MIBC cases were 2 cases for ≤3 and 22 for ≥4, and in non-MIBC cases 91 cases for ≤3 and 14 for ≥4. The diagnostic performance of VI-RADS for MIBC was 92% for sensitivity, 87% for specificity, 61% for positive predictive value, 98% for negative predictive value, 88% for accuracy and the area under the curve (AUC) was 0.89. There were no statistical differences of age and %male cases between TP (22 cases), FP (14), TN (91) and FN (2) groups. Pathological features of the (TP, FP, TN, FN) groups were shown (table). TP had significantly larger tumor size than the other three groups, and higher %G3, %tumor necrosis and %variant+ than FP and TN. FP group had significantly larger tumor size than the TN. Conclusions: VI-RADS showed high diagnostic performance in predicting MIBC. Our study showed that larger tumor size was a significant factor for overestimation, suggesting the need for improved accuracy in cases with large tumor size.[Table: see text]
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Affiliation(s)
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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26
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Endo Y, Kimura G, Akatsuka J, Takeda H, Yanagi M, Mikami H, Ikuma S, Toyama Y, Kondo Y. Prognostic impact of serum cytokeratin 19 fragments in patient with metastatic urothelial cancer treated with immune checkpoint inihibitors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
555 Background: Recent clinical trials such as Keynote-045, EV-201 and Javelin bladder100 have provided new therapeutic agents for metastatic urothelial carcinoma (mUC). However, the only tool that can evaluate the therapeutic responses is a radiological criteria, Response Evaluation Criteria in Solid Tumors (RECIST) in mUC. In the clinical practice, biomarkers that can predict the efficacy and prognosis of various agents are essential to treat these patients, and the search for such biomarkers is urgently needed. We reported that Performance status ≥ 1, liver metastasis and elevated serum cytokeratin 19 fragments (sCYFRA) are the prognostic factors for first-line cytotoxic cheomotherapy (CTC) for mUC. In this study we evaluated pretreated clinical biomarkers including sCYFRA that can predict overall survival (OS) in patients with mUC treated with immune-checkpoint inhibitors (ICI). Methods: Thirty four patients with mUC received pembrolizuab (PB) from February 2018 to July 2020 at our institution. We retrospectively collected performance status, metastasis site, blood neutrophil-lymphocyte ratio (NLR), hemoglobin (Hb), and serum levels of lactose dehydrogenase (LD), alkaline phosphatase (ALP), C-reacted protein (CRP), total protein, albumin, corrected calcium (Ca), carbohydrate antigen19-9, sCYFRA before PB was administered. OS rate were analyzed by Kaplan-Meier curves and log-rank test. Multivariate analysis was carried out using the Cox hazards model. Objective Response rate (ORR) was evaluated based on RECIST (version 1.1). Results: Of 34 patients (Pts), with median age of 73(31-86), during the median follow-up period of 25 (7-126) months, 21patients (65%) had died. Median OS was 9.2 months (0.2-33.4), A 1-year OS rate was 33%. ORR was 33% and 9 Pts was SD (27%) and 14 pts (40%) was progressive disease. On univariate analysis, bone metastasis (p=0.028), LD (p=0.003), ALP (p=0.001), Ca (p=0.003) and sCYFRA (p=0.001) were the significant prognostic factor for OS. On multivariate analysis, ALP (HR9.2, 95%CI [2.89-135.9], p=0.002), Ca (HR7.3, (95%CI [2.36-22.49], p=0.001), sCYFRA (HR 5.0, 95%CI [1.63-15.55], p=0.005) were the significant prognostic factor for OS. Based on these 3 factors we divided pts into three groups, good risk (G1,0 factor), intermediate risk (G2, 1 factor) and poor risk (G3, 2-3 factors)3. There was a significant difference between the three groups for OS on K-M curve (G1 vs G2, p=0.001, G2vs G3, p=0.009). Conclusions: sCYFRA, ALP and Ca were the independent prognostic factors for OS in patients with mUC treated with ICI. sCYFRA was the independent prognostic factor for OS in the 1st line CTC and 2nd line ICI and it can be a prognostic factor though those therapies.
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Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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Akatsuka J, Numata Y, Morikawa H, Sekine T, Kayama S, Mikami H, Yanagi M, Endo Y, Takeda H, Toyama Y, Yamaguchi R, Kimura G, Kondo Y, Yamamoto Y. A data-driven ultrasound approach discriminates pathological high grade prostate cancer. Sci Rep 2022; 12:860. [PMID: 35039648 PMCID: PMC8764059 DOI: 10.1038/s41598-022-04951-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
Accurate prostate cancer screening is imperative for reducing the risk of cancer death. Ultrasound imaging, although easy, tends to have low resolution and high inter-observer variability. Here, we show that our integrated machine learning approach enabled the detection of pathological high-grade cancer by the ultrasound procedure. Our study included 772 consecutive patients and 2899 prostate ultrasound images obtained at the Nippon Medical School Hospital. We applied machine learning analyses using ultrasound imaging data and clinical data to detect high-grade prostate cancer. The area under the curve (AUC) using clinical data was 0.691. On the other hand, the AUC when using clinical data and ultrasound imaging data was 0.835 (p = 0.007). Our data-driven ultrasound approach offers an efficient tool to triage patients with high-grade prostate cancers and expands the possibility of ultrasound imaging for the prostate cancer detection pathway.
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Affiliation(s)
- Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan
| | - Yasushi Numata
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan
| | - Hiromu Morikawa
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Shigenori Kayama
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Yuka Toyama
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Ruri Yamaguchi
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, 113-8603, Japan
| | - Yoichiro Yamamoto
- Pathology Informatics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, 103-0027, Japan.
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28
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Nakajima N, Miyajima A, Shinohara N, Obara W, Kondo T, Kimura G, Kume H, Fujimoto H, Sugiyama T, Nonomura N, Hongo F, Fukumori T, Takahashi M, Kanayama HO, Eto M. Risk factors for recurrence after operation in patients with pT1a renal cell carcinoma: sub-analysis of the multi-institutional national database of the Japanese Urological Association. Jpn J Clin Oncol 2022; 52:274-280. [PMID: 34994772 DOI: 10.1093/jjco/hyab201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND More patients with renal cell carcinoma are now diagnosed with the disease in its early stages. Although patients with pT1a renal cell carcinoma have a good prognosis and low recurrence rate, a few patients still experience recurrence. Herein, we evaluated the clinicopathological risk factors for postoperative recurrence of pT1aN0M0 renal cell carcinoma. METHODS An renal cell carcinoma survey was conducted by the Japanese Urological Association to register newly diagnosed cases of renal cell carcinoma. A total of 1418 patients diagnosed with pT1aN0M0 renal cell carcinoma who underwent surgery as the primary surgical treatment were included. We analyzed the recurrence-free survival using the Kaplan-Meier method and clinicopathological factors for recurrence using Cox proportional hazards models. RESULTS Among 1418 patients, 58 (4.1%) had recurrences after a median follow-up of 62.8 months. The median time to recurrence was 31.0 months. Metastases to the lungs and the bone were observed in 20 and 10 cases, respectively. Significant differences in sex, tumor size, Eastern Cooperative Oncology Group performance status, and dialysis history, preoperative hemoglobin levels, C-reactive protein levels and creatinine levels were observed between the recurrence and non-recurrence groups. Multivariate analysis identified male sex, high C-reactive protein level and tumor size ≥3 cm as independent risk factors. The 5-year recurrence-free survival of patients with 0, 1, 2 and 3 risk factors was 99.0, 97.2, 93.1 and 80.7%, respectively. CONCLUSIONS Male sex, tumor diameter and a high C-reactive protein level were independent recurrence risk factors for pT1a renal cell carcinoma; special attention should be paid to patients with these risk factors during postoperative follow-up.
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Affiliation(s)
- Nobuyuki Nakajima
- Tokai University, School of Medicine, Department of Urology, Kanagawa, Japan
| | - Akira Miyajima
- Tokai University, School of Medicine, Department of Urology, Kanagawa, Japan
| | - Nobuo Shinohara
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Hokkaido University, Graduate School of Medicine, Department of Renal and Genitourinary Surgery, Hokkaido, Japan
| | - Wataru Obara
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Iwate Medical University, School of Medicine, Department of Urology, Iwate, Japan
| | - Tsunenori Kondo
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Tokyo Women's Medical University Medical Center East, Department of Urology, Tokyo, Japan
| | - Go Kimura
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Nippon Medical School of Medicine, Department of Urology, Tokyo, Japan
| | - Haruki Kume
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,The University of Tokyo, Graduate School of Medicine, Department of Urology, Tokyo, Japan
| | - Hiroyuki Fujimoto
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,National Cancer Center Hospital, Urology Division, Tokyo, Japan
| | - Takayuki Sugiyama
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Hamamatsu University, School of Medicine Faculty of Medicine, Department of Urology, Shizuoka, Japan
| | - Norio Nonomura
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Osaka University, Graduate School of Medicine, Department of Urology, Osaka, Japan
| | - Fumiya Hongo
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Kyoto Prefectural University of Medicine, Department of Urology, Kyoto, Japan
| | - Tomoharu Fukumori
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Tokushima Municipal Hospital, Department of Urology, Tokushima, Japan
| | - Masayuki Takahashi
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Tokushima University, Graduate School of Biomedical Sciences, Department of Urology, Tokushima, Japan
| | - Hiro-Omi Kanayama
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Tokushima University, Graduate School of Biomedical Sciences, Department of Urology, Tokushima, Japan
| | - Masatoshi Eto
- The Cancer Registration Committee of the Japanese Urological Association, Tokyo, Japan.,Kyushu University, Graduate School of Medical Sciences, Department of Urology, Fukuoka, Japan
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Tamada S, Kondoh C, Matsubara N, Mizuno R, Kimura G, Anai S, Tomita Y, Oyama M, Masumori N, Kojima T, Matsumoto H, Chen M, Li M, Matsuda K, Tanaka Y, Rini BI, Uemura H. Pembrolizumab plus axitinib versus sunitinib in metastatic renal cell carcinoma: outcomes of Japanese patients enrolled in the randomized, phase III, open-label KEYNOTE-426 study. Int J Clin Oncol 2022; 27:154-164. [PMID: 34800178 PMCID: PMC8732816 DOI: 10.1007/s10147-021-02014-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the phase III open-label KEYNOTE-426 (NCT02853331) study, first-line pembrolizumab and axitinib improved overall survival (OS) and progression-free survival (PFS) versus sunitinib for metastatic renal cell carcinoma (mRCC). KEYNOTE-426 evaluated patients enrolled from 25 sites in Japan. METHODS Patients enrolled in Japan were included in this post hoc subgroup analysis. Adults with clear cell mRCC were randomly assigned 1:1 to receive intravenous pembrolizumab 200 mg every 3 weeks plus oral axitinib 5 mg twice daily or oral sunitinib 50 mg once daily (4 weeks on/2 weeks off). Dual primary endpoints were OS and PFS as assessed by blinded independent central review. Objective response rate (ORR) and safety were secondary endpoints. RESULTS The Japanese subgroup comprised 94 patients (pembrolizumab-axitinib, n = 44; sunitinib, n = 50; 11% of the intent-to-treat population). Median time from randomization to data cutoff (January 6, 2020) was 29.5 months (range 24.6-37.3). Consistent with the intent-to-treat population, the OS, PFS, and ORR suggested improvement with pembrolizumab-axitinib versus sunitinib in the Japanese subgroup. Grade ≥ 3 treatment-related adverse events (TRAEs) occurred in 70% of patients receiving pembrolizumab-axitinib versus 78% receiving sunitinib; 11 (25%) patients receiving pembrolizumab-axitinib and 13 (27%) patients receiving sunitinib discontinued the study medication due to AEs. TRAEs led to the discontinuation of pembrolizumab, axitinib, pembrolizumab-axitinib, or sunitinib in 32%, 34%, 14%, and 20%, respectively. No deaths from TRAEs occurred. CONCLUSIONS Efficacy outcomes for the Japanese subgroup were consistent with those of the global population. Safety in Japanese patients was consistent with the results from the global population.
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Affiliation(s)
- Satoshi Tamada
- Bell Land General Hospital, Higashiyama 500-3, Naka-ku, Sakai, Osaka, 599-8247, Japan.
| | - Chihiro Kondoh
- Toranomon Hospital, 2 Chome-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Nobuaki Matsubara
- National Cancer Center Hospital East, 6 Chome Kashiwanoha, Kashiwa, Chiba, 277-0882, Japan
| | - Ryuichi Mizuno
- Keio University Hospital, Shinanomachi, Shinjuku City, Tokyo, 〒160-8582, Japan
| | - Go Kimura
- Nippon Medical School Hospital, 1-1-5 Sendagi Bunkyo, Tokyo, 113-8603, Japan
| | - Satoshi Anai
- Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yoshihiko Tomita
- Niigata University Medical & Dental Hospital, 1-757 Asahimachi, Chuou-ku, Niigata, 951-8510, Japan
| | - Masafumi Oyama
- Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Naoya Masumori
- Sapporo Medical University, S1, W16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takahiro Kojima
- University of Tsukuba, 1 Chome-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
- Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Hiroaki Matsumoto
- Yamaguchi University, 1-1-1, Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Mei Chen
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Mengran Li
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Kenji Matsuda
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Yoshinobu Tanaka
- MSD K.K., Kitanomaru Square, 1 Chome-13-12 Kudankita, Chiyoda City, Tokyo, 102-0073, Japan
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, CA Building, 10201 Carnegie Ave, Cleveland, OH, 44106, USA
- Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - Hirotsugu Uemura
- Kindai University, 3 Chome-4-1 Kowakae, Higashiosaka, Osaka, 577-8502, Japan
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Yanagi M, Kimura G, Yuichiro H, Katsu A, Ryota F, Nishikawa Y, Ikuma S, Hikaru M, Endo Y, Akatsuka J, Takeda H, Toyama Y, Kondo Y. How can we reduce the rate of incomplete resection in patients with non-muscle-invasive bladder cancer (NMIBC) undergoing first transurethral resection of bladder tumor (TURBT)? Impact of two-loop wide resection of surrounding tumor tissue. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03203-1] [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: 12/01/2022] Open
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31
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Tomita Y, Kimura G, Fukasawa S, Numakura K, Sugiyama Y, Yamana K, Naito S, Kaneko H, Tajima Y, Oya M. Erratum to: Subgroup analysis of the AFTER I-O study: a retrospective study on the efficacy and safety of subsequent molecular targeted therapy after immune-oncology therapy in Japanese patients with metastatic renal cell carcinoma. Jpn J Clin Oncol 2021; 51:1770. [PMID: 34585728 PMCID: PMC8643447 DOI: 10.1093/jjco/hyab161] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/05/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazutoshi Yamana
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | | | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Matsubara N, Uemura H, Nagamori S, Suzuki H, Uemura H, Kimura G. A Phase II, Randomized, Open-Label, Multi-arm Study of TAS-115 for Castration-Resistant Prostate Cancer Patients With Bone Metastases. Clin Genitourin Cancer 2021; 19:491-500. [PMID: 34493431 DOI: 10.1016/j.clgc.2021.07.013] [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: 03/14/2021] [Revised: 07/05/2021] [Accepted: 07/25/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION TAS-115 is an oral multikinase inhibitor targeting the MET proto-oncogene, vascular endothelial growth factor receptor, and colony-stimulating factor 1 receptor. We evaluated the efficacy and safety of TAS-115 in castration-resistant prostate cancer (CRPC) patients with bone metastases. PATIENTS AND METHODS This phase II study, conducted in Japan, comprised 2 cohorts of CRPC patients. Cohort A included patients with bone metastasis and no history of docetaxel; TAS-115 200 to 400 mg/d was administered with abiraterone and prednisone. Cohort B included patients with symptomatic multiple bone metastases, post- or unfit for docetaxel, randomized 1:1 to receive TAS-115 400 or 600 mg/d orally, once daily, in a repeated weekly schedule of 5 days on/2 days off. The primary endpoint was bone scan index (BSI) response rate at Week 12 in each dose group. RESULTS Cohorts A and B included 24 and 26 patients, respectively. The 12-week BSI response rates for 200, 300, and 400 mg were 0%, 33.3%, and 16.7% in Cohort A, and for 400 and 600 mg were 7.1% and 25.0% in Cohort B. The best BSI response rates for 200, 300, and 400 mg were 0%, 66.7%, and 16.7% in Cohort A, and for 400 and 600 mg were 7.1% and 33.3% in Cohort B. A ≥ 30% reduction in BPI-SF score was shown in 57.7% of patients in Cohort B. The most frequent Grade ≥ 3 adverse drug reactions were hypophosphatemia (20.8%) in Cohort A and anemia (23.1%) in Cohort B. CONCLUSION TAS-115 appears to demonstrate anti-tumor activity and acceptable tolerability in CRPC patients with bone metastases.
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Affiliation(s)
- Nobuaki Matsubara
- Division of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Satoshi Nagamori
- Department of Urology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Sakura City, Chiba, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Bellmunt J, Powles T, van der Heijden M, Galsky M, He P, Wang Z, Xiao F, Jones F, Scott M, Walker J, Angra N, Gupta A, Drakaki A, Kimura G, Mizokami A, Wildsmith S. 708P PD-L1 as a predictor of survival in patients with metastatic urothelial carcinoma (mUC) from the phase III DANUBE trial of durvalumab (D) or durvalumab plus tremelimumab (D+T) versus standard of care chemotherapy (SoC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.104] [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: 12/01/2022] Open
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Tomita Y, Kimura G, Fukasawa S, Numakura K, Sugiyama Y, Yamana K, Naito S, Kaneko H, Tajima Y, Oya M. Subgroup analysis of the AFTER I-O study: a retrospective study on the efficacy and safety of subsequent molecular targeted therapy after immune-oncology therapy in Japanese patients with metastatic renal cell carcinoma. Jpn J Clin Oncol 2021; 51:1656-1664. [PMID: 34350454 PMCID: PMC8558912 DOI: 10.1093/jjco/hyab114] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background We performed subgroup analyses of the AFTER I-O study to clarify the association of time-to-treatment failure (TTF) and discontinuation reason of prior immune-oncology (I-O) therapy, and molecular targeted therapy (TT) regimen with the outcomes of TT after I-O. Methods The data of Japanese metastatic renal cell carcinoma patients treated with TT after nivolumab (NIVO) (CheckMate 025) or NIVO + ipilimumab (IPI) (CheckMate 214) were retrospectively analyzed. The objective response rates (ORRs), progression-free survival (PFS) and overall survival (OS) of TT after I-O were analyzed by subgroups: TTF (<6 or ≥6 months) and discontinuation reason of prior I-O (progression or adverse events), and TT regimen (sunitinib or axitinib). We also analyzed PFS2 of prior I-O and OS from first-line therapy. Results The ORR and median PFS of TT after NIVO and NIVO+IPI among the subgroups was 17–36% and 20–44%, and 7.1–11.6 months and 16.3-not reached (NR), respectively. The median OS of TT after NIVO was longer in patients with longer TTF of NIVO and treated with axitinib. Conversely, median OS of TT after NIVO+IPI was similar among subgroups. The median PFS2 of NIVO and NIVO+IPI was 36.7 and 32.0 months, respectively. The median OS from first-line therapy was 70.5 months for patients treated with NIVO and NR with NIVO+IPI. The safety profile of each TT after each I-O was similar to previous reports. Conclusions The efficacy of TT after NIVO or NIVO+IPI was favorable regardless of the TTF and discontinuation reason of prior I-O, and TT regimen.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazutoshi Yamana
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | | | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Tomita Y, Kimura G, Fukasawa S, Numakura K, Sugiyama Y, Yamana K, Naito S, Kabu K, Tajima Y, Oya M. Efficacy and safety of subsequent molecular targeted therapy after immuno-checkpoint therapy, retrospective study of Japanese patients with metastatic renal cell carcinoma (AFTER I-O study). Jpn J Clin Oncol 2021; 51:966-975. [PMID: 33594427 PMCID: PMC8163064 DOI: 10.1093/jjco/hyaa266] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Guidelines for treatment of mRCC recommend nivolumab monotherapy (NIVO) for treated patients, and nivolumab plus ipilimumab combination therapy (NIVO+IPI) for untreated IMDC intermediate and poor-risk mRCC patients. Although molecular-targeted therapies (TTs) such as VEGFR-TKIs and mTORi are recommended as subsequent therapy after NIVO or NIVO+IPI, their efficacy and safety remain unclear. Methods Outcome of Japanese patients with mRCC who received TT after NIVO (CheckMate 025) or NIVO+IPI (CheckMate 214) were retrospectively analyzed. Primary endpoints were investigator-assessed ORR of the first TT after either NIVO or NIVO+IPI. Secondary endpoints included TFS, PFS, OS and safety of TTs. Results Twenty six patients in CheckMate 025 and 19 patients in CheckMate 214 from 20 centers in Japan were analyzed. As the first subsequent TT after NIVO or NIVO+IPI, axitinib was the most frequently treated regimen for both CheckMate 025 (54%) and CheckMate 214 (47%) patients. The ORRs of TT after NIVO and NIVO+IPI were 27 and 32% (all risks), and median PFSs were 8.9 and 16.3 months, respectively. During the treatment of first TT after either NIVO or NIVO+IPI, 98% of patients experienced treatment-related adverse events, including grade 3–4 events in 51% of patients, and no treatment-related deaths occurred. Conclusions TTs have favorable antitumor activity in patients with mRCC after ICI, possibly via changing the mechanism of action. Safety signals of TTs after ICI were similar to previous reports. These results indicate that sequential TTs after ICI may contribute for long survival benefit.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | - Kazuyuki Numakura
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Yutaka Sugiyama
- Department of Urology, Graduate School of Medical Sciences, Kumamoto, Japan
| | - Kazutoshi Yamana
- Department of Urology, Molecular Oncology, Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Koki Kabu
- Bristol-Myers Squibb, Shinjuku-ku, Tokyo, Japan
| | | | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Yanagi M, Kimura G, Sekine T, Takeda H, Akatsuka J, Endo Y, Hayashi T, Hamasaki T, Kondo Y. Factors Associated with Prolonged Retroperitoneal Laparoscopic Radical Nephrectomy Performed by Non-expert Surgeons. J NIPPON MED SCH 2021; 88:109-112. [PMID: 32475903 DOI: 10.1272/jnms.jnms.2021_88-302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND High body mass index (BMI) and visceral obesity were reported to be associated with prolonged transperitoneal laparoscopic radical nephrectomy (LRN); however, factors that prolong retroperitoneal LRN remain unknown. We therefore investigated factors associated with prolonged retroperitoneal LRN performed by non-expert surgeons. METHODS We defined non-experts surgeons as surgeons not certified to perform laparoscopic surgery by the Japanese Society of Endourology. We retrospectively reviewed the medical records of 59 consecutive patients with renal cell carcinoma treated with retroperitoneal LRN performed by non-experts at our hospital between 2014 and 2019. Associations of surgical duration with age, sex, BMI, visceral fat area (VFA), subcutaneous fat area (SFA), laterality and location of the tumor, length of the major tumor axis (tumor length), clinical T stage, ipsilateral adrenalectomy and specimen weight were analyzed using Spearman rank correlation coefficients. RESULTS Surgical duration positively correlated with ipsilateral adrenalectomy (rs = 0.3162, p = 0.0147) and specimen weight (rs = 0.3103, p = 0.0168) but not with BMI (rs = 0.2016, p = 0.1257) or VFA (rs = 0.0185, p = 0.8894). CONCLUSIONS Ipsilateral adrenalectomy and specimen weight were associated with prolonged retroperitoneal LRN, when performed by non-expert surgeons.
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Affiliation(s)
- Masato Yanagi
- Department of Urology, Nippon Medical School Hospital
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital
| | | | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital
| | | | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Musashi Kosugi Hospital
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Iguchi T, Kimura G, Fukasawa S, Suzuki H, Uemura H, Nishimura K, Matsumoto H, Yokomizo A, Armstrong AJ, Rosbrook B, Sugg J, Baron B, Chen L, Kunieda F, Stenzl A. Enzalutamide with androgen deprivation therapy in Japanese men with metastatic hormone-sensitive prostate cancer: A subgroup analysis of the phase III ARCHES study. Int J Urol 2021; 28:765-773. [PMID: 33955599 PMCID: PMC8360194 DOI: 10.1111/iju.14568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/10/2021] [Indexed: 12/01/2022]
Abstract
Objective To evaluate the efficacy and safety of enzalutamide plus androgen deprivation therapy in Japanese men with metastatic hormone‐sensitive prostate cancer. Methods A post‐hoc analysis of the Japanese subgroup in the phase III, randomized, multinational ARCHES study (NCT02677896) was carried out. Patients with metastatic hormone‐sensitive prostate cancer were randomized to receive enzalutamide or a placebo, plus androgen deprivation therapy, stratified by disease volume and prior docetaxel therapy. The primary end‐point was radiographic progression‐free survival. Secondary end‐points included time to prostate‐specific antigen progression and overall survival. Results Of 1150 patients, 92 Japanese patients were randomized to enzalutamide (n = 36) or a placebo (n = 56), plus androgen deprivation therapy; none received prior docetaxel. Enzalutamide plus androgen deprivation therapy reduced the risk of radiographic progression or death in Japanese patients by 61% versus the placebo, similar to the overall population. Similar results were observed with secondary end‐points, showing clinical benefit of enzalutamide plus androgen deprivation therapy in Japanese patients. Overall survival data were immature. Grade 3–4 adverse events were reported in 47% and 25% of the enzalutamide and placebo groups, respectively. Nasopharyngitis, hypertension and abnormal hepatic function were reported more frequently in Japanese patients versus the overall population. Conclusions Enzalutamide plus androgen deprivation therapy has clinical benefit with a tolerable safety profile in Japanese men with metastatic hormone‐sensitive prostate cancer, consistent with the overall population.
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Affiliation(s)
- Taro Iguchi
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | - Hiroji Uemura
- Yokohama City University Medical Center, Yokohama, Japan
| | | | - Hiroaki Matsumoto
- Graduate School of Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | | | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina, USA
| | | | | | | | - Lucy Chen
- Astellas Pharma Inc., Northbrook, Illinois, USA
| | | | - Arnulf Stenzl
- Eberhard Karls University of Tübingen, Tübingen, Germany
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Akatsuka J, Suzuki Y, Endo Y, Yanagi M, Matsuzawa I, Hamasaki T, Kimura G, Kondo Y. Nephrostomy catheter entering the right renal vein during an exchange procedure: A case report and literature review. IJU Case Rep 2021; 4:168-171. [PMID: 33977251 PMCID: PMC8088896 DOI: 10.1002/iju5.12276] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION We encountered an extremely rare case of a nephrostomy catheter entering the right renal vein during an exchange procedure. CASE PRESENTATION An 80-year-old man underwent radical cystectomy. Urinary diversion was achieved through right percutaneous nephrostomy. After the 15th nephrostomy catheter exchange, the patient bled heavily from the catheter. We clamped the catheter immediately, and the patient became hemodynamically stable. Emergency angiography showed the nephrostomy catheter entering the renal vein from outside the renal pelvis. Under fluoroscopy, we pulled the catheter until its tip was located in the previous penetration site of the renal pelvic wall and inserted the catheter over the guidewire into the renal pelvis. CONCLUSIONS Herein, we report an extremely rare case of a nephrostomy catheter inserted into the right renal vein during an exchange procedure. Inserting a nephrostomy catheter in the appropriate position and performing exchange under imaging guidance techniques could help clinicians avoid severe complications.
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Affiliation(s)
- Jun Akatsuka
- Department of UrologyNippon Medical SchoolTokyoJapan
| | | | - Yuki Endo
- Department of UrologyNippon Medical SchoolTokyoJapan
| | - Masato Yanagi
- Department of UrologyNippon Medical SchoolTokyoJapan
| | | | | | - Go Kimura
- Department of UrologyNippon Medical SchoolTokyoJapan
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Akatsuka J, Kimura G, Toyama Y, Hasegawa H, Mikami H, Endo Y, Takeda H, Hayashi T, Kondo Y. Clinical significance of the sonazoid-enhanced ultrasound for prostate cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
212 Background: This was a prospective study to evaluate the diagnostic accuracy of the Sonazoid-enhanced ultrasound (SEU) for prostate cancer. The primary end-point was accuracy of SEU to detect prostate cancer. The exploratory end-point was to analyze the prognostic significance of SEU positibity after radical prostatectomy (RP) in patients diagnosed as prostate cancer. Methods: In all cases locations of suspected prostate cancer were examined with SEU, digital rectal examination (DRE), B-mode (B), and power-doppler ultrasound (PDU) before prostate biopsy. We compared the sensitivity, specificity, PPV, NPV, and accuracy of SEU, RE, B, and PD. Among prostate cancer cases, effect of SEU positivity on biochemical recurrence (BCR) after radical prostatectomy was compared with that of DRE, B, and PDU. Results: Of 687 cases 416 cases (60.6%) were prostate cancer. The sensitivity, specificity, PPV, NPV, and accuracy were 52.9%, 63.5%, 69.0%, 46.7%, and 57.1% by DRE, 69.2%, 43.9%, 65.5%, 48.2%, and 59.2% by B, 66.6%, 59.0%, 71.4%, 53.5%, and 63.6% by PDU, and 66.1%, 70.1%, 77.2%, 57.4%, and 67.7% by SEU, respectively. SEU was the highest in specificity, PPV, NPV, and accuracy rate. Eighty three patients underwent radical prostatectomy. The SEU + group (69.3%) had a significantly poor prognosis compared to the SEU− group (88.7%) on the five-year BCR-free survival rate (p < 0.05). Univariate analysis showed SEU+ (HR 3.5; p = 0.02), DRE+ (HR 2.7; p = 0.04), PDU+ (HR2.6; p = 0.09), and B+ (HR 2.0; p = 0.21). SEU was the highest prognostic factor on BCR after radical prostatectomy. Conclusions: Sonazoid was able to visualize even small blood vessels in the prostate. SEU showed the highest accuracy for cancer detection and was the highest prognostic factor on BCR in the univariate analysis. To obtain the maximum benefit of Sonazoid, further examinations are needed.
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Affiliation(s)
- Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | - Hiroya Hasegawa
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Tatsuro Hayashi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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Endo Y, Kimura G, Akatsuka J, Yanagi M, Mikami H, Takeda H, Hasegawa H, Toyama Y, Ikuma S, Nishikawa Y, Takasaki S, Hayashi T, Kondo Y. Prognostic impact of serum cytokeratin 19 fragments in patient with metastatic urothelial cancer (mUC) treated with first-line chemotherapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
473 Background: Even today, when several immune checkpoint Inhibitors have been approved for the treatment of metastatic urothelial cancer (mUC), cytotoxic chemotherapy (CTC) still remains the mainstay for first-line treatment. We believe that the prognostic factors for the first-line CTC have become more important again and need to be re-analyzed. Current guidelines do not yet provide recommendations for any serum tumor markers in patients with mUC. Previous studies have shown that serum cytokeratin 19 fragments levels (sCK) were correlated with depth of tumor invasion and metastatic burden in patients with bladder cancer. In this study we evaluated whether sCK, and other clinical parameters could predict overall survival (OS) in patients with mUC treated with CTC. Methods: Two hundreds fifty two patients with mUC received CTC from December 2006 to 2016 at our institution. sCK had been measured in 128 patients at diagnosis of mUC. OS rate were analyzed by Kaplan–Meier curves and log–rank test. Multivariate analysis was carried out using the Cox hazards model. Tumor burden (TB) was measured based on Response Evaluation Criteria In Solid Tumor (version 1.1). Results: Of 128 patients, with median age of 72 (44-93), 36 (28%) had lung metastasis, 11 (9%) had bone metastasis, 10 (8%) had liver metastasis (LM). Ninety five (74%) patients received platinum based chemotherapy as a first-line treatment. During the median follow-up period of 19 (1-89) months, 72 patients (70%) had died. A 1-year (1y) OS was 51% and a 2y-OS was 36%. On univariate analysis, performance status (PS) (HR2.0, p<0.005), sCK (HR3.9, p<0.001), CRP (HR4.0, p<0.001), neutrophil-lymphocyte ratio (HR1.9, p<0.049), LM (HR2.0, p=0.042) and TB (HR2.4, p<0.001) were the significant prognostic factors for OS. On multivariate analysis, PS (HR2.0, 95%CI (1.05-3.85) p=0.036 ), sCK (HR3.1, 95%CI (1.3-8.3), p=0.011), and LM (HR3.0, 95%CI (1.06-6.98), p=0.022) were the independent prognostic factors for OS. Based on these 3 factors we divided patients into three groups, good risk (G, 0 factor), intermediate risk (I, 1 factor) and poor risk (P, 2-3 factors). There was a significant difference between the three groups. (G vs I: p<0.001, I vs P: p=0.001). Conclusions: PS, sCK, and LM were the independent prognostic factors for OS in patients with mUC receiving CTC. For the patients in good or intermediate risk with this score, early exposure of ICIs should be performed after CTCs. Treatment strategy should be changed in patients with poor risk since CTC is primary refractory in such population.
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Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Masato Yanagi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hikaru Mikami
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroya Hasegawa
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | | | - Tatsuro Hayashi
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
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Nomura S, Toyama Y, Akatsuka J, Endo Y, Kimata R, Suzuki Y, Hamasaki T, Kimura G, Kondo Y. Prostatic abscess with infected aneurysms and spondylodiscitis after transrectal ultrasound-guided prostate biopsy: a case report and literature review. BMC Urol 2021; 21:11. [PMID: 33478455 PMCID: PMC7818722 DOI: 10.1186/s12894-021-00780-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Transrectal ultrasonography (TRUS)-guided prostate biopsy is the conventional method of diagnosing prostate cancer. TRUS-guided prostate biopsy can occasionally be associated with severe complications. Here, we report the first case of a prostate abscess with aneurysms and spondylodiscitis as a complication of TRUS-guided prostate biopsy, and we review the relevant literature. Case presentation A 78-year-old man presented with back pain, sepsis, and prostate abscesses. Twenty days after TRUS-guided prostate biopsy, he was found to have a 20-mm diameter abdominal aortic aneurysm that expanded to 28.2 mm in the space of a week, despite antibiotic therapy. Therefore, he underwent transurethral resection of the prostate to control prostatic abscesses. Although his aneurysm decreased to 23 mm in size after surgery, he continued to experience back pain. He was diagnosed as having pyogenic spondylitis and this was managed using a lumbar corset. Sixty-four days after the prostate biopsy, the aneurysm had re-expanded to 30 mm; therefore, we performed endovascular aneurysm repair (EVAR) using a microcore stent graft 82 days after the biopsy. Four days after the EVAR, the patient developed acute cholecystitis, and he underwent endoscopic retrograde biliary drainage. One hundred and sixty days after the prostate biopsy, all the complications had improved, and he was discharged. A literature review identified a further six cases of spondylodiscitis that had occurred after transrectal ultrasound-guided prostate biopsy. Conclusions We have reported the first case of a complication of TRUS-guided prostate biopsy that involved prostatic abscesses, aneurysms, and spondylodiscitis. Although such complications are uncommon, clinicians should be aware of the potential for such severe complications of this procedure to develop.
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Affiliation(s)
- Shunichiro Nomura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yuka Toyama
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryoji Kimata
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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42
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Kimura G, Akatsuka J, Obayashi K, Tsutsumi K, Yanagi M, Endo Y, Takeda H, Hayashi T, Toyama Y, Suzuki Y, Hamasaki T, Yamamoto Y, Kondo Y. Outcomes of starting low-dose pazopanib in patients with metastatic renal cell carcinoma who do not meet eligibility criteria for clinical trials. Urol Sci 2021. [DOI: 10.4103/uros.uros_145_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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43
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Ito K, Mikami S, Kuroda N, Nagashima Y, Tatsugami K, Masumori N, Kondo T, Takagi T, Nakanishi S, Eto M, Kamba T, Tomita Y, Matsuyama H, Tsushima T, Nakazawa H, Oya M, Kimura G, Shinohara N, Asano T. Difficulty in differential diagnosis for renal cancer with microscopic papillary architecture: overlapped pathological features among papillary renal cell carcinoma (RCC), mutinous tubular and spindle cell carcinoma, and unclassified RCC. Lessons from a Japanese multicenter study. Jpn J Clin Oncol 2020; 50:1313-1320. [PMID: 33089867 DOI: 10.1093/jjco/hyaa114] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES In our multicenter study evaluating metastatic papillary renal cell carcinoma (PRCC), 29% of tumors diagnosed as PRCC in collaborative institutes were finally diagnosed as other RCCs under central review. In those tumors, mucinous tubular and spindle cell carcinoma (MTSCC) was the leading histology, followed by unclassified RCC (ucRCC). We focused on those patients with MTSCC or ucRCC. METHODS We reviewed the processes for the pathological diagnoses of nine tumors and reviewed their clinical features. RESULTS All of the MTSCCs and ucRCCs were positive for AMACR, which is frequently positive in PRCC. Mucin was demonstrated in 80% of the MTSCCs, and its presence is important for their diagnoses. One MTSCC was diagnosed as a mucin-poor variant. The presence of spindle cells with low-grade nuclei was suggestive of MTSCC, but the diagnosis of high-grade MTSCC was difficult. Four tumors were diagnosed as ucRCC by histological and immunohistochemical findings. Three of the four tumors were suspicious of ucRCC in the initial review due to atypical findings as PRCC. Sunitinib and interferon-α were effective for one MTSCC patient who survived for >5 years. Two MTSCC patients who were Memorial Sloan-Kettering Cancer Center poor risk had unfavorable prognoses. One patient with mucin-poor MTSCC had an indolent clinical course. Two of four ucRCC patients showed durable stable disease with targeted agents (TAs) and survived >3 years. CONCLUSION Some MTSCC metastases progressed very slowly and poor-risk tumors progressed rapidly. Systemic therapies including TAs showed some efficacies. Some patients who have metastatic ucRCC with microscopic papillary architecture can benefit from TAs.
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Affiliation(s)
- Keiichi Ito
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shotaro Nakanishi
- Department of Urology, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomomi Kamba
- Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiko Tomita
- Division of Urology, Dept. of Regenerative and Transplant Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | | | - Hayakazu Nakazawa
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomohiko Asano
- Department of Urology, National Defense Medical College, Saitama, Japan
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Kondoh C, Bae W, Tamada S, Matsubara N, Lee H, Mizuno R, Ani S, Kimura G, Tomita Y, Chang CH, Chang JC, Lin J, Perini R, Molife L, Powles T, Rini B, Chung HJ. 200O Pembrolizumab plus axitinib (pembro + axi) vs sunitinib in metastatic renal cell carcinoma (mRCC) outcomes of the KEYNOTE-426 study in patients from eastern Asia. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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45
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Tsuzuki T, Ohe C, Osawa T, Yasuda Y, Tanaka T, Anai S, Yamana K, Hatakeyama S, Yoshimoto T, Nakagawa Y, Fukuyama T, Matsubara N, Kimura G, Uemura H. 725P Prognostic values of PD-L1 expression and CD8 infiltration phenotype in metastatic and recurrent renal cell carcinoma: An exploratory analysis of the ARCHERY study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.797] [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: 11/16/2022] Open
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46
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Nozawa M, Tamada S, Ohba K, Mizuno R, Takamoto A, Ohe C, Yoshimoto T, Nakagawa Y, Fukuyama T, Matsubara N, Kimura G, Tomita Y, Nonomura N, Eto M. 729P Prognostic value of PD-L1 status in the primary lesion as a risk factor for developing metastatic disease in localized renal cell carcinoma: A subgroup analysis of the ARCHERY study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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47
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Takeda H, Kimura G, Nozaki S, Shibasaki M, Hasegawa H, Nodotsuka N, Amakawa R, Minaguchi S, Mikami H, Yanagi M, Akatsuka J, Endo Y, Hayashi T, Kondo Y. Early therapeutic intervention improves radiation induced hemorrhagic cystitis and proctitis when treated with hyperbaric oxygen therapy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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48
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Nomura S, Suzuki Y, Akatsuka J, Endo Y, Shimizu A, Hamasaki T, Kimura G, Kondo Y. Expression of epithelial-Mesenchymal transition related markers in Plasmacytoid Urothelial carcinoma of the urinary bladder. BMC Urol 2020; 20:72. [PMID: 32571273 PMCID: PMC7309983 DOI: 10.1186/s12894-020-00641-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background Plasmacytoid urothelial carcinoma (PUC) of the urinary bladder is a variant of urothelial carcinoma that carries a poor prognosis. The epithelial-mesenchymal transition (EMT) has been demonstrated to contribute to tumor progression. As the cause of the increased aggressiveness of PUC is unknown, we investigated PUC and EMT-related marker expression. Methods A total of 633 bladder carcinoma cases diagnosed from 2006 to 2015 at the Nippon Medical School Hospital were analyzed. Twelve patients were found to have plasmacytoid histology and diagnosed with PUC. Slides were evaluated for percentage of plasmacytoid variant, and stained for E-cadherin, N-cadherin, Vimentin, Fibronectin and Snail expression. Results The incidence of PUC was 1.9% (12/633). The median patient age at diagnosis was 71 years (range, 60–80 years) and the male-female ratio was 11:1. All but three patients had stage T2b or higher. The median overall survival was 10 months. In 10/12 cases, Snail and N-cadherin were positive. Vimentin was positive in 9/12 cases. Fibronectin was positive in 8/12 cases. While E-cadherin was negative in 10/12 cases. Nine cases showed > 10% plasmacytoid component. Eight of the nine patients (88.9%) with > 10% plasmacytoid component died. Conclusions The results indicate that PUC may induce EMT and may be associated with high invasion.
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Affiliation(s)
- Shunichiro Nomura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yasutomo Suzuki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Akira Shimizu
- Analytic Human Pathology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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49
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Tomita Y, Kondo T, Kimura G, Inoue T, Wakumoto Y, Yao M, Sugiyama T, Oya M, Fujii Y, Obara W, Motzer RJ, Uemura H. Nivolumab plus ipilimumab versus sunitinib in previously untreated advanced renal-cell carcinoma: analysis of Japanese patients in CheckMate 214 with extended follow-up. Jpn J Clin Oncol 2020; 50:12-19. [PMID: 31633185 PMCID: PMC6978670 DOI: 10.1093/jjco/hyz132] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/04/2022] Open
Abstract
Background Nivolumab plus ipilimumab (NIVO+IPI) demonstrated superior efficacy over sunitinib (SUN) for previously untreated advanced renal cell carcinoma (aRCC) in CheckMate 214, with a manageable safety profile. We report efficacy and safety with extended follow-up amongst Japanese patients. Methods CheckMate 214 patients received NIVO (3 mg/kg) plus IPI (1 mg/kg) every 3 weeks for four doses, then NIVO (3 mg/kg) every 2 weeks; or SUN (50 mg) once daily for 4 weeks (6-week cycle). This subgroup analysis assessed overall survival (OS), objective response rate (ORR) and progression-free survival (PFS) per investigator in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) intermediate/poor-risk and intent-to-treat (ITT) patients and safety (ITT patients). Results Of 550 and 546 patients randomized to NIVO+IPI and SUN, 38 and 34, respectively, were Japanese. Of these, 31 (NIVO+IPI) and 29 (SUN) patients were IMDC intermediate/poor-risk. In IMDC intermediate/poor-risk patients with 30 months’ minimum follow-up, there was a delayed trend in OS benefit with NIVO+IPI (hazard ratio [HR] 0.56; 95% confidence interval [CI]: 0.19–1.59; P = 0.2670), and 24-month OS probability favoured NIVO+IPI (84%) versus SUN (76%). The ORR was 39% with NIVO+IPI and 31% with SUN (P = 0.6968). PFS was similar in both treatment arms (HR 1.17; 95% CI: 0.62–2.20; P = 0.6220). Efficacy in ITT patients was similar to IMDC intermediate/poor-risk patients. Grade 3–4 treatment-related adverse event incidence was lower with NIVO+IPI versus SUN (58 versus 91%). Conclusions Japanese patients with untreated aRCC in the NIVO+IPI arm had a numerically higher ORR and improved safety profile versus patients in the SUN arm. A delayed OS benefit appears to be emerging with NIVO+IPI. Longer follow-up is needed. https://clinicaltrials.gov/ct2/show/NCT02231749?term=NCT02231749&rank=1 identifier: NCT02231749.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Niigata University, Niigata, Japan
- Department of Urology, Yamagata University Hospital, Yamagata, Japan
- For reprints and all correspondence: Yoshihiko Tomita, Department of Urology, Niigata University, Asahimachi 1-757, Niigata 951-8510, Japan. E-mail:
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Hospital, Akita, Japan
| | | | - Masahiro Yao
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University Hospital, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Surgery, Urology, Tokyo Medical and Dental University Hospital, University Hospital of Medicine, Tokyo, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University Hospital, Morioka, Japan
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Hospital, Faculty of Medicine, Osakasayama, Japan
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50
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Tomita Y, Kimura G, Fukasawa S, Sugiyama Y, Numakura K, Yamana K, Naito S, Kabu K, Tajima Y, Oya M. Treatment-free survival after discontinuation of immuno-checkpoint therapy, and outcome of subsequent molecular targeted therapy: Retrospective study of Japanese metastatic renal cell carcinoma patients (after I-O study). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
677 Background: Guidelines for treatment of metastatic renal cell carcinoma (mRCC) recommend nivolumab monotherapy (NIVO) for treated mRCC, and nivolumab + ipilimumab combination therapy (NIVO+IPI) for untreated IMDC intermediate and poor risk mRCC patients. Though molecular targeted therapies (TTs) such as VEGFR-TKIs and mTORi are recommended as subsequent therapy after NIVO or NIVO+IPI, their impact is still unclear. Methods: Japanese mRCC patients treated with TT after NIVO (CheckMate 025) or NIVO+IPI (CheckMate 214) were retrospectively analyzed. Primary endpoints were investigator assessed ORR of the first TT after NIVO, and after NIVO+IPI. Secondary endpoints included treatment-free survival (TFS) after discontinuation of NIVO and NIVO+IPI, and progression-free survival (PFS) and safety of the first subsequent TT after NIVO and NIVO+IPI. Results: Twenty-six patients of CheckMate 025 and 19 patients of CheckMate 214 from 20 centers in Japan were analyzed. Median TFS after ICI discontinuation was 1.0m and 2.5m for CheckMate 025 and CheckMate 214 patients, respectively. Median follow-up period from the start of TT after ICI discontinuation to date of analysis or death was 22.1m for CheckMate 025, and 20.3m for CheckMate 214 patients. As the first subsequent TT after NIVO or NIVO+IPI, axitinib was the most treated therapy for both CheckMate 025 (53.8%) and CheckMate 214 (47.4%) patients. ORR of TT after NIVO and NIVO+IPI was 26.9% and 31.6%, and median PFS was 8.9m and 16.3m, respectively. During the treatment of first TT after NIVO and NIVO+IPI, 98% percent experienced treated-related adverse events, 51% experienced grade 3-4, but no treatment related death. Conclusions: TTs have favorable antitumor activity for mRCC after NIVO and NIVO+IPI, possibly by changing the mode of action. Safety signals of TTs after ICI were similar to the previous reports. These results indicate sequential TTs after ICI may contribute for durable survival benefit.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Department of Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | - Yutaka Sugiyama
- Department of Urology, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | | | | | - Sei Naito
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Koki Kabu
- Bayer Ltd. Medical Affairs, Oncology and Hematology, Tokyo, Japan
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