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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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2
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Transition to Targeted Therapies Improved the Prognosis and Increased the Utilization of Medical Treatments among Patients with Synchronous Metastatic Renal Cell Cancer. Int J Surg Oncol 2021; 2021:5237695. [PMID: 34422411 PMCID: PMC8378950 DOI: 10.1155/2021/5237695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Since the introduction of targeted therapies (TTs) for metastatic renal cell cancer (mRCC) in 2005, a limited amount of epidemiological data on efficacy of modern drug therapies for synchronous mRCC has been published. We present a comprehensive nationwide cohort including all cases of primarily metastasized renal cell cancer among adults diagnosed between 2005 and 2010, based on data from the Finnish Cancer Registry and patient records from treating hospitals. Applied treatment protocols and survival outcomes were analyzed. A total of 977 patients were included in the analysis; 499 patients were diagnosed between 2005 and 2007 and 478 patients were diagnosed between 2008 and 2010. The median overall survival (OS) was 8.80 months (95% confidence interval (CI): 7.60–10.02). The median OS of the patients diagnosed at the latter era was significantly better (11.1; 95% CI: 8.8–13.4 vs. 7.0; 95% CI: 5.7–8.3 months, p ≤ 0.001). A total number of 524 (53.8%) patients received drug therapy. Altogether, TTs including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors (mTORi), and vascular endothelial growth factor inhibitor covered 331 (63.2%) of first-line treatments, whereas interferon and its combinations with chemotherapy were used for 186 (35.5%) patients. The median OS rates for TT and interferon as first-line therapy groups were 19.9 (16.9–22.8) and 14.9 (12.3–17.4) months, respectively. The OS for patients who did not receive drug therapy after cytoreductive nephrectomy was dismal. We found that the OS estimate of mRCC patients in Finland has improved since the introduction of tyrosine kinase inhibitors. However, the prognosis remains poor for frail, elderly patients with an impaired performance status.
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Araujo DV, Wells JC, Hansen AR, Dizman N, Pal SK, Beuselinck B, Donskov F, Gan CL, Yan F, Tran B, Kollmannsberger CK, de Velasco G, Yuasa T, Reaume MN, Ernst DS, Powles T, Bjarnason GA, Choueiri TK, Heng DYC, Dudani S. Efficacy of immune-checkpoint inhibitors (ICI) in the treatment of older adults with metastatic renal cell carcinoma (mRCC) - an International mRCC Database Consortium (IMDC) analysis. J Geriatr Oncol 2021; 12:820-826. [PMID: 33674246 DOI: 10.1016/j.jgo.2021.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Older adults with metastatic renal cell carcinoma(mRCC) are underrepresented in immune-checkpoint inhibitor(ICI) registration trials. Here we compare the efficacy of ICI treatments in older vs. younger adults with mRCC. METHODS Using the International mRCC Database Consortium(IMDC), patients treated with a PD(L)-1 based ICI were identified. Older adult was defined as ≥70-years at the time of treatment. Descriptive statistics were summarized in means, medians, and proportions. Effectiveness endpoints included overall survival (OS), time-to-treatment failure(TTF), time-to-next treatment(TNT), and overall response rate(ORR). Hazards ratios were adjusted(aHR) for IMDC risk factors, histology, line of treatment and older age. RESULTS Of 1427 included patients, 397(28%) were older adults. ICI was used as 1st line(1 L) in 40%, 2nd line(2 L) in 49% and 3rd line(3 L) in 11% of patients. In univariable analysis, older adults had inferior OS compared to younger adults(25.1 m vs. 30.8 m, p < 0.01). There were no significant differences in TTF (6.9 m vs. 6.9 m, p = 0.4) or TNT(9.1 m vs 10 m, p = 0.3) between groups. In multivariable analyses, older age was not independently associated with worse OS(aHR = 1.02, p = 0.8), TTF(aHR = 0.95, p = 0.6) or TNT(aHR = 0.93, p = 0.5). Older adults had a lower ORR compared to younger adults(24% vs. 31%, p = 0.01), which was mainly driven by responses in 1 L(31% vs. 44%, p = 0.02) and not observed in 2 L/3 L. CONCLUSIONS After multivariable analyses, older adults with mRCC treated with ICI had no difference in OS, TTF or TNT when compared to younger adults. Our data support that chronological older age should not preclude patients from receiving ICI based therapies.
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Affiliation(s)
| | - J Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Nazli Dizman
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Benoit Beuselinck
- University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Chun L Gan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Flora Yan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Takeshi Yuasa
- Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Neil Reaume
- The Ottawa Hospital Cancer Centre, University of Ottawa, ON, Canada
| | - D Scott Ernst
- London Regional Cancer Program, London Health Sciences Centre and University of Western Ontario, London, ON, Canada
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Shaan Dudani
- William Osler Health System, Brampton, ON, Canada.
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Hermansen CK, Donskov F. Outcomes based on age in patients with metastatic renal cell carcinoma treated with first line targeted therapy or checkpoint immunotherapy: Older patients more prone to toxicity. J Geriatr Oncol 2020; 12:827-833. [PMID: 33388280 DOI: 10.1016/j.jgo.2020.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Older patients with metastatic renal cell carcinoma (mRCC) were underrepresented in pivotal trials. MATERIALS AND METHODS Consecutive patients with mRCC treated at Aarhus University Hospital with first line tyrosine kinase inhibitors (TKI), mTOR inhibitors, or checkpoint immunotherapy (CPI) were retrospectively analyzed in age-subgroups; ≥ 75, 65-74, and < 65 years, with overall survival (OS), time-to-treatment discontinuation (TTD), and progression-free survival (PFS) as endpoints. Hazards ratios were adjusted (aHR) for International Metastatic RCC Database Consortium (IMDC) risk factors, histology, and age. RESULTS Of 838 patients, 159 (19%) were ≥ 75 years, 324 (39%) 65-74 years, and 355 (42%) < 65 years. Treatments were TKI in 729 (87%) patients, mTOR in 43 (5%) and CPI in 67 (8%). Older patients ≥ 75 years compared with 65-74 years and < 65 years had lower toxicity-adjusted median doses of pazopanib, 300 mg vs. 400 mg vs. 600 mg, respectively, (p < 0.001), and sunitinib, 25 mg vs. 37.5 mg vs. 50 mg, respectively (p < 0.001); numerically fewer doses of CPI, median 2 vs. 5 vs. 5, respectively, (p = 0.2); a higher proportion had dose reduction/interruption, 76% vs. 55% vs. 41%, respectively, (p < 0.001); and shorter mean time to dose reduction/interruption, 0.5 months vs. 1.9 months vs. 3.4 months, respectively, (p < 0.001). After adjusting IMDC prognostic factors and histology in multivariate analyses, age did not impact OS (aHR 1.0; 95% CI 0.99-1.02, p = 0.2), TTD (aHR 1.0; 95% CI 0.99-1.01, p = 0.4) or PFS (aHR 1.0, 95% CI 0.99-1.01; p = 0.9). CONCLUSION Older patients with mRCC were more prone to toxicity; but age did not impact outcomes. Proactive dose modification/interruption and awareness may help to reduce toxicity while maintaining efficacy.
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Affiliation(s)
- Carina K Hermansen
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Frede Donskov
- Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Nakai Y, Takeuchi A, Osawa T, Kojima T, Hara T, Sugimoto M, Eto M, Minami K, Ueda K, Ozawa M, Uemura M, Miyauchi Y, Ohba K, Kashiwagi A, Murakami M, Sazuka T, Yasumoto H, Morizane S, Kawasaki Y, Morooka D, Shimazui T, Yamamoto Y, Nakagomi H, Tomida R, Ito YM, Murai S, Kitamura H, Nishiyama H, Shinohara N. Efficacy and safety of second-line axitinib in octogenarians with metastatic renal cell carcinoma. J Geriatr Oncol 2020; 12:834-837. [PMID: 33388281 DOI: 10.1016/j.jgo.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Mikio Sugimoto
- Department of Urology, Kagawa University, Takamatsu, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | | | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Masaya Murakami
- Department of Urology, The Jikei University, School of Medicine, Tokyo, Japan
| | | | | | | | | | - Daichi Morooka
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | - Yoshiaki Yamamoto
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Ryotaro Tomida
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Yoichi M Ito
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Prognostic and Predictive Factors in Metastatic Renal Cell Carcinoma: Current Perspective and a Look Into the Future. ACTA ACUST UNITED AC 2020; 26:365-375. [PMID: 32947304 DOI: 10.1097/ppo.0000000000000468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Metastatic renal cell carcinoma (mRCC) comprises a highly heterogeneous group of diseases with varied clinical outcomes. As a result, models to estimate prognosis were developed in an attempt to aid patient counseling, treatment selection, and clinical trial design. Contemporary prognostic models have been mostly generated based on clinical factors because of their ease of use. Recent advances in molecular techniques have allowed unprecedented molecular profiling of RCC and the discovery of genomic and proteotranscriptomic factors that may contribute to disease trajectory. With the advent of multiple systemic therapies in mRCC in recent years, predictive biomarkers have become increasingly relevant in treatment selection. In this review, we discuss the existing staging systems and prognostic models in mRCC. We also highlight various promising molecular biomarkers according to the subtypes of RCC and explore their integration into the traditional prognostic models. In addition, we discuss emerging predictive biomarkers in the era of immuno-oncology. Lastly, we explore future directions with a focus on liquid biopsies and composite biomarkers.
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Teishima J, Murata D, Inoue S, Hayashi T, Mita K, Hasegawa Y, Kato M, Kajiwara M, Shigeta M, Maruyama S, Moriyama H, Fujiwara S. Improved prognosis for elderly patients with metastatic renal cell carcinoma in the era of targeted therapy. Mol Clin Oncol 2020; 12:557-564. [PMID: 32337038 DOI: 10.3892/mco.2020.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
The present study investigated the outcomes of targeted therapy for elderly patients with metastatic renal cell carcinoma (mRCC). A total of 277 patients with mRCC who were treated with tyrosine kinase inhibitor as a first-line therapy from January 2008 to May 2018 were retrospectively investigated by reviewing clinicopathological data. Patients 75 years or older were classified into the older-aged group (n=55) while all others were classified into the younger-aged group (n=222). The preoperative clinicopathological characteristics and the overall survival (OS) rate for these two groups were subsequently compared. The median age in the older- and younger-aged groups was 78 and 63 years (P<0.0001), respectively. A total of 7, 42 and 6 cases in the older-aged group and 46, 118 and 58 cases in the younger-aged group were classified into favorable, intermediate, and poor risk groups, respectively. The rate of patients with cardiovascular diseases (29.1%) and malignant diseases other than RCC (20.0%) was significantly higher in the older-aged group compared with the younger-aged group (6.8%; P<0.0001 and 7.2%; P=0.0042, respectively). There was a significant improvement in the OS rate for patients beginning targeted therapy after 2011 compared with those starting therapy prior to 2010. The 50% OS rate in patients starting targeted therapy before 2010 and after 2011 was, respectively, 17.1 and 38.6 months for the older-aged group (P=0.0066), while there was no significant difference for the younger-aged group (P=0.1441; 50% OS; 35.9 vs. 30.5 months). The results of the present study indicated that the prognosis for older patients has improved since the introduction of targeted therapy.
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Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Daiki Murata
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Koji Mita
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Yasuhisa Hasegawa
- Department of Urology, Fukuyama Medical Center, Fukuyama, Hiroshima 720-8520, Japan
| | - Masao Kato
- Department of Urology, Hiroshima General Hospital, Hatsukaichi, Hiroshima 738-8503, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - Masanobu Shigeta
- Department of Urology, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima 737-0023, Japan
| | - Satoshi Maruyama
- Department of Urology, Miyoshi Central Hospital, Miyoshi, Tokushima 728-8502, Japan
| | - Hiroyuki Moriyama
- Department of Urology, Onomichi General Hospital, Onomichi, Hiroshima 722-8508, Japan
| | - Seiji Fujiwara
- Department of Urology, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Hiroshima 739-0041, Japan
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Facchini G, Rossetti S, Berretta M, Cavaliere C, Scagliarini S, Vitale MG, Ciccarese C, Di Lorenzo G, Palesandro E, Conteduca V, Basso U, Naglieri E, Farnesi A, Aieta M, Borsellino N, La Torre L, Iovane G, Bonomi L, Gasparro D, Ricevuto E, De Tursi M, De Vivo R, Lo Re G, Grillone F, Marchetti P, De Vita F, Scavelli C, Sini C, Pisconti S, Crispo A, Gebbia V, Maestri A, Galli L, De Giorgi U, Iacovelli R, Buonerba C, Cartenì G, D'Aniello C. Second line therapy with axitinib after only prior sunitinib in metastatic renal cell cancer: Italian multicenter real world SAX study final results. J Transl Med 2019; 17:296. [PMID: 31464635 PMCID: PMC6716812 DOI: 10.1186/s12967-019-2047-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This multi-institutional retrospective real life study was conducted in 22 Italian Oncology Centers and evaluated the role of Axitinib in second line treatment in not selected mRCC patients. METHODS 148 mRCC patients were evaluated. According to Heng score 15.5%, 60.1% and 24.4% of patients were at poor risk, intermediate and favorable risk, respectively. RESULTS PFS, OS, DCR and ORR were 7.14 months, 15.5 months, 70.6% and 16.6%, respectively. The duration of prior sunitinib treatment correlated with a longer significant mPFS, 8.8 vs 6.3 months, respectively. Axitinib therapy was safe, without grade 4 adverse events. The most frequent toxicities of all grades were: fatigue (50%), hypertension (26%), and hypothyroidism (18%). G3 blood pressure elevation significantly correlated with longer mPFS and mOS compared to G1-G2 or no toxicity. Dose titration (DT) to 7 mg and 10 mg bid was feasible in 24% with no statistically significant differences in mPFS and mOS. The sunitinib-axitinib sequence was safe and effective, the mOS was 41.15 months. At multivariate analysis, gender, DCR to axitinib and to previous sunitinib correlated significantly with PFS; whereas DCR to axitinib, nephrectomy and Heng score independently affected overall survival. CONCLUSIONS Axitinib was effective and safe in a not selected real life mRCC population. Trial registration INT - Napoli - 11/16 oss. Registered 20 April 2016. http://www.istitutotumori.na.it.
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Affiliation(s)
- Gaetano Facchini
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy.
| | - Sabrina Rossetti
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Massimiliano Berretta
- Department of Medical Oncology, Centro di Riferimento Oncologico, Istituto Nazionale Tumori CRO, Aviano, PN, Italy
| | - Carla Cavaliere
- UOC of Medical Oncology ASL NA 3 SUD Ospedali Riuniti Area Nolana, Naples, Italy
| | - Sarah Scagliarini
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Maria Giuseppa Vitale
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
| | - Chiara Ciccarese
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Erica Palesandro
- Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Vincenza Conteduca
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Azzurra Farnesi
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Michele Aieta
- Medical Oncology Department, National Institute of Cancer, Rionero in Vulture, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Gelsomina Iovane
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Lucia Bonomi
- Oncology Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Enrico Ricevuto
- S. Salvatore Hospital, ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Oncology and Experimental Medicine, "G. D'Annunzio" University, Chieti, Italy
| | | | | | - Francesco Grillone
- Medical Oncology Unit Azienda Ospedaliera "Mater Domini", Catanzaro, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Claudio Scavelli
- Medical Oncology Unit, "S. Cuore di Gesù" Hospital, Gallipoli, Italy
| | | | | | - Anna Crispo
- Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 80131, Napoli, Italy
| | - Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, University of Palermo, Palermo, Italy
| | - Antonio Maestri
- Medical Oncology Department, "Santa Maria della Scaletta" Hospital AUSL, Imola, Italy
| | - Luca Galli
- University Hospital of Pisa, Oncology Unit 2, Pisa, Pisa, Italy
| | - Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | - Roberto Iacovelli
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giacomo Cartenì
- Division of Oncology, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Naples, Italy
| | - Carmine D'Aniello
- Division of Medical Oncology, AORN Dei Colli "Ospedali Monaldi-Cotugno-CTO", Napoli, Italy
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Marchioni M, Bandini M, Preisser F, Tian Z, Kapoor A, Cindolo L, Primiceri G, Berardinelli F, Briganti A, Shariat SF, Schips L, Karakiewicz PI. Survival after Cytoreductive Nephrectomy in Metastatic Non-clear Cell Renal Cell Carcinoma Patients: A Population-based Study. Eur Urol Focus 2019; 5:488-496. [DOI: 10.1016/j.euf.2017.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 01/27/2023]
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10
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Graham J, Heng DYC, Brugarolas J, Vaishampayan U. Personalized Management of Advanced Kidney Cancer. Am Soc Clin Oncol Educ Book 2018; 38:330-341. [PMID: 30231375 DOI: 10.1200/edbk_201215] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The treatment of renal cell carcinoma represents one of the great success stories in translational cancer research, with the development of novel therapies targeting key oncogenic pathways. These include drugs that target the VEGF and mTOR pathways, as well as novel immuno-oncology agents. Despite the therapeutic advancements, there is a paucity of well-validated prognostic and predictive biomarkers in advanced kidney cancer. With a number of highly effective therapies available across multiple lines, it will become increasingly important to develop a more tailored approach to treatment selection. Prognostic clinical models, such the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model, are routinely used for prognostication in clinical practice. The IMDC model has demonstrated a predictive capability in the context of these treatments including immune checkpoint inhibition. A number of promising molecular markers and gene expression signatures are being explored as prognostic and predictive biomarkers, but none are ready to be widely used for treatment selection. In this review, we will explore the current landscape of personalized care in metastatic renal cell carcinoma. This will include a focus on both prognostic and predictive factors as well as clinical applications of biology in kidney cancer.
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Affiliation(s)
- Jeffrey Graham
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Daniel Y C Heng
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - James Brugarolas
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Ulka Vaishampayan
- From the Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Karmanos Cancer Institute, Wayne State University, Detroit, MI
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Graham J, Dudani S, Heng DYC. Prognostication in Kidney Cancer: Recent Advances and Future Directions. J Clin Oncol 2018; 36:JCO2018790147. [PMID: 30372388 DOI: 10.1200/jco.2018.79.0147] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The most common type of cancer originating in the kidney is renal cell carcinoma (RCC). In both localized and advanced RCC, a number of clinical, pathologic, and molecular factors have been identified as having prognostic significance. In localized disease, risk stratification has traditionally involved the anatomic extent of disease, and several integrated scoring systems have been developed to help predict outcomes after definitive local therapy. In metastatic RCC, integrated prognostic models have also been established. These are used to stratify patients in contemporary clinical trials and to guide risk-directed treatment selection in clinical practice. Although many prognostic factors are common to both localized and advanced disease, there are some important distinctions. In both of these types of disease, the prognostic role of specific molecular and genomic alterations is an area of active investigation. In this review, we highlight the current staging systems and prognostic factors in localized and metastatic RCC. We also explore future directions in this area, including the expanding role of molecular biomarkers and their integration into the traditional prognostic models.
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Affiliation(s)
- Jeffrey Graham
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
| | - Shaan Dudani
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Y C Heng
- Jeffrey Graham and Daniel Y.C. Heng, University of Calgary, Calgary, Alberta; and Shaan Dudani, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
Real-world evidence has played an important role in expanding our knowledge on the treatment and prognostication of advanced renal cell carcinoma. This type of data has been particularly helpful in providing a better understanding of groups that are traditionally excluded from randomized controlled trials. The International mRCC Database Consortium (IMDC) represents the largest collection of real-world data on patients with advanced kidney cancer treated with targeted therapies. The IMDC prognostic model has been used to stratify patients in contemporary clinical trials and to provide risk-directed treatment selection in everyday clinical practice. More recently, it has been shown to predict response to first-line combination immunotherapy in the phase III CheckMate 214 clinical trial. In this review, we highlight the real-world evidence associated with the treatment of mRCC. We focus on first-line therapy, as well as second-line and third-line therapeutic options, including novel immuno-oncology agents. We also address the real-world evidence for the use of cytoreductive nephrectomy in advanced renal cell carcinoma in the targeted therapy era.
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Affiliation(s)
- Jeffrey Graham
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Yc Heng
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Roethke SK, Ryan JC, Wood SY. Management of Older Patients With Metastatic Renal Cell Carcinoma Receiving Sunitinib: A Hypothetical, Illustrative Case Scenario. J Adv Pract Oncol 2018; 9:67-76. [PMID: 30564469 PMCID: PMC6296420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CASE STUDY Tom, a 75-year-old white male, was recently diagnosed with metastatic renal cell carcinoma (RCC; Tom's case is not an actual clinical case but has been developed by the authors as an exemplar). Two years prior, he had undergone a left partial (laparoscopic) nephrectomy for clear cell RCC. At that time, he had a stage 3 disease (the tumor extended into perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota's fascia [Cancer.net, 2016]), and regularly (every 3-6 months) scheduled surveillance imaging did not show metastatic disease. Recent imaging with a computed tomography (CT) of the chest/abdomen/pelvis revealed small bilateral pulmonary nodules that did not have the radiographic appearance of a primary lung tumor, but rather that of metastatic disease. Therefore, a decision was made to repeat CT scans in a shorter interval (in 6 weeks) to assess growth kinetics. Subsequent CT scan showed an increase in size and number of pulmonary nodules, so the decision was made to begin systemic treatment. At the time of Tom's metastatic evaluation, his Eastern Cooperative Oncology Group performance status was 0 as he was asymptomatic and fully active (Table 1). He was classified as favorable risk according to Heng criteria (Table 2). Tom is married and lives with his wife. He is independent in his self-care but also relies on his wife for health-care decision-making. He does not drink alcohol and is a former smoker with a history of 30 pack-years. Tom's medical history includes hypertension that is adequately controlled with lisinopril (20 mg/day), coronary artery disease (on daily aspirin 81 mg) with left ventricular ejection fraction (LVEF) of > 50%, which is within the normal range (50%-75%), benign prostatic hyperplasia for which he is treated with finasteride, and hyperlipidemia that is treated with atorvastatin.
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Affiliation(s)
| | - Joanne C. Ryan
- Pfizer Oncology, US Medical Affairs, New York, New York;
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Lindskog M, Wahlgren T, Sandin R, Kowalski J, Jakobsson M, Lundstam S, Ljungberg B, Harmenberg U. Overall survival in Swedish patients with renal cell carcinoma treated in the period 2002 to 2012: Update of the RENCOMP study with subgroup analysis of the synchronous metastatic and elderly populations. Urol Oncol 2017. [PMID: 28623071 DOI: 10.1016/j.urolonc.2017.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era. METHODS Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (M1) and the elderly (aged≥75y). RESULTS A total of 4,217 patients with mRCC were identified, including 1,533 patients with M1 and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (≥75 vs.<75y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, M1, and elderly populations. CONCLUSION This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in M1 and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age.
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Affiliation(s)
- Magnus Lindskog
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | - Sven Lundstam
- Department of Urology, Sahlgrenska University Hospital and the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology, and Andrology, Umeå University, Umeå, Sweden
| | - Ulrika Harmenberg
- Department of Oncology-Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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15
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Beisland C, Johannesen TB, Klepp O, Axcrona U, Torgersen KM, Kowalski J, Solli O, Sandin R, Oldenburg J. Overall survival in renal cell carcinoma after introduction of targeted therapies: a Norwegian population-based study. Onco Targets Ther 2017; 10:371-385. [PMID: 28144152 PMCID: PMC5248939 DOI: 10.2147/ott.s123061] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This population-wide retrospective, non-interventional registry study assessed changes in overall survival (OS) and factors influencing OS in Norwegian patients with renal cell carcinoma (RCC). METHODS Two population-wide health registries were used to identify all RCC patients with (mRCC) or without metastases diagnosed before (2002-2005) and after (2006-2008 and 2009-2011) introduction of targeted therapies. Median OS was estimated using Kaplan-Meier method. Cox proportional hazards regression modeling was used to identify prognostic factors. RESULTS Overall, 5,463 patients were diagnosed with RCC during 2002-2005 (n=1,898), 2006-2008 (n=1,631), and 2009-2011 (n=1,934); of these, 1,678 (31%) had mRCC. Patients diagnosed in 2009-2011 and 2006-2008 had significant (P<0.001) improvements in OS versus those diagnosed in 2002-2005: median OS, not reached and not reached versus 82.0 months in RCC; 14.0 and 12.0 months versus 9.0 months in mRCC. Similarly, OS improvements were seen in the primary and elderly (≥75 years) mRCC populations. Median OS was comparable (12 months) between clear cell and papillary mRCC, but it was longer (24.0 months) for chromophobe mRCC. Multivariate regression analyses showed that younger age, previous nephrectomy, and 1 or more prescriptions of targeted therapy were significantly associated with longer OS in mRCC patients. CONCLUSION OS increased in RCC and mRCC patients in Norway between 2002 and 2011 following introduction of targeted therapies.
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Affiliation(s)
- Christian Beisland
- Department of Urology, Haukeland University Hospital
- Department of Clinical Medicine, University of Bergen, Bergen
| | | | | | - Ulrika Axcrona
- Department of Pathology, Oslo University Hospital, the Norwegian Radium Hospital, Oslo
| | | | | | | | | | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog
- Medical Faculty, University of Oslo, Oslo, Norway
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Daste A, Chakiba C, Domblides C, Gross-goupil M, Quivy A, Ravaud A, Soubeyran P. Targeted therapy and elderly people: A review. Eur J Cancer 2016; 69:199-215. [DOI: 10.1016/j.ejca.2016.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
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17
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Miyake H, Harada KI, Ozono S, Fujisawa M. Efficacy and safety of axitinib in elderly patients with metastatic renal cell carcinoma. Med Oncol 2016; 33:95. [PMID: 27444960 DOI: 10.1007/s12032-016-0813-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 12/31/2022]
Abstract
The objective of this study was to analyze the impact of age on clinical outcomes of metastatic renal cell carcinoma (mRCC) patients receiving axitinib. This study included 144 consecutive mRCC patients who received axitinib for at least 12 weeks as second-line therapy in a routine clinical setting. The efficacy, safety and quality of life (QOL) were compared between patients aged <75 (n = 116) and ≥75 (n = 28) years. No significant differences in the clinicopathological characteristics were noted between younger and older patients. There was no significant difference in the response rate, clinical benefit rate or proportion of patients going on to receive third-line therapy between these two groups. In addition, the progression-free and overall survivals in older patients were similar to those in younger patients. There were no significant differences in the incidences of adverse events between these two groups, except for that of fatigue, which was significantly more frequent in older than younger patients. There was no significant difference in the incidence of the discontinuation of axitinib due to adverse events between the two groups. QOL assessment at 12 weeks after the introduction of axitinib using the Medical Outcomes Study 36-Item Short Form showed no significant differences in any of the eight scale scores between the two groups. Taken together, it might be possible to achieve clinical outcomes in older patients receiving axitinib comparable to those in younger patients, suggesting that advanced age should not be a contraindication to treatment with axitinib as a second-line setting in mRCC patients.
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Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. .,Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seiichiro Ozono
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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van den Brom R, van Es S, Leliveld A, Gietema J, Hospers G, de Jong I, de Vries E, Oosting S. Balancing treatment efficacy, toxicity and complication risk in elderly patients with metastatic renal cell carcinoma. Cancer Treat Rev 2016; 46:63-72. [DOI: 10.1016/j.ctrv.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/15/2022]
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Zanardi E, Grassi P, Cavo A, Verzoni E, Maggi C, De Braud F, Boccardo F, Procopio G. Treatment of elderly patients with metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2016; 16:323-34. [PMID: 26654225 DOI: 10.1586/14737140.2016.1131613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of developing renal cell carcinoma (RCC) increases with age, and given the constant gain in life expectancy of the general population, both localized RCC and metastatic RCC (mRCC) are more frequently observed in the elderly population. The elderly are a heterogeneous group of patients often characterized by the presence of comorbidities, different compliance to treatment and polypharmacy. Here we review the available data with the aim to analyze the safety and efficacy of new targeted therapies (TTs) in elderly mRCC patients. TTs seem to be effective in both older and younger patients, but elderly patients appear to show reduced tolerance to treatments compared to younger patients. Prospective trials are needed to better understand how to manage mRCC in elderly patients.
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Affiliation(s)
- Elisa Zanardi
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Paolo Grassi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Alessia Cavo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Elena Verzoni
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Claudia Maggi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Filippo De Braud
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Francesco Boccardo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Giuseppe Procopio
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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Azawi NH, Joergensen SM, Jensen NV, Clark PE, Lund L. Trends in kidney cancer among the elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:79-84. [PMID: 26784139 DOI: 10.3109/0284186x.2015.1115121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study is to elucidate incidence, mortality, survival, and prevalence of kidney cancer in elderly persons compared with younger persons in Denmark. MATERIAL AND METHODS Cancer of the kidney was defined as ICD-10 code DC 64. Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS The proportion of patients diagnosed with kidney cancer over the age of 70 years has decreased from 43% in 1980 to 32% in 2012 in men and remained almost constant in women, around 50%. Incidence rates were at least five times higher in men aged 70 years more but there was no particular trend with time. In men aged less than 70 years, the incidence rates started increasing around 2000. The incidence rates were lower in women but with a similar pattern as in men. Mortality rates remained stable over time in persons aged 70 years or more while they decreased with time in younger women. Both the one- and the five-year relative survival increased steadily over time for all age groups but the survival was lower for patients aged 70 years or more than for younger patients. The prevalence increased three times from 1559 patients being alive after kidney cancer in 1980 to 4713 in 2012. CONCLUSION A challenge in managing kidney cancer in the elderly is to establish interdisciplinary collaborations between different specialties, such as surgeons, clinical oncologists, and geriatricians to be able to deliver the best possible care in the future.
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Affiliation(s)
- Nessn H Azawi
- a Department of Urology , Roskilde Hospital , Roskilde , Denmark
- d Department of Urology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Simon Moeller Joergensen
- b Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Niels Viggo Jensen
- b Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Peter E Clark
- c Department of Urologic Surgery , Vanderbilt University , Tennessee , USA
- e Clinical Institute, University of Southern Denmark , Odense , Denmark
| | - Lars Lund
- d Department of Urology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
- e Clinical Institute, University of Southern Denmark , Odense , Denmark
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Della-Morte D, Riondino S, Ferroni P, Palmirotta R, Pastore D, Lauro D, Guadagni F, Roselli M. Impact of VEGF gene polymorphisms in elderly cancer patients: clinical outcome and toxicity. Pharmacogenomics 2015; 16:61-78. [PMID: 25560471 DOI: 10.2217/pgs.14.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Vascular endothelial growth factors (VEGFs) are the key regulators in angiogenesis and have been shown to play a significant role in the progression and prognosis of angiogenesis-related diseases, such as cancer. VEGF inhibitors are a current pharmacological tumoral strategy. However, despite the strong association between aging and cancer incidence and progression, recent findings suggest impaired angiogenesis accompanied by a reduced expression of VEGF in cells derived from aging subjects. Specific variations of VEGF genes have been demonstrated to be genetic determinants for susceptibility, outcome and therapy response, especially for the solid tumors. Considering the complications present in frail elderly patients, analysis of VEGF genetic polymorphisms in these subjects may further help in tailoring an angiogenic pharmacological strategy, and in improving our ability to better understand prognosis during therapy-related to cancer.
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Affiliation(s)
- David Della-Morte
- Department of Systems Medicine, School of Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy
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