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Thomas AZ, Adibi M, Borregales LD, Karam JA, Wood CG. Cytoreductive surgery in the era of targeted molecular therapy. Transl Androl Urol 2016; 4:301-9. [PMID: 26815334 PMCID: PMC4708236 DOI: 10.3978/j.issn.2223-4683.2015.04.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cytoreductive nephrectomy (CN) was regarded standard of care for patients with metastatic renal cell carcinoma (mRCC) in the immunotherapy era. With the advent of targeted molecular therapy (TMT) for the treatment of mRCC, the routine use of CN has been questioned. Up to date evidence continues to suggest that CN remains an integral part of treatment in appropriately selected patients. This review details the original context in which the efficacy of CN was established and rationale for the continued use of cytoreductive surgery in the era of TMT.
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Affiliation(s)
- Arun Z Thomas
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Mehrad Adibi
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Leonardo D Borregales
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Jose A Karam
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Christopher G Wood
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
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2
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Presurgical Therapy in Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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3
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Harshman LC, Srinivas S. Current status of cytoreductive nephrectomy in metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2014; 7:1749-61. [DOI: 10.1586/14737140.7.12.1749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Coppin C. Immunotherapy for renal cell cancer in the era of targeted therapy. Expert Rev Anticancer Ther 2014; 8:907-19. [DOI: 10.1586/14737140.8.6.907] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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5
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Calabrò F, Sternberg CN. Is there a role for presurgical therapy for renal cell carcinoma? Expert Rev Anticancer Ther 2014; 10:807-12. [DOI: 10.1586/era.10.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Song W, Dang Q, Xu D, Chen Y, Zhu G, Wu K, Zeng J, Long Q, Wang X, He D, Li L. Kaempferol induces cell cycle arrest and apoptosis in renal cell carcinoma through EGFR/p38 signaling. Oncol Rep 2014; 31:1350-6. [PMID: 24399193 DOI: 10.3892/or.2014.2965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/02/2013] [Indexed: 11/06/2022] Open
Abstract
Kaempferol has been shown to inhibit cell growth, induce apoptosis and cell cycle arrest in several tumors, but not in renal cell carcinoma (RCC). In the present study, we investigated the effects of kaempferol and the underlying mechanism(s) on the cell growth of RCC cells. MTT assay and colony formation assay were used to study cell growth, and flow cytometry was used to study apoptosis and cell cycles in different RCC cells treated with various doses of kaempferol. A significant inhibition on cell growth, induction of apoptosis and cell cycle arrest were observed in 786-O and 769-P cells after kaempferol treatment compared with the control group. Moreover, the results clearly showed that kaempferol causes a strong inhibition of the activation of the EGFR/p38 signaling pathways, upregulation of p21 expression and downregulation of cyclin B1 expression in human RCC cells, together with activation of PARP cleavages, induction of apoptotic death and inhibition of cell growth. Collectively, our results suggest that kaempferol may serve as a candidate for chemo-preventive or chemotherapeutic agents for RCC.
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Affiliation(s)
- Wenbin Song
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qiang Dang
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Defeng Xu
- School of Pharmaceutical and Life Sciences, Changzhou University, Changzhou, Jiangsu 213164, P.R. China
| | - Yule Chen
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Guodong Zhu
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jin Zeng
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Qingzhi Long
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xinyang Wang
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Lei Li
- Department of Urology, The First Affiliated Hospital of the Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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7
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Presurgical Therapy in Renal Cell Carcinoma. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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8
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Chapin BF, Delacroix SE, Culp SH, Nogueras Gonzalez GM, Tannir NM, Jonasch E, Tamboli P, Wood CG. Safety of presurgical targeted therapy in the setting of metastatic renal cell carcinoma. Eur Urol 2011; 60:964-71. [PMID: 21621907 PMCID: PMC4378825 DOI: 10.1016/j.eururo.2011.05.032] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/15/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND In patients with metastatic renal cell carcinoma (mRCC), the timing of systemic targeted therapy in relation to cytoreductive nephrectomy (CN) is under investigation. OBJECTIVE To evaluate postoperative complications after the use of presurgical targeted therapy prior to CN. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of all patients who underwent a CN at The University of Texas M.D. Anderson Cancer Center from 2004 to 2010 was performed. Inclusion in this study required documented evidence of mRCC, with treatment incorporating CN. INTERVENTIONS Patients receiving presurgical systemic targeted therapy prior to CN were compared to those undergoing immediate CN. MEASUREMENTS Complications were assessed using the modified Clavien system for a period of 12 mo postoperatively. RESULTS AND LIMITATIONS Presurgical therapy was administered to 70 patients prior to CN (presurgical), while 103 patients had an immediate CN (immediate). A total of 232 complications occurred in 57% of patients (99 of 173). Use of presurgical systemic targeted therapy was predictive of having a complication>90 d postoperatively (p=0.002) and having multiple complications (p=0.013), and it was predictive of having a wound complication (p<0.001). Despite these specific complications, presurgical systemic targeted therapy was not associated with an increased overall complication risk on univariable or multivariate analysis (p=0.064 and p=0.237) and was not predictive for severe (Clavien ≥3) complications (p=0.625). This study is limited by its retrospective nature. As is inherent to any retrospective study reporting on complications, we are limited by reporting bias and the potential for misclassification of specific complications. CONCLUSIONS Despite an increased risk for specific wound-related complications, overall surgical complications and the risk of severe complications (Clavien ≥3) are not greater after presurgical targeted therapy in comparison to upfront cytoreductive surgery.
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Affiliation(s)
- Brian F Chapin
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Scott E Delacroix
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen H. Culp
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Nizar M. Tannir
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Pheroz Tamboli
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Christopher G. Wood
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Targeted therapies in renal cell cancer: recent developments in imaging. Target Oncol 2010; 5:95-112. [PMID: 20625845 PMCID: PMC2929340 DOI: 10.1007/s11523-010-0146-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/24/2010] [Indexed: 01/14/2023]
Abstract
Targeted therapy has significantly improved the perspectives of patients with metastatic renal cell cancer (mRCC). Frequently, these new molecules cause disease stabilization rather than substantial tumor regression. As treatment options expand with the growing number of targeted agents, there is an increasing need for surrogate markers to early assess tumor response. Here, we review the currently available imaging techniques and response evaluation criteria for the assessment of tumor response in mRCC patients. For computed tomography (CT), different criteria are discussed including the Response Evaluation Criteria in Solid Tumors (RECIST), the Choi criteria, the modified Choi criteria, and the size and attenuation CT (SACT) criteria. Functional imaging modalities are discussed, such as dynamic contrast-enhanced CT (DCE-CT), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), dynamic contrast-enhanced ultrasonography (DCE-US), and positron emission tomography (PET).
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10
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Bex A, Van der Veldt AAM, Blank C, Meijerink MR, Boven E, Haanen JBAG. Progression of a caval vein thrombus in two patients with primary renal cell carcinoma on pretreatment with sunitinib. Acta Oncol 2010; 49:520-3. [PMID: 20105087 DOI: 10.3109/02841860903521111] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Bracarda S, Ravaud A. Current and Future Treatment Options for Metastatic Renal Cell Carcinoma. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eursup.2009.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Chiong E, Wood CG, Margulis V. Role of cytoreductive nephrectomy in renal cell carcinoma. Future Oncol 2009; 5:859-69. [DOI: 10.2217/fon.09.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cytoreductive nephrectomy prior to cytokine therapy has a well-established role in the treatment of appropriately selected patients with metastatic renal cell carcinoma (RCC). Recent use of novel molecular targeted agents in the management of metastatic RCC has challenged the current dogma of treatment with regards to the necessity, patient selection for and timing of cytoreductive nephrectomy. Current evidence suggests that cytoreductive nephrectomy still plays an integral part in the multimodal paradigm of management for metastatic RCC. This review highlights the role of cytoreductive nephrectomy, and discusses controversial issues surrounding cytoreductive nephrectomy in the treatment of metastatic RCC, in the context of immunotherapy and also in the new era of targeted therapy. It also gives updates on the changing concepts of surgical approaches to cytoreductive nephrectomy in metastatic RCC.
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Affiliation(s)
- Edmund Chiong
- Department of Surgery, National University of Singapore, Singapore and, Department of Urology, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Christopher G Wood
- Department of Urology – Unit 1373, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
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13
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Abel EJ, Wood CG. Cytoreductive nephrectomy for metastatic RCC in the era of targeted therapy. Nat Rev Urol 2009; 6:375-83. [PMID: 19528960 DOI: 10.1038/nrurol.2009.102] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Metastatic renal cell carcinoma (RCC) has traditionally been associated with a poor prognosis with few effective treatments. In the multimodal treatment of metastatic RCC, cytoreductive nephrectomy (CN) became the standard of care after two randomized trials demonstrated a benefit in overall survival in patients who received CN prior to treatment with interferon. More recently, several agents (sunitinib, sorafenib, temsirolimus, everolimus and bevacizumab) have been developed that target angiogenesis and the cellular growth pathways involved in metastatic RCC. These targeted agents have demonstrated improved outcomes compared to cytokine therapy, and have transformed metastatic RCC treatment. Targeted agents are being used as a first-line systemic treatment in patients with metastatic RCC with unprecedented success, and many studies are now focusing on the role of CN in combination with these agents for patients with metastatic RCC.
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Affiliation(s)
- E Jason Abel
- Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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14
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Heldwein FL, Escudier B, Smyth G, Souto CAV, Vallancien G. Metastatic renal cell carcinoma management. Int Braz J Urol 2009; 35:256-70. [DOI: 10.1590/s1677-55382009000300002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2008] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Bernard Escudier
- Université Rene Descartes, France; Santa Casa Hospital (CAVS), Brazil
| | - Gordon Smyth
- Université Rene Descartes, France; Santa Casa Hospital (CAVS), Brazil
| | | | - Guy Vallancien
- Université Rene Descartes, France; Santa Casa Hospital (CAVS), Brazil
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Abstract
The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.
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Affiliation(s)
- J.B. Lattouf
- Correspondence to: Jean-Baptiste Lattouf, Department of Surgery–Urology, Centre Hospitalier de l’Université de Montréal, 1058 rue St-Denis, Montreal, Quebec H2X 3J4. E-mail:
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Neoadjuvant sunitinib for surgically complex advanced renal cell cancer of doubtful resectability: initial experience with downsizing to reconsider cytoreductive surgery. World J Urol 2009; 27:533-9. [PMID: 19145434 DOI: 10.1007/s00345-008-0368-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 12/15/2008] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate neoadjuvant sunitinib in patients with synchronous metastatic renal cell cancer (mRCC) to downsize surgically complex tumours and reconsider cytoreductive surgery. PATIENTS AND METHODS Retrospective analysis of ten consecutive mRCC patients treated with sunitinib in an expanded access program who presented with surgically complex primary tumours or bulky locoregional metastases. Surgery-limiting tumour sites (SLTSs) were defined as primary or retroperitoneal lesions with direct invasion of adjacent organs or encasement of vital structures on imaging. Patients received sunitinib 50 mg/day for 4 weeks on and 2 weeks off to be followed by cytoreductive surgery after downsizing and individual reassessment. Response was measured according to Response Evaluation Criteria in Solid Tumours (RECIST). RESULTS Six out of ten SLTSs revealed a reduction of tumour size with a median of 14% according to RECIST. None of the ten SLTSs had a partial response (PR), whilst at distant metastatic sites one complete remission and two PRs occurred. Downsizing of SLTSs appeared most prominent in the first 2-4 months, which resulted in reconsidering cytoreductive nephrectomy in three patients. These three tumours invaded the liver on imaging and were reduced by 11, 18 and 20%. CONCLUSIONS In this patient group with mRCC and surgically complex primary tumours or locoregional metastases, downsizing of SLTSs by neoadjuvant sunitinib was limited. Cytoreductive surgery was reconsidered in three patients. Given the overall reduction in tumour burden by sunitinib alone, further investigation to define the role of cytoreductive surgery is warranted.
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Li L, Gao Y, Zhang L, Zeng J, He D, Sun Y. Silibinin inhibits cell growth and induces apoptosis by caspase activation, down-regulating survivin and blocking EGFR–ERK activation in renal cell carcinoma. Cancer Lett 2008; 272:61-9. [DOI: 10.1016/j.canlet.2008.06.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 03/06/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
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Abstract
Pre-surgical systemic therapy with targeted molecular agents is an attractive option as an approach to the treatment of patients with renal cell carcinoma. This treatment strategy offers a rational approach for selecting patients with metastatic disease who are most likely to benefit from cytoreductive nephrectomy, but also allows access to treated tumour tissue to study the molecular mechanisms of response and resistance. In patients with locally advanced disease, this strategy offers the potential for improved resectability and timely delivery of systemic therapy to treat subclinical metastatic disease. Preliminary evidence indicates that the use of targeted therapies before nephrectomy is safe. Reliable therapy-specific prognostic biomarkers are needed for the optimal integration of aggressive surgical intervention and systemic therapy to maximize the oncological benefits for the patient.
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Affiliation(s)
- Vitaly Margulis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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19
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Abstract
PURPOSE OF REVIEW Cytoreductive nephrectomy has an established role in management of metastatic renal cell carcinoma when performed in properly selected patients prior to administration of systemic cytokine therapy. Within the past several years, novel molecular targeted agents have not only revolutionized management of metastatic renal cell carcinoma but also created controversy regarding the necessity, patient selection for and timing of cytoreductive nephrectomy. RECENT FINDINGS Benefits of targeted molecular therapeutics have largely been observed in the context of prior cytoreductive nephrectomy, and limited available evidence supports cytoreductive nephrectomy in appropriately selected patients with metastatic renal cell carcinoma who are candidates for targeted systemic therapy. Presurgical systemic therapy with targeted molecular agents is an attractive paradigm, which not only offers a rational approach to select patients who are most likely to benefit from cytoreductive nephrectomy but also allows access to treated tumor tissue to study molecular mechanisms of response and resistance. Surgical approaches increasingly utilized in patients with localized kidney cancer, such as nephron-sparing and minimally invasive techniques are similarly relevant and should be utilized, when appropriate, in patients with metastatic renal cell carcinoma. SUMMARY Cytoreductive nephrectomy should be considered to provide a survival benefit for patients with metastatic renal cell carcinoma and should be used in patients who are candidates for systemic therapy before or after surgery.
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Neill MG, Jewett MA. The once and future role of cytoreductive nephrectomy. Urol Oncol 2008; 26:346-52. [DOI: 10.1016/j.urolonc.2007.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 05/25/2007] [Indexed: 01/16/2023]
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van der Veldt AAM, Meijerink MR, van den Eertwegh AJM, Bex A, de Gast G, Haanen JBAG, Boven E. Sunitinib for treatment of advanced renal cell cancer: primary tumor response. Clin Cancer Res 2008; 14:2431-6. [PMID: 18413834 DOI: 10.1158/1078-0432.ccr-07-4089] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Nephrectomy before immunotherapy in patients with metastatic renal cell cancer (RCC) will improve patient outcome. In addition, the primary tumor is known to be refractory to cytokines. Sunitinib is now approved for treatment of advanced RCC, but its effect on the primary tumor has yet to be reported. EXPERIMENTAL DESIGN All patients treated with sunitinib for advanced RCC without prior nephrectomy were reviewed and sequential computed tomography scans were evaluated for response in the primary tumor as well as metastases according to Response Evaluation Criteria in Solid Tumors. Volumes of primary tumors and central necrotic areas were measured with the perimeter method. RESULTS Computed tomography scans were available for evaluation of response in 17 of 22 patients with a primary tumor in situ (1 patient with two primaries). According to Response Evaluation Criteria in Solid Tumors, 4 patients had a partial response, 12 had stable disease, and 1 had progressive disease. The one-dimensional longest diameter of the primary tumor correlated with the volumetric measurements both at baseline and at the time of evaluation of response. Excluding the patient with progressive disease, the median volume reduction was 31% associated with a median increase in the volume of necrosis of 39%. Three patients underwent nephrectomy and tumors showed extensive necrotic areas next to small fields of vital tumor cells. CONCLUSIONS Sunitinib can induce a significant reduction in volume of primary renal cell tumors. Further trials need to address the role of nephrectomy in advanced RCC patients on sunitinib treatment.
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Affiliation(s)
- Astrid A M van der Veldt
- Department of Medical Oncology, VU University medical center, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Shang D, Ito N, Watanabe J, Awakura Y, Nishiyama H, Kamoto T, Ogawa O. Synergy of Interferon-α and 5-Fluorouracil in Human Renal Cell Carcinoma Requires p53 Activity. Eur Urol 2007; 52:1131-9. [PMID: 17275163 DOI: 10.1016/j.eururo.2007.01.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 01/11/2007] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Immunochemical therapy combining cytokines and chemotherapeutic agents is expected to be effective for treating advanced renal cell carcinoma (RCC). We investigated the mechanism underlying the synergism of interferon-alpha (IFN-alpha) and 5-fluorouracil (5-FU) and the effect of p53 status on the synergy of the combined therapy in RCC cell lines. METHODS The synergy of IFN-alpha and 5-FU was analyzed by isobolographic analysis in five RCC cell lines. The effect of combined treatment on apoptosis induction was measured by flow cytometric analysis, Hoechst staining, and caspase activity assay; PCNA expression was investigated by Western blotting to examine the effect of combined treatment on the antiproliferative effect. RESULTS We demonstrated synergy of IFN-alpha and 5-FU in five RCC cell lines with wild-type p53. IFN-alpha suppressed the proliferation of RCC cells via G1 or G2/M cell cycle arrest without inducing apoptosis, whereas 5-FU induced apoptosis in a dosage-dependent manner. IFN-alpha enhanced the apoptosis of RCC cells induced by 5-FU, whereas 5-FU did not increase the antiproliferative effect of IFN-alpha. However, the synergistic inhibition by IFN-alpha and 5-FU was abolished when the cell lines were transfected with p53 dominant-negative vector. CONCLUSIONS The synergy of IFN-alpha and 5-FU requires p53 activity, suggesting that p53 status may serve as a predictive factor for response to the combination therapy. Because metastatic RCC frequently has p53 mutations, therapy restoring p53 may markedly improve the response rate of immunochemical therapy combining IFN-alpha and 5-FU.
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Affiliation(s)
- Donghao Shang
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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Shang D, Liu Y, Ito N, Kamoto T, Ogawa O. Defective Jak?Stat activation in renal cell carcinoma is associated with interferon-? resistance. Cancer Sci 2007; 98:1259-64. [PMID: 17573897 DOI: 10.1111/j.1349-7006.2007.00526.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy is ineffective against metastatic renal cell carcinoma (RCC). Interferon (IFN)-alpha has become the most common agent used in clinical therapy to overcome this malignant tumor, although a satisfactory response has not been achieved and the mechanism of resistance of RCC to IFN-alpha remains unclear. The purpose of the present study was to evaluate the susceptibility of RCC cells to IFN-alpha and clarify the mechanism of IFN-alpha resistance in RCC. Six RCC cell lines and three types of IFN-alpha were used, and the expression, activation and effects of transfection of possible proteins or factors reported to be involved in IFN-alpha signaling were examined to clarify the mechanism of resistance. The results suggest that the resistance of RCC to IFN-alpha is associated with the lack of Jak1, Tyk2 and Stat1 expression and defective Jak-Stat activation, but not with a lack of IFN-alpha receptor, suppressors of cytokine signaling induction or other factors examined. Moreover, phosphorylation of Jak-Stat pathway components and reversion of IFN-alpha resistance in RCC were observed upon transfection with Jak1, Tyk2 or Stat1 vector. These results suggest that restoring the expression of Jak or Stat1 might strikingly increase the susceptibility of RCC to IFN-alpha and may be a new strategy for improving the response of RCC to IFN-alpha treatment. The Jak-Stat pathway should therefore be an appropriate target for the treatment of RCC.
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Affiliation(s)
- Donghao Shang
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Shang D, Ito N, Kamoto T, Ogawa O. Demethylating Agent 5-Aza-2′-Deoxycytidine Enhances Susceptibility of Renal Cell Carcinoma to Paclitaxel. Urology 2007; 69:1007-12. [PMID: 17482960 DOI: 10.1016/j.urology.2007.02.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/12/2007] [Accepted: 02/18/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the effect of 5-aza-2'-deoxycytidine (DAC), a DNA methyltransferase inhibitor, on the growth of renal cell carcinoma (RCC) and examine the synergistic growth suppression by DAC and chemotherapeutic agents. METHODS The synergy of DAC and chemotherapeutic agents against RCC cell lines was analyzed by isobolographic analysis. The induction of apoptosis and cell cycle arrest by each single agent or the combination of agents was examined by flow cytometric analysis. Caspase activity assays and proliferating cell nuclear antigen protein expression were also examined to clarify the mechanism of the synergism of DAC and chemotherapeutic agents against RCC. RESULTS We demonstrated that DAC combined with paclitaxel (PTX) synergistically inhibited the growth of all the RCC cell lines tested, but DAC did not show such synergism with 5-fluorouracil, vinblastine, or Adriamycin. DAC suppressed RCC cell proliferation by inducing G2/M cell cycle arrest without inducing apoptosis, and PTX induced both apoptosis and G2/M cell cycle arrest in a dosage-dependent manner. DAC could enhance the PTX-induced upregulation of caspase activity and antiproliferative effect to increase the fraction of cells in the sub-G1 and G2/M phase. CONCLUSIONS DAC and PTX caused synergistic growth suppression of RCC, suggesting that DAC could strikingly increase the susceptibility of RCC to PTX and that combination chemotherapy with DAC and PTX might be a novel strategy to improve the clinical response rate of RCC.
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Affiliation(s)
- Donghao Shang
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Klatte T, Ittenson A, Röhl FW, Ecke M, Allhoff EP, Böhm M. Perioperative immunomodulation with interleukin-2 in patients with renal cell carcinoma: results of a controlled phase II trial. Br J Cancer 2006; 95:1167-73. [PMID: 17031403 PMCID: PMC2360567 DOI: 10.1038/sj.bjc.6603391] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We conducted a non-randomised controlled phase II trial to investigate the role of preoperative administration of interleukin-2 (IL-2) in patients with renal cell carcinoma undergoing tumour nephrectomy. A total of 120 consecutive patients were allocated alternately to the two study groups: perioperative immunomodulation with IL-2 (IL-2 group; n=60) and perioperative immunomonitoring without immunomodulation (control group; n=60). Patients from the IL-2 group received four doses of 10 × 106 IU m−2 twice daily subcutaneously a week before operation followed by a daily maintenance dose of 3 × 106 IU m−2 subcutaneously until a day before the operation. Parameters of cellular and humoral immunity (leucocytes, T-cell markers CD3, CD4, and CD8, B-cell marker CD19, monocyte marker CD14, natural killer (NK) cell markers CD16, CD56, and CD57, activation markers CD6, CD25, CD28, and CD69, progenitor cell marker CD34, as well as IL-2, IL-6, IL-10, soluble IL-2 receptor, IL-1 receptor antagonist, transforming growth factor-β1, and vascular endothelial growth factor) were measured in peripheral venous blood at various intervals. Interleukin-2-related toxicity was WHO grade 1 (24%), 2 (67%), and 3 (9%). In the postoperative period, T-cell markers, activation markers, and NK cell markers decreased, and IL-6 and IL-10 increased. However, all these alterations were significantly less accentuated in patients who had been pretreated with IL-2. Median follow-up was 40 months. Tumour-specific survival in the IL-2 group and the control group was 98 vs 81% after 1 year and 86 vs 73% after 5 years (P=0.04). A similar effect was found for progression-free survival. We conclude that IL-2 can be safely administered in the perioperative period and modulates immunological parameters. However, to validate the survival data, a larger randomised phase III trial is needed.
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Affiliation(s)
- T Klatte
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A Ittenson
- Institute of Immunology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - F-W Röhl
- Institute of Biometrics and Medical Informatics, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - M Ecke
- Department of Urology, Städtisches Klinikum, Birkenallee 34, 39130 Magdeburg, Germany
| | - E P Allhoff
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - M Böhm
- Department of Urology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
- E-mail:
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Autenrieth M, Heidenreich A, Gschwend JE. Systemische Therapie des metastasierten Nierenzellkarzinoms. Urologe A 2006; 45:594-9. [PMID: 16622645 DOI: 10.1007/s00120-006-1036-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cytokine-based immunotherapy was the only viable option in metastatic, nonresectable renal cell carcinoma (RCC) for many years. Systemic immunotherapy has become increasingly established as a standard therapy during the last 15 years. In this context, interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) turned out to be the most effective single agents in RCC. Subsequently, the approved subcutaneous application of these compounds was the preferred administration route in Germany. Response rates with cytokine combination therapy were almost similar to those of more aggressive concepts using additional chemotherapeutic agents.Currently, new compounds targeting specific signaling pathways are readily available and have passed clinical testing. Such small molecules like tyrosine kinase inhibitors, monoclonal antibodies, or the mTOR inhibitor CCI-779 may dramatically change the established concepts of systemic RCC treatment. This paper gives an overview of established, current, and evolving concepts of systemic therapy in RCC.
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Affiliation(s)
- M Autenrieth
- Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik, Ulm, Germany
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