1
|
Čugura T, Boštjančič E, Uhan S, Hauptman N, Jeruc J. Epithelial-mesenchymal transition associated markers in sarcomatoid transformation of clear cell renal cell carcinoma. Exp Mol Pathol 2024; 138:104909. [PMID: 38876079 DOI: 10.1016/j.yexmp.2024.104909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/18/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
Epithelial-mesenchymal transition (EMT) plays a pivotal role in the development and progression of many cancers. Partial EMT (pEMT) could represent a critical step in tumor migration and dissemination. Sarcomatoid renal cell carcinoma (sRCC) is an aggressive form of renal cell carcinoma (RCC) composed of a carcinomatous (sRCC-Ca) and sarcomatous (sRCC-Sa) component. The role of (p)EMT in the progression of RCC to sRCC remains unclear. The aim of this study was to investigate the involvement of (p)EMT in RCC and sRCC. Tissue samples from 10 patients with clear cell RCC (ccRCC) and 10 patients with sRCC were selected. The expression of main EMT markers (miR-200 family, miR-205, SNAI1/2, TWIST1/2, ZEB1/2, CDH1/2, VIM) was analyzed by qPCR in ccRCC, sRCC-Ca, and sRCC-Sa and compared to non-neoplastic tissue and between both groups. Expression of E-cadherin, N-cadherin, vimentin and ZEB2 was analyzed using immunohistochemistry. miR-200c was downregulated in sRCC-Ca compared to ccRCC, while miR-200a was downregulated in sRCC-Sa compared to ccRCC. CDH1 was downregulated in sRCC-Sa when compared to any other group. ZEB2 was downregulated in ccRCC and sRCC compared to corresponding non-neoplastic kidney. A positive correlation was observed between CDH1 expression and miR-200a/b/c. Our results suggest that full EMT is not present in sRCC. Instead, discreet molecular differences exist between ccRCC, sRCC-Ca, and sRCC-Sa, possibly representing distinct intermediary states undergoing pEMT.
Collapse
Affiliation(s)
- Tanja Čugura
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Emanuela Boštjančič
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Uhan
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nina Hauptman
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jera Jeruc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
2
|
Adeniran AJ, Shuch B, Humphrey PA. Sarcomatoid and Rhabdoid Renal Cell Carcinoma: Clinical, Pathologic, and Molecular Genetic Features. Am J Surg Pathol 2024:00000478-990000000-00350. [PMID: 38736105 DOI: 10.1097/pas.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Renal cell carcinoma (RCC) with sarcomatoid and rhabdoid morphologies has an aggressive biological behavior and a typically poor prognosis. The current 2022 WHO classification of renal tumors does not include them as distinct histologic entities but rather as transformational changes that may arise in a background of various distinct histologic types of RCC. The sarcomatoid component shows malignant spindle cells that may grow as intersecting fascicles, which is reminiscent of pleomorphic undifferentiated sarcoma. The rhabdoid cells are epithelioid cells with eccentrically located vesicular nuclei with prominent nucleoli and large intracytoplasmic eosinophilic inclusions. Studies have shown that RCCs with sarcomatoid and rhabdoid differentiation have distinctive molecular features. Sarcomatoid RCC harbors shared genomic alterations in carcinomatous and rhabdoid components, but also enrichment of specific genomic alterations in the sarcomatoid element, suggesting molecular pathways for development of sarcomatoid growth from a common clonal ancestor. Rhabdoid differentiation also arises through clonal evolution although less is known of specific genomic alterations in rhabdoid cells. Historically, treatment has lacked efficacy, although recently immunotherapy with PD-1/PD-L1/CTLA-4 inhibitors has produced significant clinical responses. Reporting of sarcomatoid and rhabdoid features in renal cell carcinoma is required by the College of American Pathologists and the International Collaboration on Cancer Reporting. This manuscript reviews the clinical, pathologic, and molecular features of sarcomatoid RCC and rhabdoid RCC with emphasis on the morphologic features of these tumors, significance of diagnostic recognition, the molecular mechanisms of tumorigenesis and differentiation along sarcomatoid and rhabdoid lines, and advances in treatment, particularly immunotherapy.
Collapse
Affiliation(s)
| | - Brian Shuch
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
3
|
Zhao J, Ding X, Zhou S, Wang M, Peng C, Bai X, Zhang X, Liu K, Ma X, Zhang X, Wang H. Renal cell carcinoma and venous tumor thrombus: predicting sarcomatoid dedifferentiation through preoperative IVIM-based MR imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04210-1. [PMID: 38411691 DOI: 10.1007/s00261-024-04210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To evaluate the value of preoperative intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and conventional MRI indicators in identifying sarcomatoid dedifferentiation in renal cell carcinoma (RCC) and tumor thrombus. METHODS From September 2016 to April 2023, consecutive patients with RCC and tumor thrombus who received routine MRI examination and IVIM-DWI before radical resection were enrolled prospectively. Kaplan-Meier method with log-rank test was used to calculate and compare the survival probability. The preoperative imaging features were analyzed. Univariate and multivariable logistic regression analyses were employed to identify independent predictors of sarcomatoid dedifferentiation. The predictive ability was evaluated by receiver operating characteristic (ROC) curves. RESULTS Twenty-two patients (15.3%) of the 144 patients in the training set (median age, 58.0 years [IQR, 52.0-65.0 years]; 108 men) and 11 patients (22.4%) of the 49 patients in the test set (median age, 58.0 years [IQR, 53.0-63.0 years]; 38 men) had sarcomatoid dedifferentiated tumors. Patients with sarcomatoid-differentiated tumors had poor progress-free survival in the training set and test set (P < 0.001 and P = 0.007). f value (P = 0.011), mN stage (P = 0.007), and necrosis (P = 0.041) were independent predictors for predicting sarcomatoid dedifferentiation in the training set. The model combining conventional MRI features and f value had AUCs of 0.832 (95% CI 0.755-0.909) and 0.825 (95% CI 0.702-0.948) in predicting sarcomatoid dedifferentiation in the training set and test set. CONCLUSION It is feasible to preoperatively identify sarcomatoid dedifferentiation based on IVIM-DWI and conventional MR imaging indicators.
Collapse
Affiliation(s)
- Jian Zhao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
- Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, 614000, Sichuan, People's Republic of China
| | - Xiaohui Ding
- Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Shaopeng Zhou
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Meifeng Wang
- Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100037, People's Republic of China
| | - Cheng Peng
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xu Bai
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Xiaojing Zhang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China
| | - Kan Liu
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Haiyi Wang
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People's Republic of China.
| |
Collapse
|
4
|
Ullah A, Yasinzai AQK, Sakhalkar OV, Lee KT, Khan I, Tareen B, Wali A, Waheed A, Khan J, Andam G, Kakar K, Heneidi S, Karki NR. Demographic Patterns and Clinicopathological Analysis of Sarcomatoid Renal Cell Carcinoma in US Population. Clin Genitourin Cancer 2024; 22:38-46. [PMID: 37550179 DOI: 10.1016/j.clgc.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Sarcomatoid renal cell carcinoma (RCC) is defined by the presence of any amount of sarcomatoid components admixed with other RCC histologic subtypes. Our investigation utilizes a large, diverse set of sarcomatoid RCC patients to summarize clinical, demographic, and pathological factors along with demographic disparities that may affect the prognosis and survival of sarcomatoid RCC patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was employed to compile data from 2000 to 2018 from 2695 patients diagnosed with sarcomatoid RCC. RESULTS The mean age for sarcomatoid RCC diagnosis is 62.8 years. Males (68.2%) and White patients (82.6%) were more likely to be diagnosed with sarcomatoid RCC. Among the 64.4% of tumors with known size, 35.4% were less than 7 cm, 27.6% were 7.1 to 10 cm, and 36.4% were larger than 10 cm. Among the 95.8% of patients with known stage, 15.3% were localized, 28.9% were regionalized, and 55.8% were found in distant sites. Among the 44.2% of cases with known metastases site, lung was found to be the most common metastatic site.. Surgery was the most common treatment (70.9%). While the overall 5-year survival was 18.1%, it was 27.1% among patients who underwent surgery. Independent risk factors for mortality include age > 60 years, distant stage, and tumor size > 10 cm, per our multivariate analysis. CONCLUSION Sarcomatoid RCC most commonly affects White males in their seventh decade. Increased age, distant stage, and size > 10 cm tumor size have associations with unfavorable prognosis. Surgery is associated with better survival outcomes in localized disease and multimodal therapy (surgery with adjuvant chemoradiation was associated with better survival.).
Collapse
Affiliation(s)
- Asad Ullah
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX.
| | | | | | | | - Imran Khan
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Bisma Tareen
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Agha Wali
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA
| | - Jaffar Khan
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN
| | - Gul Andam
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Kaleemullah Kakar
- Department of Medicine, Bolan Medical College, Quetta, Balochistan, Pakistan
| | - Saleh Heneidi
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA
| | - Nabin R Karki
- Department of Medical Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL
| |
Collapse
|
5
|
Blum KA, Silagy AW, Knezevic A, Weng S, Wang A, Mano R, Marcon J, DiNatale RG, Sanchez A, Tickoo S, Gupta S, Motzer R, Haas NB, Kim SE, Uzzo RG, Coleman JA, Hakimi AA, Russo P. Localised non-metastatic sarcomatoid renal cell carcinoma: a 31-year externally verified study. BJU Int 2024; 133:169-178. [PMID: 37589200 PMCID: PMC10841268 DOI: 10.1111/bju.16125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To evaluate post-nephrectomy outcomes and predictors of cancer-specific survival (CSS) between patients with localised sarcomatoid renal cell carcinoma (sRCC) and those with Grade 4 RCC (non-sRCC), as most sRCC research focuses on advanced or metastatic disease with limited studies analysing outcomes of patients with localised non-metastatic sRCC. PATIENTS AND METHODS A total of 564 patients with localised RCC underwent partial or radical nephrectomy between June 1988 to March 2019 for sRCC (n = 204) or World Health Organization/International Society of Urological Pathology Grade 4 non-sRCC (n = 360). The CSS at every stage between groups was assessed. Phase III ASSURE clinical trial data were used to externally validate the CSS findings. The Mann-Whitney U-test and chi-squared test compared outcomes and the Kaplan-Meier method evaluated CSS, overall survival (OS) and recurrence-free survival. Clinicopathological features associated with RCC death were evaluated using Cox proportional hazards regression. RESULTS The median follow-up was 31.5 months. The median OS and CSS between the sRCC and Grade 4 non-sRCC groups was 45 vs 102 months and 49 vs 152 months, respectively (P < 0.001). At every stage, sRCC had worse CSS compared to Grade 4 non-sRCC. Notably, pT1 sRCC had worse CSS than pT3 Grade 4 non-sRCC. Negative predictors of CSS were sarcomatoid features, non-clear cell histology, positive margins, higher stage (pT3/pT4), and use of minimally invasive surgery (MIS). ASSURE external verification showed worse CSS in patients with sRCC (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.12-2.36; P = 0.01), but not worse outcomes in MIS surgery (HR 1.39, 95% CI 0.75-2.56; P = 0.30). CONCLUSIONS Localised sRCC had worse CSS compared to Grade 4 non-sRCC at every stage. Negative survival predictors included positive margins, higher pathological stage, use of MIS, and non-clear cell histology. sRCC is an aggressive variant even at low stages requiring vigilant surveillance and possible inclusion in adjuvant therapy trials.
Collapse
Affiliation(s)
- Kyle A. Blum
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew W. Silagy
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stanley Weng
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan Wang
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roy Mano
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Julian Marcon
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renzo G. DiNatale
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alejandro Sanchez
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Satish Tickoo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sounak Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Motzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Naomi B. Haas
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Se Eun Kim
- Department of Data Science, Dana Farber Cancer Center, Boston, MA
| | - Robert G. Uzzo
- Department of Surgical Oncology, Division of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Jonathan A. Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
6
|
Bersanelli M, Rebuzzi SE, Roviello G, Catalano M, Brunelli M, Rizzo M. Immune checkpoint inhibitors in non-conventional histologies of renal-cell carcinoma. Hum Vaccin Immunother 2023; 19:2171672. [PMID: 36758960 PMCID: PMC10012923 DOI: 10.1080/21645515.2023.2171672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
For years, prospective randomized clinical trials excluded patients with non-conventional histologies of renal cell carcinoma (RCC). The paucity of data has led to adopting the same treatment strategies used for clear-cell RCC (ccRCC). In the present narrative review, we explored state of the art about use of immune checkpoint inhibitors (ICIs) in variant histologies of RCC. According to the results collected, ICIs as monotherapy showed promising antitumor activity in advanced non-clear cell (ncc)RCC. The objective response rate (ORR) was similar to that observed with single-agent anti-PD-1 in the ccRCC population, either in the first-line or the second-line setting, and responder patients experienced an early and durable benefit. Combined ICI-based strategies have shown increasing evidence in nccRCC and robust results in the sarcomatoid variants of RCC. A definitive recommendation about treating non-conventional histologies, either in adjuvant or metastatic settings, should be supported by more extensive dedicated trials.
Collapse
Affiliation(s)
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | | | - Martina Catalano
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Matteo Brunelli
- Department of Pathology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Mimma Rizzo
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| |
Collapse
|
7
|
Hahn AW, Kotecha RR, Viscuse PV, Pieretti AC, Wiele AJ, Jonasch E, Lee CH, Gao J, Zurita AJ, Shah AY, Campbell MT, Sharma P, Motzer RJ, Russo P, Wood CG, Tannir NM, Voss MH, Karam JA, Hakimi AA, Msaouel P. Cytoreductive Nephrectomy for Patients with Metastatic Sarcomatoid and/or Rhabdoid Renal Cell Carcinoma Treated with Immune Checkpoint Therapy. Eur Urol Focus 2023; 9:734-741. [PMID: 36863962 PMCID: PMC10460829 DOI: 10.1016/j.euf.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/09/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) with sarcomatoid and/or rhabdoid (S/R) dedifferentiation is a highly aggressive tumor with a poor prognosis. Immune checkpoint therapy (ICT) has shown significant treatment efficacy in this subtype. There remains uncertainly regarding the role of cytoreductive nephrectomy (CN) for patients with metastatic RCC (mRCC) with S/R who received ICT. OBJECTIVE Here, we report the outcomes with ICT for patients with mRCC and S/R dedifferentiation by CN status. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was conducted of 157 patients with sarcomatoid, rhabdoid, or sarcomatoid plus rhabdoid dedifferentiation who received an ICT-based regimen at two cancer centers. INTERVENTION CN performed at any time point; nephrectomy with curative intent was excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS ICT treatment duration (TD) and overall survival (OS) from ICT initiation were recorded. To address the immortal time bias, a time-dependent Cox regression model was generated that accounted for confounders identified by a directed acyclic graph as well as a time-dependent nephrectomy variable. RESULTS AND LIMITATIONS A total of 118 patients underwent CN, and of them, 89 underwent upfront CN. The results did not contradict the supposition that CN does not improve ICT TD (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.65-1.47, p = 0.94) or OS from ICT initiation (HR 0.79, 95% CI 0.47-1.33, p = 0.37). In patients who underwent upfront CN compared with those who did not undergo CN, there was no association with ICT duration or OS (HR 0.61, 95% CI 0.35-1.06, p = 0.08). A detailed clinical summary of 49 patients with mRCC and rhabdoid dedifferentiation is provided. CONCLUSIONS In this multi-institutional cohort of mRCC with S/R dedifferentiation treated with ICT, CN was not significantly associated with improved TD or superior OS when accounting for the lead time bias. There appears to be a subset of patients who derive meaningful benefit from CN, so improved tools for stratification prior to CN are needed to optimize outcomes. PATIENT SUMMARY Immunotherapy has improved outcomes for patients with metastatic renal cell carcinoma (mRCC) who have sarcomatoid and/or rhabdoid (S/R) dedifferentiation, which is an aggressive and uncommon feature; yet, the utility of a nephrectomy in this setting is unclear. We found that nephrectomy did not significantly improve survival or time on immunotherapy for these patients with mRCC and S/R dedifferentiation; yet, there may be a subset of patients who benefit from this surgical approach.
Collapse
Affiliation(s)
- Andrew W Hahn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ritesh R Kotecha
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul V Viscuse
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Alberto C Pieretti
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chung-Han Lee
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amado J Zurita
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew T Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Padmanee Sharma
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Martin H Voss
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Ari Hakimi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
8
|
Gutiérrez Hidalgo B, Gómez Rivas J, de la Parra I, Marugán MJ, Serrano Á, Hermida Gutiérrez JF, Barrera J, Moreno-Sierra J. The Use of Radiomic Tools in Renal Mass Characterization. Diagnostics (Basel) 2023; 13:2743. [PMID: 37685281 PMCID: PMC10487148 DOI: 10.3390/diagnostics13172743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023] Open
Abstract
The incidence of renal mass detection has increased during recent decades, with an increased diagnosis of small renal masses, and a final benign diagnosis in some cases. To avoid unnecessary surgeries, there is an increasing interest in using radiomics tools to predict histological results, using radiological features. We performed a narrative review to evaluate the use of radiomics in renal mass characterization. Conventional images, such as computed tomography (CT) and magnetic resonance (MR), are the most common diagnostic tools in renal mass characterization. Distinguishing between benign and malignant tumors in small renal masses can be challenging using conventional methods. To improve subjective evaluation, the interest in using radiomics to obtain quantitative parameters from medical images has increased. Several studies have assessed this novel tool for renal mass characterization, comparing its ability to distinguish benign to malign tumors, the results in differentiating renal cell carcinoma subtypes, or the correlation with prognostic features, with other methods. In several studies, radiomic tools have shown a good accuracy in characterizing renal mass lesions. However, due to the heterogeneity in the radiomic model building, prospective and external validated studies are needed.
Collapse
Affiliation(s)
- Beatriz Gutiérrez Hidalgo
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - Juan Gómez Rivas
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - Irene de la Parra
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - María Jesús Marugán
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - Álvaro Serrano
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - Juan Fco Hermida Gutiérrez
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| | - Jerónimo Barrera
- Radiodiagnosis Department, Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain
| | - Jesús Moreno-Sierra
- Department of Urology, Clínico San Carlos Hospital, Health Research Institute of Clínico San Carlos Hospital, Complutense University, 28040 Madrid, Spain; (I.d.l.P.); (M.J.M.); (Á.S.); (J.F.H.G.); (J.M.-S.)
| |
Collapse
|
9
|
Perelli L, Carbone F, Zhang L, Huang JK, Le C, Khan H, Citron F, Del Poggetto E, Gutschner T, Tomihara H, Soeung M, Minelli R, Srinivasan S, Peoples M, Lam TNA, Lundgren S, Xia R, Zhu C, Mohamed AMT, Zhang J, Sircar K, Sgambato A, Gao J, Jonasch E, Draetta GF, Futreal A, Bakouny Z, Van Allen EM, Choueiri T, Signoretti S, Msaouel P, Litchfield K, Turajlic S, Wang L, Chen YB, Di Natale RG, Hakimi AA, Giuliani V, Heffernan TP, Viale A, Bristow CA, Tannir NM, Carugo A, Genovese G. Interferon signaling promotes tolerance to chromosomal instability during metastatic evolution in renal cancer. NATURE CANCER 2023; 4:984-1000. [PMID: 37365326 PMCID: PMC10368532 DOI: 10.1038/s43018-023-00584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Molecular routes to metastatic dissemination are critical determinants of aggressive cancers. Through in vivo CRISPR-Cas9 genome editing, we generated somatic mosaic genetically engineered models that faithfully recapitulate metastatic renal tumors. Disruption of 9p21 locus is an evolutionary driver to systemic disease through the rapid acquisition of complex karyotypes in cancer cells. Cross-species analysis revealed that recurrent patterns of copy number variations, including 21q loss and dysregulation of the interferon pathway, are major drivers of metastatic potential. In vitro and in vivo genomic engineering, leveraging loss-of-function studies, along with a model of partial trisomy of chromosome 21q, demonstrated a dosage-dependent effect of the interferon receptor genes cluster as an adaptive mechanism to deleterious chromosomal instability in metastatic progression. This work provides critical knowledge on drivers of renal cell carcinoma progression and defines the primary role of interferon signaling in constraining the propagation of aneuploid clones in cancer evolution.
Collapse
Affiliation(s)
- Luigi Perelli
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Federica Carbone
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Nerviano Medical Sciences, NMS Group Spa, Milan, Italy
| | - Li Zhang
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justin K Huang
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney Le
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hania Khan
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesca Citron
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edoardo Del Poggetto
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tony Gutschner
- Junior Research Group 'RNA Biology and Pathogenesis', Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hideo Tomihara
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melinda Soeung
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosalba Minelli
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjana Srinivasan
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Peoples
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Truong Nguyen Anh Lam
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sebastian Lundgren
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ruohan Xia
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cihui Zhu
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alaa M T Mohamed
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianhua Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kanishka Sircar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandro Sgambato
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - JianJun Gao
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Giulio F Draetta
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sabina Signoretti
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Linghua Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Bei Chen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renzo G Di Natale
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Ari Hakimi
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Virginia Giuliani
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy P Heffernan
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea Viale
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher A Bristow
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandro Carugo
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Biology, IRBM S.p.A., Rome, Italy.
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- TRACTION platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
10
|
Lasorsa F, di Meo NA, Rutigliano M, Milella M, Ferro M, Pandolfo SD, Crocetto F, Tataru OS, Autorino R, Battaglia M, Ditonno P, Lucarelli G. Immune Checkpoint Inhibitors in Renal Cell Carcinoma: Molecular Basis and Rationale for Their Use in Clinical Practice. Biomedicines 2023; 11:biomedicines11041071. [PMID: 37189689 DOI: 10.3390/biomedicines11041071] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Renal cell carcinoma (RCC) is the seventh most common cancer in men and the ninth most common cancer in women worldwide. There is plenty of evidence about the role of the immune system in surveillance against tumors. Thanks to a better understanding of immunosurveillance mechanisms, immunotherapy has been introduced as a promising cancer treatment in recent years. Renal cell carcinoma (RCC) has long been thought chemoresistant but highly immunogenic. Considering that up to 30% of the patients present metastatic disease at diagnosis, and around 20–30% of patients undergoing surgery will suffer recurrence, we need to identify novel therapeutic targets. The introduction of immune checkpoint inhibitors (ICIs) in the clinical management of RCC has revolutionized the therapeutic approach against this tumor. Several clinical trials have shown that therapy with ICIs in combination or ICIs and the tyrosine kinase inhibitor has a very good response rate. In this review article we summarize the mechanisms of immunity modulation and immune checkpoints in RCC and discuss the potential therapeutic strategies in renal cancer treatment.
Collapse
Affiliation(s)
- Francesco Lasorsa
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Nicola Antonio di Meo
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Monica Rutigliano
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Martina Milella
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Octavian Sabin Tataru
- The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Târgu Mureș, Romania
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Michele Battaglia
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70124 Bari, Italy
| |
Collapse
|
11
|
Teishima J, Murata D, Yukihiro K, Sekino Y, Inoue S, Hayashi T, Mita K, Hasegawa Y, Kato M, Kajiwara M, Shigeta M, Maruyama S, Moriyama H, Fujiwara S, Matsubara A. Significance of timing of therapeutic line on effectiveness of nivolumab for metastatic renal cell carcinoma. Curr Urol 2023; 17:52-57. [PMID: 37692134 PMCID: PMC10487289 DOI: 10.1097/cu9.0000000000000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 10/16/2022] Open
Abstract
Objectives This study aimed to clarify the significance of therapeutic timing on the effectiveness of nivolumab for treating metastatic renal cell carcinoma. Marterials and methods Fifty-eight patients with metastatic renal cell carcinoma treated with nivolumab monotherapy were retrospectively studied. Patients who were treated with nivolumab as second-line therapy were included in the second-line group, while the others were included in the later-line group. The clinicopathological characteristics, effects of nivolumab, and prognoses of these groups were compared. Results Twenty and thirty-eight patients were included in the second-line and later-line groups, respectively. There were no significant differences in the distribution of International Metastatic Renal Cell Carcinoma Database Consotium risk and other clinicopathological characteristics between the 2 groups. The proportion of patients whose objective best response was progressive disease in the second-line group was significantly lower than that in the later-line group (15% vs. 50%, p = 0.0090). The 50% progression-free survival with nivolumab in the second-line group was significantly better than that in the later-line group (not reached and 5 months, p = 0.0018). Multivariate analysis showed that the second-line setting was an independent predictive factor for better progression-free survival (p = 0.0028, hazard ratio = 0.108). The 50% overall survival after starting nivolumab in the second-line and later-line groups was not reached and 27.8 months, respectively (p = 0.2652). Conclusions The therapeutic efficacy of nivolumab as second-line therapy is expected to be better than that of later therapy.
Collapse
Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daiki Murata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuma Yukihiro
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koji Mita
- Department of Urology, Hiroshima-City Asa Citizens Hospital, Hiroshima, Japan
| | | | - Masao Kato
- Department of Urology, Hiroshima General Hospital, Hatsukaichi, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Masanobu Shigeta
- Department of Urology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | | | | | - Seiji Fujiwara
- Department of Urology, Higashi-Hiroshima Medical Center, Higashi-Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Urology, Hiroshima General Hospital, Hatsukaichi, Japan
| |
Collapse
|
12
|
Climent C, Soriano S, Bonfill T, Lopez N, Rodriguez M, Sierra M, Andreu P, Fragio M, Busquets M, Carrasco A, Cano O, Seguí MA, Gallardo E. The role of immunotherapy in non-clear cell renal cell carcinoma. Front Oncol 2023; 13:941835. [PMID: 36816976 PMCID: PMC9936973 DOI: 10.3389/fonc.2023.941835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
The category of non-clear cell renal cell carcinoma (nccRCC) includes several clinically, histologically, and molecularly diverse entities. Traditionally, they comprise type 1 and type 2 papillary, chromophobe, unclassified, and other histologies (medullary, collecting duct carcinoma, and translocation-associated). Molecular knowledge has allowed the identification of some other specific subtypes, such as fumarate hydratase-deficient renal cell carcinoma (RCC) or succinate dehydrogenase-associated RCC. In addition, it has recognized some alterations with a possible predictive role, e.g., MET proto-oncogene receptor tyrosine kinase (MET) alterations in papillary tumors. Standard therapies for the management of advanced clear cell RCC (ccRCC), i.e., vascular endothelial growth factor receptor (VEGFR) pathway inhibitors and mammalian target of rapamycin inhibitors, have shown poorer results in nccRCC patients. Therefore, there is a need to improve the efficacy of the treatment for advanced nccRCC. Immunotherapy, especially immune checkpoint inhibitors (ICIs) targeting programmed death 1/programmed death ligand 1 and cytotoxic T-lymphocyte associated protein 4 (CTLA-4), has demonstrated a significant survival benefit in several malignant neoplasias, including ccRCC, with a proportion of patients achieving long survival. The combinations of ICI or ICI + VEGFR tyrosine kinase inhibitors (TKIs) are the standard of care in advanced ccRCC. Unfortunately, major pivotal trials did not include specific nccRCC populations. In recent years, several studies have retrospectively or prospectively evaluated ICIs alone or in combination with another ICI or with TKIs in nccRCC patients. In this article, we review data from available trials in order to elucidate clinical and molecular profiles that could benefit from immunotherapy approaches.
Collapse
|
13
|
Tully KH, Berg S, Paciotti M, Janisch F, Reese SW, Noldus J, Shariat SF, Choueiri T, Müller G, McGregor B, Chang SL, Trinh QD, Mossanen M. The Natural History of Renal-Cell Carcinoma with Sarcomatoid Differentiation, a Stage-by-Stage Analysis. Clin Genitourin Cancer 2023; 21:63-68. [PMID: 36517393 DOI: 10.1016/j.clgc.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sarcomatoid differentiation in patients diagnosed with renal cell carcinoma (sRCC) imply aggressive behavior and often metastatic disease at the time of diagnosis. We aim to examine the overall survival (OS) in patients with sRCC using the National Cancer Database (NCDB). MATERIALS AND METHODS We identified patients diagnosed with sRCC between 2010-2015. We employed Kaplan-Meier curves and multivariable Cox proportional hazards regression models to examine the impact of several potential risk factors on OS in patients diagnosed with sRCC. RESULTS In total, 8582 patients with renal cancer were found to have sarcomatoid differentiation, with 4105 patients (47.8%) being diagnosed with AJCC stage IV disease. The median OS was 17.2 months (IQR 5.4, 68.7 months). Compared to patients who did not undergo surgery, OS was significantly longer in patients undergoing partial or total nephrectomy across all stages. This result remained consistent on multivariable Cox proportional hazards regression adjusting for patient and tumor characteristics (Surgery: Hazard ratio 0.54, 95%Confidence interval 0.43 - 0.68, P < .001). CONCLUSION In our cohort sRCC was found to have an unfavorable median OS, which was mainly caused by the high number of cases diagnosed with late-stage disease. Additionally, surgery was associated with favorable OS across all stages. This study supports the notion that surgical therapy, even in the setting of cytoreductive surgery, provides a survival benefit in patients with sRCC.
Collapse
Affiliation(s)
- Karl H Tully
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sebastian Berg
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marco Paciotti
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Hamburg, Hamburg, Germany
| | - Stephen W Reese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Hamburg, Hamburg, Germany; Department of Urology, Weill Cornell Medical School, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Toni Choueiri
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Guido Müller
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany; Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
| | - Bradley McGregor
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Mossanen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
14
|
Rini BI, Signoretti S, Choueiri TK, McDermott DF, Motzer RJ, George S, Powles T, Donskov F, Tykodi SS, Pal SK, Gupta S, Lee CW, Jiang R, Tannir NM. Long-term outcomes with nivolumab plus ipilimumab versus sunitinib in first-line treatment of patients with advanced sarcomatoid renal cell carcinoma. J Immunother Cancer 2022; 10:jitc-2022-005445. [PMID: 36549781 PMCID: PMC9791431 DOI: 10.1136/jitc-2022-005445] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with advanced renal cell carcinoma with sarcomatoid features (sRCC) have a poor prognosis and limited therapeutic options. First-line nivolumab plus ipilimumab (NIVO+IPI) provided efficacy benefits over sunitinib (SUN) in patients with intermediate/poor-risk sRCC at 42 months minimum follow-up in the phase 3 CheckMate 214 trial. In this exploratory post hoc analysis, we report clinical efficacy of NIVO+IPI in sRCC after a minimum follow-up of 5 years. METHODS In CheckMate 214, patients with clear cell advanced RCC were randomized to NIVO 3 mg/kg plus IPI 1 mg/kg every 3 weeks (four doses), then NIVO 3 mg/kg every 2 weeks versus SUN 50 mg once daily (4 weeks; 6-week cycles). Randomized patients with sRCC were identified via independent central pathology review of archival tumor tissue or histological classification per local pathology report. Overall survival (OS), as well as progression-free survival (PFS) and objective response rate (ORR) per independent radiology review using Response Evaluation Criteria in Solid Tumors V.1.1, were evaluated in all International Metastatic Renal Cell Carcinoma Database Consortium intermediate/poor-risk sRCC patients and by baseline tumor PD-L1 expression level (≥1% vs <1%). Safety outcomes are reported using descriptive statistics. RESULTS In total, 139 patients with intermediate/poor-risk sRCC were identified (NIVO+IPI, n=74; SUN, n=65). At 5 years minimum follow-up, more patients remained on treatment with NIVO+IPI versus SUN (12% vs zero). Efficacy benefits with NIVO+IPI versus SUN were maintained with median OS of 48.6 vs 14.2 months (HR 0.46), median PFS of 26.5 vs 5.5 months (HR 0.50), and ORR 60.8% vs 23.1%. In addition, median duration of response was longer (not reached vs 25.1 months), and more patients had complete responses (23.0% vs 6.2%) with NIVO+IPI versus SUN, respectively. Efficacy was better with NIVO+IPI versus SUN regardless of tumor PD-L1 expression, but the magnitude of OS, PFS, and ORR benefits with NIVO+IPI was greater for sRCC patients with tumor PD-L1 ≥1%. No new safety signals emerged in either arm with longer follow-up. CONCLUSIONS Among patients with intermediate/poor-risk sRCC, NIVO+IPI maintained long-term survival benefits and demonstrated durable and deep responses over SUN at minimum follow-up of 5 years, supporting NIVO+IPI as a preferred first-line therapy in this population. TRIAL REGISTRATION NUMBER NCT02231749.
Collapse
Affiliation(s)
- Brian I Rini
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA,Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, USA
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Thomas Powles
- Department of Urology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust, London, UK
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Scott S Tykodi
- Department of Medicine, University of Washington and Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, USA
| | - Saurabh Gupta
- Department of Translational Medicine, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Chung-Wei Lee
- Department of Clinical Trials, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Ruiyun Jiang
- Division of Biostatistics, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
15
|
Hahn AW, Lebenthal J, Genovese G, Sircar K, Tannir NM, Msaouel P. The significance of sarcomatoid and rhabdoid dedifferentiation in renal cell carcinoma. Cancer Treat Res Commun 2022; 33:100640. [PMID: 36174377 DOI: 10.1016/j.ctarc.2022.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
Dedifferentiation in renal cell carcinoma (RCC), either sarcomatoid or rhabdoid, is an infrequent event that may occur heterogeneously in the setting of any RCC histology and is associated with poor outcomes. Sarcomatoid dedifferentiation is associated with inferior survival with angiogenesis targeted therapy and infrequent responses to cytotoxic chemotherapy. However, immune checkpoint therapy has significantly improved outcomes for patients with sarcomatoid dedifferentiation. Biologically, sarcomatoid dedifferentiation has increased programmed death-ligand 1 (PD-L1) expression and an inflamed tumor microenvironment, in addition to other distinct molecular alterations. Less is known about rhabdoid dedifferentiation from either a clinical, biological, or therapeutic perspective. In this focused review, we will discuss the prognostic implications, outcomes with systemic therapy, and underlying biology in RCC with either sarcomatoid or rhabdoid dedifferentiation present.
Collapse
Affiliation(s)
- Andrew W Hahn
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Justin Lebenthal
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Kanishka Sircar
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| |
Collapse
|
16
|
Warli SM, Andy A, Mariedina CT, Nasution R, Kadar DD. A Rare Case of Sarcomatoid Renal Cell Carcinoma in a Young Adult Patient. Res Rep Urol 2022; 14:241-245. [PMID: 35734241 PMCID: PMC9208668 DOI: 10.2147/rru.s370975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Sarcomatoid differentiation is a rare condition that could present in different subtypes of renal cell carcinomas (RCCs) and is associated with a significantly poor prognosis. Sarcomatoid renal cell carcinoma (SRCC) patients are typically aged between 54 and 63, with a male-to-female ratio ranging from 1.3:1 to 2:1. Here, we report a case of SRCC in a 29-year-old female patient. Case Presentation A 29-year-old female presented with left flank pain. A large lump was palpated on left flank and there was costovertebral angle tenderness. The lump was enlarged, and the patient also suffered from anemia. Abdominopelvic CT demonstrated solid mass with an internal gliosis in the left part of the renal cortex and the solid component was enhanced with contrast admission. Then, the patient underwent left radical nephrectomy with wide perirenal excision and paraaortic lymph nodes resection. Histopathological examination revealed SRCC with no lymphovascular invasion. Conclusion The scarcity of data on SRCCs emphasizes the need for ongoing research into the biology, diagnostics, and effective treatment options for patients with this disease, as responses to conventional therapies have been disappointing, leaving patients with few options. Cytoreductive nephrectomy for SRCC patients with metastatic disease is debatable, although some research suggests resection at any stage in patients with good performance status. In this case, radical nephrectomy was performed and there was no evidence of metastasis.
Collapse
Affiliation(s)
- Syah Mirsya Warli
- Department of Urology, Universitas Sumatera Utara Hospital – Universitas Sumatera Utara, Medan, Indonesia
- Correspondence: Syah Mirsya Warli, Department of Urology, Universitas Sumatera Utara Hospital – Universitas Sumatera Utara, Medan, Indonesia, Tel +6261-8218928, Email
| | - Andy Andy
- Division of Urology, Department of Surgery, Haji Adam Malik General Hospital – Universitas Sumatera Utara, Medan, Indonesia
| | | | - Ramlan Nasution
- Division of Urology, Department of Surgery, Haji Adam Malik General Hospital – Universitas Sumatera Utara, Medan, Indonesia
| | - Dhirajaya Dharma Kadar
- Division of Urology, Department of Surgery, Haji Adam Malik General Hospital – Universitas Sumatera Utara, Medan, Indonesia
| |
Collapse
|
17
|
Magnetic resonance imaging (MRI) helps differentiate renal cell carcinoma with sarcomatoid differentiation from renal cell carcinoma without sarcomatoid differentiation. Abdom Radiol (NY) 2022; 47:2168-2177. [PMID: 35381868 DOI: 10.1007/s00261-022-03501-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of the present study is to identify predictive imaging findings and construct a diagnostic model for differentiating renal cell carcinoma (RCC) with and without sarcomatoid dedifferentiation (sRCC and non-sRCC). METHODS This study is a single-center retrospective study. All patients had magnetic resonance imaging (MRI) with gradient-echo T1-weighted images, single-shot T2-weighted images (T2WI), and enhanced nephrographic phase images. Forty pathologically confirmed sRCCs and 80 non-sRCCs were included in this study. Control cases were selected by matching the tumor diameter and the year of MRI. Two radiologists independently evaluated the following findings: growth pattern, presence of low-intensity area on T2WI in the tumor (T2LIA), presence of non-enhancing area, local tumor stage, and presence of regional lymphadenopathy. Two radiologists measured the diameter of the tumor, T2LIA, and the non-enhancing area. Multivariable logistic regression analysis was used to identify independent predictive factors for differentiating sRCC from non-sRCC. Selected variables were entered in the logistic regression model, and the area under the curve (AUC) was calculated for each reader with 95% confidence intervals (CIs). RESULTS Larger T2LIA-to-tumor diameter ratio, regional lymphadenopathy, and local tumor stage 4 were associated with sRCC, and selected for the subsequent construction of a logistic regression model. With this model, the AUCs were 0.76 (95% CI, 0.66-0.85) and 0.70 (95% CI, 0.59-0.81) for prediction of sRCC. CONCLUSION In conclusion, larger T2LIA-to-tumor diameter ratio, regional lymphadenopathy, and local tumor stage 4 are predictive findings of sRCC. As a result, the model constructed using these findings demonstrated a moderate degree of diagnostic accuracy.
Collapse
|
18
|
Al-Juhaishi T, Deng X, Bandyopadhyay D, Paul A. The Role of Cytoreductive Nephrectomy and Targeted Therapy on Outcomes of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: A Population-Based Analysis. Cureus 2022; 14:e25395. [PMID: 35774668 PMCID: PMC9236690 DOI: 10.7759/cureus.25395] [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] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is a rare but aggressive form of kidney cancer with a poor prognosis. Despite recent advances in therapies for kidney cancers, an effective management strategy for sRCC is uncertain. We evaluated the impact of targeted therapy and cytoreductive nephrectomy (CN) on survival outcomes of patients with metastatic sRCC. We identified patients diagnosed with sRCC between January 1, 1973, and December 31, 2014, within the Surveillance, Epidemiology and End Results (SEER) database. Patients with metastatic sRCC were stratified based on the era of diagnosis (before or after the introduction of targeted systemic therapy in 2006) and the status of CN. Cancer-specific survival (CSS) and overall survival (OS) were analyzed. Data of 993 patients with metastatic sRCC were available for analysis. The median age was 62 years. Most patients were male (69%), Caucasian (71%), and were diagnosed in the targeted therapy era (83%); 53% of patients underwent CN. CSS and OS of the whole cohort were 5.0 months and 4.0 months, respectively. While the introduction of targeted therapy did not improve outcomes, CN improved CSS and OS in both pre-targeted therapy and targeted therapy era. On multivariable analysis, CN was a predictor of an improved CSS (hazard ratio [HR] 0.54, p < 0.0001) and OS (HR 0.51, p < 0.0001). Among other factors, older age at diagnosis, higher T stages, and node positivity were associated with worse outcomes. Our results showed that the introduction of targeted therapy did not improve outcomes in patients with metastatic sRCC. CN improved survival in both pre-targeted and targeted therapy eras.
Collapse
|
19
|
Zhang Y, Hu J, Yang J, Xie Y, Chen Z, Shangguan W, Han J, He W, Yang J, Zheng Z, Zhong Q, Zhu D, Xie W. Selection of Optimal Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Clear Cell Renal Cell Carcinoma: A Predictive Model Based on SEER Database. Front Oncol 2022; 12:814512. [PMID: 35127544 PMCID: PMC8814440 DOI: 10.3389/fonc.2022.814512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/03/2022] [Indexed: 12/27/2022] Open
Abstract
Background Currently, the progress of targeted drugs in the treatment of metastatic clear cell renal cell carcinoma (mccRCC) is limited. Cytoreductive nephrectomy (CN), as an alternative treatment, can improve the prognosis of patients with metastatic renal cell carcinoma to some extent. However, it is unclear which patients would benefit from this tumor reduction operation. As a consequence, we developed a predictive model to identify patients who may well benefit from CN in terms of survival. Methods We identified patients with metastatic clear cell renal cell carcinoma retrospectively from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015) and classified them into surgery and non-surgery groups. Propensity score matching (PSM) was performed to balance the baseline characteristics. Patients who survived longer than the median overall survival (OS) of no-surgery group were defined as surgical-benefit patients. Then, we developed a predictive model based on preoperative characteristics using multivariable Logistic regression. Calibration curves and the area under the receiver operating characteristic (AUC) were used to evaluate the efficiency of the predictive model. The clinical value of the nomogram was assessed utilizing decision curve analysis (DCA). Results Our study collected 5544 patients from the SEER database, with 2352(42.4%) receiving cytoreductive surgery. Overall survival (OS) was longer in the CN group than in the non-surgery group after 1:1 propensity scoring matching (median OS: 19 months vs 7 months; hazard ratio (HR) =0.4106, P< 0.001). In the matched surgery group, 65.7% (367) patients survived more than 7 months after the operation and they were considered to benefit from CN. The predictive model performed well on both the training group (AUC=73.4%) and the validation group (AUC=71.9%) and the calibration curves indicated a high degree of consistency. The decision curve analysis curve demonstrated the clinical utility. We classified surgical patients into the beneficial group and non-beneficial group by using the predictive model, then discovered a substantial difference in OS between the two groups. Conclusions We developed a nomogram to select ideal mccRCC patients who might benefit from cytoreductive nephrectomy. Clinicians could make a more precise treatment strategy for mccRCC patients.
Collapse
Affiliation(s)
- Yishan Zhang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Jintao Hu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Jingtian Yang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Yingwei Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Zhiliang Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Wentai Shangguan
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Jinli Han
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Wang He
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Jingyin Yang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Zaosong Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Qiyu Zhong
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Dingjun Zhu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| | - Wenlian Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Clinical Research Center for Urological Diseases, Guangzhou, China
| |
Collapse
|
20
|
Candelario N, Geiger C, Flaig T. Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is an aggressive form of kidney cancer that is associated with poor prognosis. It can arise from any histologic type of renal cell carcinoma. The majority of cases will present with advanced or metastatic disease requiring systemic therapy. Nephrectomy is the treatment of choice in locally resectable disease. The therapeutic options for sRCC have evolved in the past decade. Cytotoxic chemotherapy and monotherapy with targeted therapy (VEGF and mTOR) have historically shown poor response rates and survival in the treatment of metastatic sRCC. The use of checkpoint inhibitors and their combination with targeted therapy against VEGF has changed the landscape and outcomes for renal cell carcinoma. Given the rarity of sRCC most of the data on treatment is from small cohorts or extrapolation from larger clinical trials. The benefit from the combination of checkpoint inhibitors and targeted therapy to VEGF has shown promise in the sRCC population in post hoc analysis of large clinical trials. Future research focusing on further characterizing the unique biologic and clinical features of sRCC is critical in advancing the knowledge and developing effective therapy to improve clinical outcomes and survival.
Collapse
Affiliation(s)
- Nellowe Candelario
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher Geiger
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Flaig
- University of Colorado Cancer Center, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Medical Oncology, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
21
|
Buti S, Bersanelli M, Mazzaschi G, Cattrini C, Brunelli M, Maio MD. Can we identify a preferred first-line strategy for sarcomatoid renal cell carcinoma? A network meta-analysis. Immunotherapy 2021; 14:145-153. [PMID: 34806404 DOI: 10.2217/imt-2021-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Combinations based on immune checkpoint inhibitors are the new first-line standard treatment for metastatic renal cell carcinoma. Sarcomatoid renal cell carcinoma (sRCC) has a dismal prognosis but good immunogenicity. Methods: The authors performed a network meta-analysis of Phase III randomized trials of immune checkpoint inhibitor-based combinations versus standard tyrosine kinase inhibitor monotherapy reporting data for sRCC. The endpoints were overall survival, progression-free survival and objective response rate. Results: Five trials comprising 569 sRCC patients (out of a total of 4409 metastatic renal cell carcinoma patients) were included. Nivolumab-cabozantinib was the highest ranking treatment for overall survival (p-value = 88%) and progression-free survival (p-value = 81%). Atezolizumab-bevacizumab had the highest rank for objective response rate (p-value = 80%). Conclusion: Despite some limitations, nivolumab-cabozantinib might be the preferred first-line option for sRCC in terms of efficacy.
Collapse
Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy.,Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, 43126, Italy.,Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
| | - Carlo Cattrini
- Division of Oncology, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Matteo Brunelli
- Pathology Unit, Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Ordine Mauriziano Hospital, Torino, 10128, Italy
| |
Collapse
|
22
|
Durable Remission with Immunotherapy in a Patient with Sarcomatoid Renal Cell Carcinoma. J Kidney Cancer VHL 2021; 8:38-42. [PMID: 34765405 PMCID: PMC8557255 DOI: 10.15586/jkcvhl.v8i4.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Sarcomatoid differentiation is a rare and aggressive histologic subtype with poor prognosis, seen in several malignancies. In sarcomatoid renal cell carcinoma (RCC), the degree of sarcomatoid differentiation and the stage at presentation determines the prognosis. Despite resection, chemotherapy and targeted therapy response is modest, with relapse usually occurring within a few months. We present a case of a gentleman with sarcomatoid RCC managed with pembrolizumab, who has had no evidence of recurrence for over 4 years since the last dose of immunotherapy. RCCs with sarcomatoid differentiation have a high presence of programmed cell death protein 1 and programmed cell death ligand 1 in T cells and tumor cells, respectively, making immunotherapy an attractive option in this setting. Clinical trials are ongoing to further define the benefit of immunotherapy in sarcomatoid RCC.
Collapse
|
23
|
Wiele AJ, Bathala TK, Hahn AW, Xiao L, Duran M, Ross JA, Jonasch E, Shah AY, Campbell MT, Msaouel P, Tannir NM. Lenvatinib with or Without Everolimus in Patients with Metastatic Renal Cell Carcinoma After Immune Checkpoint Inhibitors and Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitor Therapies. Oncologist 2021; 26:476-482. [PMID: 33792094 PMCID: PMC8176993 DOI: 10.1002/onco.13770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/18/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Lenvatinib (Len) plus everolimus (Eve) is an approved therapy for metastatic renal cell carcinoma (mRCC) after first-line vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs), but limited data exist on the efficacy of Len ± Eve after progression on immune checkpoint inhibitors (ICIs) and VEGFR-TKIs. METHODS We retrospectively reviewed the records of patients with mRCC at our institution who were treated with Len ± Eve after ICI and VEGFR-TKI. A blinded radiologist assessed objective response as defined by RECIST version 1.1. Descriptive statistics and the Kaplan-Meier method were used. RESULTS Fifty-five patients were included in the analysis. Of these patients, 81.8% had clear-cell histology (ccRCC), and 76.4% had International Metastatic RCC Database Consortium intermediate-risk disease. Median number of prior therapies was four (range, 2-10); all patients had prior ICIs and VEGFR-TKIs, and 80% were previously treated with ICI and at least two VEGFR-TKIs, including cabozantinib. One patient (1.8%) achieved a complete response, and 11 patients (20.0%) achieved a partial response, for an overall response rate (ORR) of 21.8%; 35 patients (63.6%) achieved stable disease. In all patients, median progression-free survival (PFS) was 6.2 months (95% confidence interval [CI], 4.8-9.4) and median overall survival (OS) was 12.1 months (95% CI, 8.8-16.0). In patients with ccRCC, ORR was 24.4%, PFS was 7.1 months (95% CI, 5.0-10.5), and OS was 11.7 months (95% CI, 7.9-16.1). 50.9% of patients required dose reductions and 7.3% discontinued treatment because of toxicity. CONCLUSION Len ± Eve demonstrated meaningful clinical activity and tolerability in heavily pretreated patients with mRCC after disease progression with prior ICIs and VEGFR-TKIs. IMPLICATIONS FOR PRACTICE As the therapeutic landscape for patients with metastatic renal cell carcinoma continues to evolve, this single-center, retrospective review highlights the real-world efficacy of lenvatinib with or without everolimus in heavily pretreated patients. This article supports the use of lenvatinib with or without everolimus as a viable salvage strategy for patients whose disease progresses after treatment with immune checkpoint inhibitors and vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapies, including cabozantinib.
Collapse
Affiliation(s)
- Andrew J. Wiele
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tharakeswara K. Bathala
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Andrew W. Hahn
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Munevver Duran
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jeremy A. Ross
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Amishi Y. Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Matthew T. Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nizar M. Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| |
Collapse
|
24
|
Martini DJ, Kline MR, Liu Y, Shabto JM, Carthon BC, Russler GA, Yantorni L, Hitron EE, Caulfield S, Goldman JM, Harris WB, Kucuk O, Master VA, Bilen MA. Novel risk scoring system for metastatic renal cell carcinoma patients treated with cabozantinib. Cancer Treat Res Commun 2021; 28:100393. [PMID: 34029879 PMCID: PMC8405548 DOI: 10.1016/j.ctarc.2021.100393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cabozantinib is an effective treatment for metastatic renal cell carcinoma (mRCC). The international mRCC database consortium (IMDC) criteria is the gold standard for risk stratification in mRCC. We created a risk scoring system specific for mRCC patients treated with cabozantinib. METHODS We conducted a retrospective review of 87 patients with mRCC treated with cabozantinib at Winship Cancer Institute from 2015 to 2019. Overall survival (OS) and progression free survival (PFS) were used to measure clinical outcomes. Upon variable selection in multivariable analysis (MVA), elevated baseline monocyte-to-lymphocyte ratio (MLR), sarcomatoid histologic component, ECOG PS > 1, and absence of bone metastases were each assigned 1 point. A three-group risk scoring system was then created: low (score=0-1), intermediate (score=2), and high risk (score=3-4). The Cox proportional hazard model and Kaplan-Meier method were used for survival analyses. RESULTS The median age was 62 years-old and the majority were males (71%) with clear-cell RCC (75%). Most (67%) received at least 1 prior line of systemic therapy. High risk and intermediate risk pts had significantly shorter OS (high risk HR: 13.84, p<0.001; intermediate risk HR: 3.50, p = 0.004) and PFS (high risk HR: 7.31, p<0.001; intermediate risk HR: 1.87, p = 0.053) compared to low risk patients in MVA. CONCLUSIONS RCC patients treated with cabozantinib may benefit from specific risk stratification criteria using RCC histology, ECOG PS, sites of metastatic disease, and MLR. These variables are easily accessible in the clinical setting and may be helpful to determine which mRCC patients may benefit from treatment with cabozantinib.
Collapse
Affiliation(s)
- Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Meredith R Kline
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Julie M Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, GA, USA; Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jamie M Goldman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA.
| |
Collapse
|
25
|
Tachibana H, Kondo T, Ishihara H, Fukuda H, Yoshida K, Takagi T, Izuka J, Kobayashi H, Tanabe K. Modest efficacy of nivolumab plus ipilimumab in patients with papillary renal cell carcinoma. Jpn J Clin Oncol 2021; 51:646-653. [PMID: 33212488 DOI: 10.1093/jjco/hyaa229] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Combined immunotherapy of nivolumab plus ipilimumab for intermediate- and poor-risk metastatic clear cell renal cell carcinoma showed prolonged progression-free survival and high objective response rate in a randomized phase III clinical trial. However, the efficacy of this treatment for papillary renal cell carcinoma remains unclear. In the present study, we analysed the efficacy of nivolumab plus ipilimumab therapy for papillary renal cell carcinoma compared with that for clear cell renal cell carcinoma. MATERIALS AND METHODS This is a retrospective study of 30 patients with metastatic renal cell carcinoma who received nivolumab and ipilimumab as first-line therapy between December 2015 and May 2020. The objective response rate, progression-free survival and toxicity were compared between the two groups (clear cell renal cell carcinoma and papillary renal cell carcinoma). RESULTS Out of 30 patients, 7 and 23 were diagnosed with papillary renal cell carcinoma and clear cell renal cell carcinoma, respectively. With a median follow-up of 7.2 months, the median progression-free survival was significantly shorter in papillary renal cell carcinoma than in clear cell renal cell carcinoma (2.4 vs. 28.1 months, P = 0.014). Of the seven patients with papillary renal cell carcinoma, one had partial response, one had stable disease and five had progressive disease, resulting in an objective response rate of 14.2%, which was lower compared to that of clear cell renal cell carcinoma (14.2 vs. 52.1%, P = 0.06). Discontinuation due to toxicity was not observed with papillary renal cell carcinoma, meanwhile 60.8% of patient with clear cell renal cell carcinoma discontinued treatment due to toxicity. CONCLUSION Nivolumab plus ipilimumab had modest efficacy for papillary renal cell carcinoma compared with that for clear cell renal cell carcinoma. Nivolumab plus ipilimumab remains an option for a limited number of patients with intermediate- or poor-risk papillary renal cell carcinoma.
Collapse
Affiliation(s)
- Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | - Junpei Izuka
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University Tokyo, Tokyo, Japan
| |
Collapse
|
26
|
Zoumpourlis P, Genovese G, Tannir NM, Msaouel P. Systemic Therapies for the Management of Non-Clear Cell Renal Cell Carcinoma: What Works, What Doesn't, and What the Future Holds. Clin Genitourin Cancer 2021; 19:103-116. [PMID: 33358151 PMCID: PMC8169717 DOI: 10.1016/j.clgc.2020.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/31/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Non-clear cell renal cell carcinoma (nccRCC) is a broad term that refers to a diverse group of tumors, each with its own distinct biologic and therapeutic profile. The management of nccRCCs is often based on extrapolating data from clinical trials in the more common clear cell renal cell carcinoma, but our emerging prospective and retrospective clinical experience in nccRCC allows us to make more precise recommendations tailored to each histology. The systemic therapy options for metastatic nccRCC include targeted therapies such as tyrosine kinase inhibitors, immune checkpoint inhibitors, and, for specific rare subtypes, cytotoxic chemotherapy. Each nccRCC histology may respond differently to these regimens, which makes accurate pathologic diagnosis imperative. In the present review, we discuss the available clinical and biological data that can help guide systemic therapy recommendations for specific nccRCC subtypes.
Collapse
Affiliation(s)
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX.
| |
Collapse
|
27
|
Adashek JJ, Zhang Y, Skelton WP, Bilotta A, Chahoud J, Zemp L, Li J, Dhillon J, Manley B, Spiess PE. Dissecting Outcomes: Should Cytoreductive Nephrectomy Be Performed for Patients With Metastatic Renal Cell Carcinoma With Sarcomatoid Dedifferentiation? Front Oncol 2021; 10:627025. [PMID: 33643921 PMCID: PMC7902859 DOI: 10.3389/fonc.2020.627025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/30/2020] [Indexed: 01/22/2023] Open
Abstract
Background It is highly contested whether cytoreductive nephrectomy for treating advanced renal cell carcinoma (RCC) with sarcomatoid features (sRCC) benefits overall survival. Patients with sRCC are known to have a poor prognosis, and these tumors have a more aggressive biology than those without sarcomatoid features. Methods Patients with clear cell RCC or non–clear cell RCC underwent cytoreductive nephrectomy in efforts to improve overall survival (OS). Patients were stratified by presence or absence of histologic sarcomatoid features within tumor samples. Results Of 167 patients who underwent cytoreductive nephrectomy, 127 had clear cell RCC, of whom 14 had sarcomatoid features, and 40 had non–clear cell RCC, of whom 13 had sarcomatoid features. Median age of the cohort was 62 years (range, 56.5–69 years). The cohort included 119 male (71.3%) and 48 (28.7%) female patients. Among all patients with advanced RCC, having sRCC had a significantly worse OS after cytoreductive nephrectomy (30 vs 8 months; hazard ratio [HR], 2.88; P <0.0001). Additionally, favorable-risk patients had significantly longer OS compared to intermediate- or poor-risk patients (56 vs 30 vs 10 months; HR, 0.21; P =0.00016). For patients with clear cell RCC, having sRCC conferred a significantly poorer survival (30 vs 9 months; HR, 2.82; P=0.0035). Patients with non–clear cell sRCC also had significantly worse outcomes compared to patients whose tumors did not have sarcomatoid features (30 vs 6.5 months; HR, 3; P =0.009). When patients with sRCC were stratified by whether there was >10% or ≤10% sarcomatoid features present within the sample, there was no significant difference in OS (8 vs 8.5 months; P =0.32). Conclusions Sarcomatoid features within tumor histology confer significantly poor prognosis. Patients with sRCC, regardless of clear cell vs non–clear cell histology, have significantly shorter OS. Even among patients with 10% or less sarcomatoid features, there was no OS benefit to cytoreductive nephrectomy. Based on our findings, there appears to be a limited to no role of cytoreductive nephrectomy if sRCC is identified on pretreatment biopsy. The role of radiomics and pre-operative biopsies may confer significant benefit in this patient population.
Collapse
Affiliation(s)
- Jacob J Adashek
- Department of Internal Medicine, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, United States
| | - Yumeng Zhang
- Division of Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, United States
| | - William Paul Skelton
- Division of Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, United States
| | - Alyssa Bilotta
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Jiannong Li
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Brandon Manley
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, United States
| |
Collapse
|
28
|
Khan Y, Slattery TD, Pickering LM. Individualizing Systemic Therapies in First Line Treatment and beyond for Advanced Renal Cell Carcinoma. Cancers (Basel) 2020; 12:E3750. [PMID: 33322163 PMCID: PMC7764621 DOI: 10.3390/cancers12123750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022] Open
Abstract
Therapeutic options for treating advanced renal cell cancer (RCC) are rapidly evolving. Vascular endothelial growth factor (VEGF)-directed therapy, predominantly VEGF receptor (VEGFr) tyrosine kinase inhibitors (TKIs) had been the most effective first line treatment since 2005 irrespective of International Metastatic RCC Database Consortium (IMDC) risk stratification. However, immune checkpoint inhibitors (ICI) have recently changed the treatment paradigm for advanced RCC particularly as the first-line systemic treatment modality. The combination of Ipilimumab and Nivolumab provides better disease control and long-term outcomes compared with the anti-VEGFr TKI Sunitinib for IMDC intermediate- to poor-risk patients and we now have the option of using ICI with TKI upfront for all IMDC risk groups. This poses a challenge for physicians, both to select the most suitable first line regimen and the most suitable subsequent therapy given the lack of data about sequencing in this setting. This treatment landscape is expected to become more complex with the emerging treatment options. Moreover, these therapeutic options cannot be generalized as significant variability exists between individual's disease biologies and their physiologies for handling treatment adverse effects. Notable efforts are being made to identify promising predictive biomarkers ranging from neo-antigen load to gene expression profiling. These biomarkers need prospective validation to justify their utility in clinical practice and in treatment decision making. This review article discusses various clinicopathological characteristics that should be carefully evaluated to help select appropriate treatment and discusses the current status of biomarker-based selection.
Collapse
Affiliation(s)
| | | | - Lisa M. Pickering
- The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; (Y.K.); (T.D.S.)
| |
Collapse
|
29
|
Outcomes of patients with metastatic renal cell carcinoma with sarcomatoid dedifferentiation to immune checkpoint inhibitors. Urol Oncol 2020; 39:134.e9-134.e16. [PMID: 33187886 DOI: 10.1016/j.urolonc.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Metastatic renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is associated with poor survival outcomes. We aimed to analyze the efficacy and safety of immune checkpoint inhibitors (ICI) in patients with sRCC comparing clear-cell (sccRCC) to non-clear cell epithelial histology (snccRCC). METHODS We performed retrospective analysis of sRCC patients who received ICI at MD Anderson Cancer Center (n = 48, 41 with ccRCC and 7 with nccRCC) to determine the overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Additionally, we performed a prespecified multivariable Cox regression comparing survival outcomes between sccRCC and snccRCC. RESULTS The ORR for the entire cohort was 35.4% (95% confidence interval [CI]: 23.4%, 49.6%), including 8 (16.7%) patients (95% CI: 8.7%, 29.6%) who achieved a complete remission. The disease control rate was 52% (95% CI: 38.3%, 65.5%). In patients with sccRCC, the ORR was 39% (95% CI: 25.7%, 54.3%) and disease control rate 58.5% (43.4%, 72.2%). Among 7 snccRCC patients, only one (14.3%) achieved an objective partial response. At a median follow-up of 51.1 months, the median PFS was 4.9 months (95% CI: 2.7, 16.3) and the median OS was 28.4 months (95% CI: 15.8, NA) for the entire cohort. For patients with sccRCC, the median PFS was 8.9 months, with median OS of 30.1 months, compared with median PFS of 2.3 months (HR 0.25 [95% CI: 0.08, 0.78]; P= 0.0145) and median OS of 6.7 months (HR 0.13 [95% CI 0.04, 0.44]; P=0.0009) for patients with snccRCC. CONCLUSION ICIs appear to be effective in sccRCC while the treatment of snccRCC remains challenging.
Collapse
|
30
|
Blum KA, Gupta S, Tickoo SK, Chan TA, Russo P, Motzer RJ, Karam JA, Hakimi AA. Sarcomatoid renal cell carcinoma: biology, natural history and management. Nat Rev Urol 2020; 17:659-678. [PMID: 33051619 PMCID: PMC7551522 DOI: 10.1038/s41585-020-00382-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Sarcomatoid dedifferentiation is an uncommon feature that can occur in most histological subtypes of renal cell carcinomas (RCCs) and carries a decidedly poor prognosis. Historically, conventional treatments for sarcomatoid RCCs (sRCCs) have shown little efficacy, and median survival is commonly 6–13 months. Despite being first described in 1968, the mechanisms driving sarcomatoid dedifferentiation remain poorly understood, and information and treatment options available to physicians and patients are limited. When diagnosed at an early stage, surgical intervention remains the treatment of choice. However, preoperative identification through routine imaging or biopsy is unreliable and most patients present with advanced disease and systemic symptoms. For these patients, the role of cytoreductive nephrectomy is disputed. The expansion of immunotherapies approved for RCCs has generated a search for biomarkers that might be indicative of treatment response in sRCCs, although a proven effective systemic agent remains elusive. PDL1 expression is increased in sarcomatoid dedifferentiated renal tumours, which suggests that patients with sRCCs could benefit from PD1 and/or PDL1 immune checkpoint blockade therapy. Treatment outcomes for sarcomatoid tumours have remained relatively consistent compared with other RCCs, but further investigation of the tumour–immune cell microenvironment might yield insights into further therapeutic possibilities. In this Review, Blum et al. summarize the current knowledge on sarcomatoid renal cell carcinoma, a diagnosis characterized by the presence of sarcomatoid dedifferentiation and a poor prognosis. They discuss the origin, presentation, molecular biology and treatment of this disease. Sarcomatoid dedifferentiation is not considered to be a unique histological subtype of renal cell carcinomas (RCCs); rather, it can be present within any subtype of RCCs. Sarcomatoid dedifferentiation appears in ~4% of all RCCs, but is present in ~20% of all metastatic RCCs. According to WHO guidelines, any RCC with sarcomatoid dedifferentiation is a WHO–International Society of Urological Pathology grade 4 lesion. Sarcomatoid dedifferentiation is often heterogeneously present within RCCs, making routine imaging and biopsy unreliable for preoperative detection. Surgical resection for localized disease is the standard of care, with subsequent close monitoring of patients following surgery. In patients with metastatic disease, conventional therapies such as surgery and systemic agents have been ineffective and overall 5-year survival remains at 23.5–33%. Previous genomic analyses have failed to identify definitive mutational drivers of disease. However, sarcomatoid RCCs (sRCCs) have been shown to have higher PD1 and PDL1 expression than other subtypes of RCCs. Newer combinations of immune checkpoint inhibitor immunotherapies could yield improved responses and outcomes. Studies investigating sRCCs are limited by patient numbers owing to the low incidence of sRCCs and their advanced stage at presentation. Multi-institutional efforts to establish a consensus on treatment recommendations based on highly powered data are essential.
Collapse
Affiliation(s)
- Kyle A Blum
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sounak Gupta
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Immunogenomics and Precision Oncology Platform, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose A Karam
- Departments of Urology and Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
31
|
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.
Collapse
|
32
|
Tannir NM, Signoretti S, Choueiri TK, McDermott DF, Motzer RJ, Flaifel A, Pignon JC, Ficial M, Frontera OA, George S, Powles T, Donskov F, Harrison MR, Barthélémy P, Tykodi SS, Kocsis J, Ravaud A, Rodriguez-Cid JR, Pal SK, Murad AM, Ishii Y, Saggi SS, McHenry MB, Rini BI. Efficacy and Safety of Nivolumab Plus Ipilimumab versus Sunitinib in First-line Treatment of Patients with Advanced Sarcomatoid Renal Cell Carcinoma. Clin Cancer Res 2020; 27:78-86. [PMID: 32873572 DOI: 10.1158/1078-0432.ccr-20-2063] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 08/27/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Patients with advanced renal cell carcinoma with sarcomatoid features (sRCC) have poor prognoses and suboptimal outcomes with targeted therapy. This post hoc analysis of the phase III CheckMate 214 trial analyzed the efficacy of nivolumab plus ipilimumab (NIVO+IPI) versus sunitinib in patients with sRCC. PATIENTS AND METHODS Patients with sRCC were identified via independent central pathology review of archival tumor tissue or histologic classification per local pathology report. Patients were randomized 1:1 to receive nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) every 3 weeks (four doses) then nivolumab 3 mg/kg every 2 weeks, or sunitinib 50 mg orally every day (4 weeks; 6-week cycles). Outcomes in patients with sRCC were not prespecified. Endpoints in patients with sRCC and International Metastatic Renal Cell Carcinoma Database Consortium intermediate/poor-risk disease included overall survival (OS), progression-free survival (PFS) per independent radiology review, and objective response rate (ORR) per RECIST v1.1. Safety outcomes used descriptive statistics. RESULTS Of 1,096 randomized patients in CheckMate 214, 139 patients with sRCC and intermediate/poor-risk disease and six with favorable-risk disease were identified. With 42 months' minimum follow-up in patients with sRCC and intermediate/poor-risk disease, median OS [95% confidence interval (CI)] favored NIVO+IPI [not reached (NR) (25.2-not estimable [NE]); n = 74] versus sunitinib [14.2 months (9.3-22.9); n = 65; HR, 0.45 (95% CI, 0.3-0.7; P = 0.0004)]; PFS benefits with NIVO+IPI were similarly observed [median 26.5 vs. 5.1 months; HR, 0.54 (95% CI, 0.33-0.86; P = 0.0093)]. Confirmed ORR was 60.8% with NIVO+IPI versus 23.1% with sunitinib, with complete response rates of 18.9% versus 3.1%, respectively. No new safety signals emerged. CONCLUSIONS NIVO+IPI showed unprecedented long-term survival, response, and complete response benefits versus sunitinib in previously untreated patients with sRCC and intermediate/poor-risk disease, supporting the use of first-line NIVO+IPI for this population.See related commentary by Hwang et al., p. 5.
Collapse
Affiliation(s)
- Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David F McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abdallah Flaifel
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jean-Christophe Pignon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Miriam Ficial
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Thomas Powles
- Department of Urology, Barts Cancer Institute, Queen Mary University of London, Royal Free NHS Trust, London, United Kingdom
| | - Frede Donskov
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Philippe Barthélémy
- Medical Oncology Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Scott S Tykodi
- Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Judit Kocsis
- Oncology Department, Debrecen University Clinical Center, Debrecen, Hungary.,Department of Oncoradiology, Bács-kiskun County Teaching Hospital (BKMK) Centre of Oncoradiology, Kecskemét, Hungary
| | - Alain Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | | | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Andre M Murad
- CENANTRON-PERSONAL-Precision Oncology, Belo Horizonte, Minas Gerais, Brazil
| | - Yuko Ishii
- Department of Clinical Trials, Bristol Myers Squibb, Princeton, New Jersey
| | | | - M Brent McHenry
- Department of Biostatistics, Bristol Myers Squibb, Princeton, New Jersey
| | - Brian I Rini
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| |
Collapse
|
33
|
Long-term follow-up results of patients with sarcomatoid RCC: A retrospective evaluation of a single center experience. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.789516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
34
|
Ji B, Li D, Fu S, Zhang Z, Yang T, Wu Y, Zuo Y, Xu Z, Yu N. A Population Study to Identify Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Sarcomatoid Renal Cell Carcinoma from the Surveillance, Epidemiology, and End Results (SEER) Database. Med Sci Monit 2020; 26:e921297. [PMID: 32516796 PMCID: PMC7299061 DOI: 10.12659/msm.921297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This population study aimed to identify suitable candidates for cytoreductive nephrectomy in patients with metastatic sarcomatoid renal cell carcinoma (RCC) from the US Surveillance, Epidemiology, and End Results (SEER) database. MATERIAL AND METHODS Demographic and clinical data from 1,229 patients with metastatic sarcomatoid RCC were retrieved from the SEER database. Patients were divided into the cytoreductive nephrectomy group (n=937) and the no surgery group (n=292). Multivariate Cox regression analysis identified factors associated with overall survival (OS) and propensity score matching identified factors that significantly impacted the OS. Survival of propensity score-matched subgroups of patients with metastatic sarcomatoid RCC treated by cytoreductive nephrectomy or no surgery was determined by the Kaplan-Meier method and compared by the log-rank test. RESULTS Of the 1,229 patients with metastatic sarcomatoid RCC retrieved from the SEER database, age, tumor size, T stage, and N stage were independent risk factors for patient survival. There were no significant differences in age, N stage, and tumor size between the cytoreductive nephrectomy-treated and non-surgically treated T stage cases following propensity score matching. OS benefits were found in cases with stage T1 (12 months increase), T2 (7.5 months increase), T3a (2 months increase), and T4 (3 months increase), but not in the T3b or T3c subgroups treated by cytoreductive nephrectomy, compared with patients with no surgical treatment. CONCLUSIONS Data from the SEER database showed that cytoreductive nephrectomy improved OS in patients with T1 and T2 metastatic sarcomatoid RCC with a significant long-term survival benefit of >6 months.
Collapse
Affiliation(s)
- Bing Ji
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, China (mainland)
| | - Dawei Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Shuai Fu
- Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong, China (mainland)
| | - Zhao Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Tong Yang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Yaohai Wu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - You Zuo
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Zhonghua Xu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Nengwang Yu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| |
Collapse
|
35
|
[SMALL RENAL CELL CARCINOMA PRESENTING WITH HUGE SACRALMETASTASIS: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2020; 111:48-52. [PMID: 33883359 DOI: 10.5980/jpnjurol.111.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 66-year-old man with buttock pain and intermittent claudication visited a nearby doctor. Magnetic resonance imaging revealed a tumor of 8 cm in diameter in his sacrum. He was referred to our hospital. Abdominal contrast enhanced computed tomography revealed a small mass of 2.5 cm in diameter on his left kidney and he was diagnosed with metastatic bone disease after needle tumor biopsy. However, needle biopsy of the renal tumor demonstrated no evidence of malignancy. As he rejected further examination, we started treatment using the tyrosine kinase inhibitor sunitinib. However, it had little effect on his sacral metastasis and he developed massive bowel bleeding twice. Extensive invasion from the sacral metastasis to the back side of the rectum was found on colonoscopy. The patient died 2 months after the introduction of sunitinib. The final diagnosis based on pathological autopsy was renal cell carcinoma with sacral metastasis.
Collapse
|
36
|
Gulati S, Philip E, Salgia S, Pal SK. Evolving treatment paradigm in metastatic non clear cell renal cell carcinoma. Cancer Treat Res Commun 2020; 23:100172. [PMID: 32252014 DOI: 10.1016/j.ctarc.2020.100172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
The treatment landscape for renal cell cancer (RCC) has evolved tremendously over the last two decades. Treatment algorithms have shifted from the highly toxic drugs with marginal benefit to better tolerated and more effective targeted therapy drugs. The latter include tyrosine kinase inhibitors, vascular endothelial growth factor inhibitors, MET inhibitors and, more recently, immunotherapy drugs alone and in various combinations. The majority of treatment algorithms for non-clear cell carcinoma have been based on extrapolating results from clear cell RCC trials and retrospective reviews. However, now that we understand that non-clear cell RCC is morphologically and clinically distinct from its clear cell counterpart, several collaborative clinical trials are underway for non-clear cell RCC. This review will delve into the historical aspects of treating non-clear cell RCC and the evolution of treatment paradigms over the last few decades with a focus on immunotherapy based trials.
Collapse
Affiliation(s)
- Shuchi Gulati
- Clinical Medicine, Division of Hematology and Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH 45267-0562, United States
| | - Errol Philip
- University of California San Francisco School of Medicine, San Francisco, CA 94143, United States
| | - Sabrina Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States
| | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States.
| |
Collapse
|
37
|
Yang B, Xia H, Xu C, Lu M, Zhang S, Wang G, Ma L. Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically. BMC Urol 2020; 20:14. [PMID: 32070319 PMCID: PMC7029456 DOI: 10.1186/s12894-020-0584-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/31/2020] [Indexed: 01/24/2023] Open
Abstract
Background Sarcomatoid differentiation in renal cell carcinoma (RCC) with vena caval tumour thrombus has been shown to be associated with aggressive behaviours and poor prognosis; however, evidence of the impact of rhabdoid differentiation on prognosis is lacking. This study evaluated the impact of sarcomatoid differentiation and rhabdoid differentiation on oncological outcomes for RCC with vena caval tumour thrombus treated surgically. Methods We retrospectively analysed patients treated surgically for RCC with vena caval tumour thrombus at our institute from Jan 2015 to Nov 2018. Prognostic variables were evaluated for associations with progression-free survival (PFS) and cancer-specific survival (CSS) by Kaplan–Meier survival analysis and log-rank test. Univariate and multivariate analyses were performed to determine independent prognostic variables. Results We identified 125 patients with RCC and vena caval tumour thrombus, including 17 (13.6%) with sarcomatoid differentiation alone, 8 (6.4%) with rhabdoid differentiation alone and 3 (2.4%) with both sarcomatoid and rhabdoid differentiation. Compared to pure RCC, patients with sarcomatoid differentiation but not rhabdoid differentiation have worse PFS (p = 0.018 and p = 0.095, respectively). The univariate and multivariate analyses both showed sarcomatoid differentiation as a significant predictor of PFS. Compared to pure RCC, patients with sarcomatoid differentiation (p = 0.002) and rhabdoid differentiation (p = 0.001) both had significantly worse CSS. The univariate analysis showed sarcomatoid differentiation, rhabdoid differentiation, metastasis and blood transfusion as significant predictors of CSS (All, p < 0.05). In the multivariate analysis, sarcomatoid differentiation (HR 3.90, p = 0.008), rhabdoid differentiation (HR 3.01, p = 0.042), metastasis (HR 3.87, p = 0.004) and blood transfusion (HR 1.34, p = 0.041) all remained independent predictors of CSS. Conclusions Sarcomatoid differentiation and rhabdoid differentiation are both independent predictors of poor prognosis in RCC with vena caval tumour thrombus treated surgically.
Collapse
Affiliation(s)
- Bin Yang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Haizhui Xia
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Chuxiao Xu
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Min Lu
- Department of Pathology, Peking University Health Science Center, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| |
Collapse
|
38
|
Wang YS, Shuang WB, Yin KQ, Tong XN, Xia MC, Yang HS. Analysis of the factors influencing the survival time of patients with sarcomatoid renal cell carcinoma. Mol Clin Oncol 2019; 11:405-410. [PMID: 31475069 DOI: 10.3892/mco.2019.1900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to identify the factors influencing the survival time of patients with sarcomatoid renal cell carcinoma (SRCC). Between January 2000 and September 2017, a total of 21 patients were enrolled, all of whom were diagnosed with SRCC. In total, eight prognostic factors were analyzed using the Kaplan-Meier estimator, a log-rank test and Cox's proportional hazards model. The log-rank test results revealed that there was a significant association between the proportion of sarcoma elements and survival time of patients with SRCC (P<0.05). In addition, there was a significant association between post-operative drug treatment and SRCC survival time (P<0.05). The results of the Kaplan-Meier estimate demonstrated that the survival curve of post-operative drug treatment was significantly greater compared with the survival curve of patients who did not undergo drug treatment (P<0.05). The survival curve of patients with a proportion of sarcoma elements <50% was significantly greater compared with the survival curve of patients with a proportion of sarcoma elements ≥50% (P<0.05). Furthermore, the Cox's proportional hazards model revealed that the mortality risk in post-operative patients without drug treatment was 5.822 times greater compared with that of patients with drug treatment (P<0.05). Mortality risk in patients with a proportion of sarcoma elements ≥50% was 4.682 times higher compared with that of patients with sarcoma elements <50% (P<0.05). Finally, post-operative drug therapy was revealed to be a protective factor which significantly affected the survival time of patients with SRCC [risk ratio (RR)=0.172], in addition to the proportion of sarcoma elements ≥50% (RR=4.682). In conclusion, drug therapy should be promoted upon patient diagnosis with SRCC and attention should be given to the proportion of sarcomatoid components.
Collapse
Affiliation(s)
- Yu-Sheng Wang
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| | - Wei-Bing Shuang
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| | - Ke-Qiang Yin
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| | - Xu-Nan Tong
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| | - Man-Cheng Xia
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| | - Hao-Sen Yang
- Department of Urology, The First Hospital of Shanxi Medical University, Yingze, Shanxi 030001, P.R. China
| |
Collapse
|
39
|
Kondisetty G, Borkar PV, Kondisetty S, Thomas A. Retrospective review of experience with sarcomatoid renal cell carcinoma: Multimodality treatment remains an unmet goal. Urol Ann 2019; 11:385-388. [PMID: 31649458 PMCID: PMC6798302 DOI: 10.4103/ua.ua_106_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Sarcomatoid change in Renal cell carcinoma(RCC) is associated with adverse outcomes with median survival of 6 months. Settings and Design: This is a retrospective study of patients diagnosed of sarcomatoid RCC(sRCC) between 2007 and 2013 which were followed up till 2017. Methods and Material: Patients (n=22) were grouped based on whether they received additional chemotherapy following nephrectomy. Two groups were followed up until 2017 and overall survival was record. Overall survival curves were estimated by Kaplan-Meier method and compared using Log Rank (Mantel-Cox) test between two groups. Statistical analysis used: Kaplan-Meier method and Log Rank (Mantel-Cox) test. Results: The patients who had chemotherapy had 13.4 cm of mean tumour size with a mean survival of 20.4 ± 8.3 months. The patients who did not undergo chemotherapy had mean tumour size of 11.7 cm with a mean survival of 21 ± 5.9 months. There was no much statistical difference between the two groups in OS with P value = 0.99. Conclusion: The current adjuvant chemotherapy used in sRCC patients who develop metastasis gives no survival advantage.
Collapse
Affiliation(s)
- Gowrinath Kondisetty
- Department of General Surgery, Medicity Institute of Medical Sciences, Medchal, Telangana, India
| | - Pallavi Vijay Borkar
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sandeep Kondisetty
- Department of Urology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| |
Collapse
|
40
|
Wang Z, Zeng X, Chen R, Chen Z. Ki-67 index and percentage of sarcomatoid differentiation were two independent prognostic predictors in sarcomatoid renal cell carcinoma. Cancer Manag Res 2018; 10:5339-5347. [PMID: 30464630 PMCID: PMC6225922 DOI: 10.2147/cmar.s176242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To identify whether and which of pathological features of sarcomatoid differentiation (SD) in renal cell carcinoma (RCC) can be used as independent predictors associated with overall survival (OS). Materials and methods After institutional review board approval, patients with a diagnosis of sarcomatoid RCC (sRCC), spindled RCC, or RCC with the presence of spindle cells between 2003 and 2017 were further selected and re-examined. The primary pathological features including histological subtypes, tumor necrosis, Ki-67 index of SD, and the percent of SD (%SD) were included into analysis. Histological subtypes were categorized into clear-cell RCC and nonclear-cell RCC. Ki-67 index of SD was confirmed by immunohistochemical staining. %SD was estimated through reviewing all of the tumor sections microscopically and then giving an approximate %SD within the entire tumor. The clinical relevant prognostic predictor's association with OS was analyzed within Cox proportional hazards regression models. Survival curves were generated using the Kaplan-Meier method, and OS differences were compared using the log-rank test. Results A total of 2,089 consecutive patients of RCC were referred to our department, of whom 62 (3.0%) patients were identified with histological element of SD after re-examining the available slides of suspicious cases. Finally, 53 patients were included into survival analysis after excluding 9 patients without adequate information. Thirty-eight (71.7%) patients died at last follow-up. The median OS for all patients was 11.0 months from the date of surgery. In patients with clinical distant metastasis (cM1), the median OS was only 3 compared with 21 months for patients with no clinical distant metastasis (cM0). Tumor stage, status of clinical distant metastasis, Ki-67 index, and %SD were independent predictors of multivariate analysis in overall 53 patients. However, in the cohort of cM0 patients, we found that only %SD and Ki-67 index were two independent predictors of OS in multivariate analysis. Conclusion Patients with sRCC are associated with very poor prognosis. Ki-67 index of SD and %SD were identified as the two most important independent predictors particularly for nonmetastatic patients. The limitations of our study were also observed, and further studies are needed.
Collapse
Affiliation(s)
- Zhixian Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China,
| | - Xiaoyong Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China, .,Hubei Institute of Urology, Wuhan, China,
| | - Ruibao Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China,
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China, .,Hubei Institute of Urology, Wuhan, China,
| |
Collapse
|
41
|
El Mouallem N, Smith SC, Paul AK. Complete Response of a Patient With Metastatic Sarcomatoid Renal Cell Carcinoma to a Programmed Death-1 Checkpoint Inhibitor. J Oncol Pract 2018; 14:511-513. [PMID: 29920137 DOI: 10.1200/jop.18.00213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Asit K Paul
- Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
42
|
Lebacle C, Pooli A, Bessede T, Irani J, Pantuck AJ, Drakaki A. Epidemiology, biology and treatment of sarcomatoid RCC: current state of the art. World J Urol 2018; 37:115-123. [PMID: 29858701 DOI: 10.1007/s00345-018-2355-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
Long recognized to confer an extremely poor prognosis, sarcomatoid dedifferentiation of renal cell carcinoma (sRCC) is a tumor phenotype that is finally beginning to be better understood on the molecular and genetic levels. With an overall incidence that ranges from 1 to 32% depending on associated RCC subtype, the survival of sarcomatoid RCC patients rarely exceeds 2 years. The main reasons for its poor outcome include its aggressive biology, its tendency to present at an advanced or metastatic stage at the time of diagnosis, its high rate of tumor recurrence after nephrectomy, and its limited response to systemic therapies. Molecular pathology studies suggest that sarcomatoid dedifferentiation originates from a focal epithelial-mesenchymal transition (EMT) arising in the carcinomatous component of the tumor. It is hoped that the growing understanding of the molecular biology of sRCC will soon make it possible to adapt treatments based on the identification of actionable tumor alterations. The deliberate inclusion of these patients in the multicenter clinical trials of immune, targeted and combination therapies is a necessary next step in pioneering future treatment strategies.
Collapse
Affiliation(s)
- Cedric Lebacle
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France.
| | - Aydin Pooli
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas Bessede
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Jacques Irani
- Department of Urology, University Hospital Bicetre, APHP, Le Kremlin Bicetre, France
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alexandra Drakaki
- Institute of Urologic Oncology (IUO), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Hematology and Oncology, David Geffen School of Medicine at University of California, Los Angeles, USA
| |
Collapse
|
43
|
Rashid S, Akhtar M. Sarcomatoid Variant of Urothelial Carcinoma of the Renal Pelvis with Inferior Vena Cava Tumour Thrombus: A Case Report and Literature Review. Case Rep Pathol 2018; 2018:1837510. [PMID: 29581908 PMCID: PMC5822868 DOI: 10.1155/2018/1837510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022] Open
Abstract
Sarcomatoid variant of urothelial carcinoma (SVUC) of the renal pelvis is a rare entity. To the best of our knowledge, around 25 cases of this neoplasm have been reported in the literature to date, most of which were of high stage. The inferior vena cava tumour thrombus, which is a hallmark of renal cell carcinoma (RCC), may rarely be found in urothelial carcinoma of renal pelvis. In this report, a case of SVUC associated with tumour extension to inferior vena cava is documented. This association has been encountered in only one previously reported case. The possibility of urothelial carcinoma of the renal pelvis should therefore be included in the differential diagnosis of tumour thrombus of the inferior vena cava.
Collapse
Affiliation(s)
- Sameera Rashid
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Akhtar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
44
|
Mouallem NE, Smith SC, Paul AK. Sarcomatoid renal cell carcinoma: Biology and treatment advances. Urol Oncol 2018; 36:265-271. [PMID: 29306556 DOI: 10.1016/j.urolonc.2017.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/22/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
Abstract
Sarcomatoid transformation in renal cell carcinoma, so called sacromatoid RCC (sRCC), is associated with an aggressive behavior and a poor prognosis. Current therapeutic approaches are largely ineffective. Recent studies looking into the genomic and molecular characterization of sRCCs have provided insights into the biology and pathogenesis of this entity. These advances in molecular signatures may help development of effective treatment strategies. We herein present a review of recent developments in the pathology, biology, and treatment modalities in sRCC.
Collapse
Affiliation(s)
- Nemer El Mouallem
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Steven C Smith
- Department of Pathology, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Asit K Paul
- Division of Hematology, Oncology and Palliative Care, Massey Cancer Center, VCU Medical Center, Virginia Commonwealth University, Richmond, VA.
| |
Collapse
|
45
|
Edelson MP, Wu WJ, Kurzyna A, Steckel J. Rapid recurrence and radiographic progression of sarcomatoid renal cell carcinoma. Urol Case Rep 2017; 16:6-8. [PMID: 29034177 PMCID: PMC5635236 DOI: 10.1016/j.eucr.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/08/2017] [Accepted: 09/26/2017] [Indexed: 12/22/2022] Open
Abstract
Sarcomatoid renal cell carcinoma (sRCC) is an aggressive variant of renal cell carcinoma (RCC) that has a significantly lower overall survival. Even after prompt surgical extirpation, this histologic variant progresses rapidly. We present a case of an early recurrence and rapid progression of sRCC despite successful radical resection.
Collapse
Affiliation(s)
- Mia P Edelson
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Wayland J Wu
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Anna Kurzyna
- Department of Medicine, NYU Langone Arena Oncology, Lake Success, NY, USA
| | - Joph Steckel
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| |
Collapse
|
46
|
Smith JA. This Month in Adult Urology. J Urol 2017. [DOI: 10.1016/j.juro.2017.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Ciccarese C, Iacovelli R, Brunelli M, Massari F, Bimbatti D, Fantinel E, De Marco V, Porcaro AB, Martignoni G, Artibani W, Tortora G. Addressing the best treatment for non-clear cell renal cell carcinoma: A meta-analysis of randomised clinical trials comparing VEGFR-TKis versus mTORi-targeted therapies. Eur J Cancer 2017; 83:237-246. [PMID: 28756136 DOI: 10.1016/j.ejca.2017.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/09/2017] [Accepted: 06/24/2017] [Indexed: 02/07/2023]
Abstract
AIM Non-clear cell renal cell carcinoma (nccRCC) tumours include a heterogeneous group of malignancies that profoundly differ in terms of morphology, genetic profile, clinical behaviour and prognosis. The optimal treatment algorithm for nccRCC is still unknown and derived mainly from evidence available for ccRCC, being therefore represented by targeted agents against vascular endothelial growth factor and mammalian target of rapamycin (mTOR) pathways. We aimed to compare the efficacy of vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKis) and mTOR inhibitors (mTORi) for the treatment of nccRCC patients. METHODS Searching the MEDLINE/PubMed, Cochrane Library and American Society of Clinical Oncology Meeting abstracts prospective studies were identified. Data extraction was conduced according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The measured outcomes were progression-free survival (PFS), overall survival (OS) and the overall response rate (ORR). RESULTS Four randomised controlled trials were selected for final analysis, with a total of 332 patients evaluable for PFS. Treatment with TKi significantly reduced the risk of progression compared with mTORi (hazard ratio [HR] = 0.71; 95% confidence interval [CI] 0.60-0.84; p < 0.0001). This difference remained significant when sunitinib was compared with everolimus in first-line setting (HR = 0.67; 95% CI, 0.56-0.80; p < 0.00001). In the 332 patients evaluable for OS, no significant difference was found between TKi and mTORi (HR = 0.86; 95% CI, 0.67-1.12; p = 0.27). In the 176 evaluable patients, TKis therapy did not improve the ORR when compared with mTORi (relative risk [RR] = 2.21; 95% CI, 0.87-5.60; p = 0.09), even if treatment with sunitinib doubled the probability of achieving a tumour response. CONCLUSIONS Treatment with TKis significantly improves PFS, but not OS, when compared with mTORi. Moreover, sunitinib as first-line therapy reduces the risk of progression compared with everolimus; therefore, supporting the standard treatment paradigm broadly used for ccRCC patients. The relatively modest efficacy of available targeted therapies reinforces the need of future histology based, molecular driven therapeutic paradigm.
Collapse
Affiliation(s)
- Chiara Ciccarese
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Roberto Iacovelli
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy.
| | - Matteo Brunelli
- Department of Pathology and Diagnostic, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | | | - Davide Bimbatti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Emanuela Fantinel
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Vincenzo De Marco
- Urologic Clinic, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Antonio Benito Porcaro
- Urologic Clinic, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Guido Martignoni
- Department of Pathology and Diagnostic, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Walter Artibani
- Urologic Clinic, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Italy
| |
Collapse
|