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Choueiri TK, Powles T, Peltola K, de Velasco G, Burotto M, Suarez C, Ghatalia P, Iacovelli R, Lam ET, Verzoni E, Gümüş M, Stadler WM, Kollmannsberger C, Melichar B, Venugopal B, Gross-Goupil M, Poprach A, De Santis M, Schutz FA, Park SH, Nosov DA, Porta C, Lee JL, Garcia-Del-Muro X, Biscaldi E, Manneh Kopp R, Oya M, He L, Wang A, Perini RF, Vickery D, Albiges L, Rini B. Belzutifan versus Everolimus for Advanced Renal-Cell Carcinoma. N Engl J Med 2024; 391:710-721. [PMID: 39167807 DOI: 10.1056/nejmoa2313906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Belzutifan, a hypoxia-inducible factor 2α inhibitor, showed clinical activity in clear-cell renal-cell carcinoma in early-phase studies. METHODS In a phase 3, multicenter, open-label, active-controlled trial, we enrolled participants with advanced clear-cell renal-cell carcinoma who had previously received immune checkpoint and antiangiogenic therapies and randomly assigned them, in a 1:1 ratio, to receive 120 mg of belzutifan or 10 mg of everolimus orally once daily until disease progression or unacceptable toxic effects occurred. The dual primary end points were progression-free survival and overall survival. The key secondary end point was the occurrence of an objective response (a confirmed complete or partial response). RESULTS A total of 374 participants were assigned to belzutifan, and 372 to everolimus. At the first interim analysis (median follow-up, 18.4 months), the median progression-free survival was 5.6 months in both groups; at 18 months, 24.0% of the participants in the belzutifan group and 8.3% in the everolimus group were alive and free of progression (two-sided P = 0.002, which met the prespecified significance criterion). A confirmed objective response occurred in 21.9% of the participants (95% confidence interval [CI], 17.8 to 26.5) in the belzutifan group and in 3.5% (95% CI, 1.9 to 5.9) in the everolimus group (P<0.001, which met the prespecified significance criterion). At the second interim analysis (median follow-up, 25.7 months), the median overall survival was 21.4 months in the belzutifan group and 18.1 months in the everolimus group; at 18 months, 55.2% and 50.6% of the participants, respectively, were alive (hazard ratio for death, 0.88; 95% CI, 0.73 to 1.07; two-sided P = 0.20, which did not meet the prespecified significance criterion). Grade 3 or higher adverse events of any cause occurred in 61.8% of the participants in the belzutifan group (grade 5 in 3.5%) and in 62.5% in the everolimus group (grade 5 in 5.3%). Adverse events led to discontinuation of treatment in 5.9% and 14.7% of the participants, respectively. CONCLUSIONS Belzutifan showed a significant benefit over everolimus with respect to progression-free survival and objective response in participants with advanced clear-cell renal-cell carcinoma who had previously received immune checkpoint and antiangiogenic therapies. Belzutifan was associated with no new safety signals. (Funded by Merck Sharp and Dohme, a subsidiary of Merck; LITESPARK-005 ClinicalTrials.gov number, NCT04195750.).
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Affiliation(s)
- Toni K Choueiri
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Thomas Powles
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Katriina Peltola
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Guillermo de Velasco
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Mauricio Burotto
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Cristina Suarez
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Pooja Ghatalia
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Roberto Iacovelli
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Elaine T Lam
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Elena Verzoni
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Mahmut Gümüş
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Walter M Stadler
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Christian Kollmannsberger
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Bohuslav Melichar
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Balaji Venugopal
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Marine Gross-Goupil
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Alexandr Poprach
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Maria De Santis
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Fabio A Schutz
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Se Hoon Park
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Dmitry A Nosov
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Camillo Porta
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Jae Lyun Lee
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Xavier Garcia-Del-Muro
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Elisa Biscaldi
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Ray Manneh Kopp
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Mototsugu Oya
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Li He
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Aobo Wang
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Rodolfo F Perini
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Donna Vickery
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Laurence Albiges
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
| | - Brian Rini
- From Dana-Farber Cancer Institute, Boston (T.K.C.); Barts Cancer Centre, Queen Mary University of London BRC, Royal Free NHS Trust, London (T.P.), and Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow (B.V.) - all in the United Kingdom; HUS Helsinki University Hospital, Comprehensive Cancer Center, Helsinki (K.P.); University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid (G.V.), and Medical Oncology, Vall d´Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus (C.S.), and Institute Catalan of Oncology-ICO-IDIBELL University of Barcelona (X.G.-M.), Barcelona - all in Spain; Bradford Hill Clinical Research Center, Santiago, Chile (M.B.); Fox Chase Cancer Center, Philadelphia (P.G.); Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome (R.I.), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (E.V.), the University of Bari "A. Moro" and Azienda Ospedaliera Policlinico di Bari, Bari (C.P.), and Fondazione Salvatore Maugeri clinica del lavoro, Pavia (E.B.) - all in Italy; the University of Colorado Cancer Center, Aurora (E.T.L.); Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey (M.G.); the University of Chicago Medical Center, Chicago (W.M.S.); BC Cancer-Vancouver Center, Vancouver, BC, Canada (C.K.); the Department of Oncology, Palacký University and University Hospital, Olomouc (B.M.), and the Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno (A.P.) - both in the Czech Republic; University Hospital Bordeaux-Hôpital Saint-André, Bordeaux (M.G.-G.), and Département de Médecine Oncologique, Gustave Roussy, Université Paris Saclay, Villejuif (L.A.) - both in France; Charité Universitaetsmedizin Berlin, Department of Urology, Berlin (M.D.S.); the Department of Urology, Medical University of Vienna, Vienna (M.D.S.); BP-A Beneficencia Portuguesa de São Paulo, Sao Paulo (F.A.S.); Samsung Medical Center, Sungkyunkwan University School of Medicine (S.H.P.), and Asan Medical Center, University of Ulsan College of Medicine (J.L.L.) - both in Seoul, South Korea; Central Clinical Hospital with Polyclinic, Moscow (D.A.N.); Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia (R.M.K.); Keio University Hospital, Tokyo (M.O.); Merck, Rahway, NJ (L.H., A.W., R.F.P., D.V.); and Vanderbilt Ingram Cancer Center, Nashville (B.R.)
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2
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Denize T, Jegede OA, Matar S, El Ahmar N, West DJ, Walton E, Bagheri AS, Savla V, Laimon YN, Gupta S, Vemula SV, Braun DA, Burke KP, Catalano PJ, Freeman GJ, Motzer RJ, Atkins MB, McDermott DF, Sharpe AH, Choueiri TK, Signoretti S. PD-1 Expression on Intratumoral Regulatory T Cells Is Associated with Lack of Benefit from Anti-PD-1 Therapy in Metastatic Clear-Cell Renal Cell Carcinoma Patients. Clin Cancer Res 2024; 30:803-813. [PMID: 38060202 PMCID: PMC10922154 DOI: 10.1158/1078-0432.ccr-23-2274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/24/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Programmed cell death protein 1 (PD-1) expression on CD8+TIM-3-LAG-3- tumor-infiltrating cells predicts positive response to PD-1 blockade in metastatic clear-cell renal cell carcinoma (mccRCC). Because inhibition of PD-1 signaling in regulatory T cells (Treg) augments their immunosuppressive function, we hypothesized that PD-1 expression on tumor-infiltrating Tregs would predict resistance to PD-1 inhibitors. EXPERIMENTAL DESIGN PD-1+ Tregs were phenotyped using multiparametric immunofluorescence in ccRCC tissues from the CheckMate-025 trial (nivolumab: n = 91; everolimus: n = 90). Expression of CD8, PD-1, TIM-3, and LAG-3 was previously determined (Ficial and colleagues, 2021). Clinical endpoints included progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). RESULTS In the nivolumab (but not everolimus) arm, high percentage of PD-1+ Tregs was associated with shorter PFS (3.19 vs. 5.78 months; P = 0.021), shorter OS (18.1 vs. 27.7 months; P = 0.013) and marginally lower ORR (12.5% vs. 31.3%; P = 0.059). An integrated biomarker (PD-1 Treg/CD8 ratio) was developed by calculating the ratio between percentage of PD-1+Tregs (marker of resistance) and percentage of CD8+PD-1+TIM-3-LAG-3- cells (marker of response). In the nivolumab (but not everolimus) arm, patients with high PD-1 Treg/CD8 ratio experienced shorter PFS (3.48 vs. 9.23 months; P < 0.001), shorter OS (18.14 vs. 38.21 months; P < 0.001), and lower ORR (15.69% vs. 40.00%; P = 0.009). Compared with the individual biomarkers, the PD-1 Treg/CD8 ratio showed improved ability to predict outcomes to nivolumab versus everolimus. CONCLUSIONS PD-1 expression on Tregs is associated with resistance to PD-1 blockade in mccRCC, suggesting that targeting Tregs may synergize with PD-1 inhibition. A model that integrates PD-1 expression on Tregs and CD8+TIM-3-LAG-3- cells has higher predictive value.
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Affiliation(s)
- Thomas Denize
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Opeyemi A. Jegede
- Department of Data Science, Dana-Farber Cancer Institute; Boston, MA
| | - Sayed Matar
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Nourhan El Ahmar
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | - Destiny J. West
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | - Emily Walton
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | | | - Varunika Savla
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
| | - Yasmin Nabil Laimon
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
| | | | | | - David A. Braun
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
- Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine; New Haven, CT
| | - Kelly P. Burke
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Department of Immunology, Blavatnik Institute, Harvard Medical School; Boston, MA
| | - Paul J. Catalano
- Harvard Medical School; Boston, MA
- Department of Biostatistics, Harvard School of Public Health; Boston, MA
| | - Gordon J. Freeman
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
| | - Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY
| | | | - David F. McDermott
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Beth Israel Deaconess Medical Center; Boston, MA
| | - Arlene H. Sharpe
- Harvard Medical School; Boston, MA
- Department of Immunology, Blavatnik Institute, Harvard Medical School; Boston, MA
| | - Toni K. Choueiri
- Harvard Medical School; Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA
- Harvard Medical School; Boston, MA
- Broad Institute of MIT and Harvard; Cambridge, MA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute; Boston, MA
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Choueiri TK, Tomczak P, Park SH, Venugopal B, Symeonides S, Hajek J, Ferguson T, Chang YH, Lee JL, Haas N, Sawrycki P, Sarwar N, Gross-Goupil M, Thiery-Vuillemin A, Mahave M, Kimura G, Perini RF, Saretsky TL, Bhattacharya R, Xu L, Powles T. Patient-Reported Outcomes in KEYNOTE-564: Adjuvant Pembrolizumab Versus Placebo for Renal Cell Carcinoma. Oncologist 2024; 29:142-150. [PMID: 37589219 PMCID: PMC10836324 DOI: 10.1093/oncolo/oyad231] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND In patients with renal cell carcinoma (RCC) enrolled in the phase III KEYNOTE-564 trial (NCT03142334), disease-free survival (DFS) following nephrectomy was prolonged with use of adjuvant pembrolizumab therapy versus placebo. Patient-reported outcomes (PROs) provide an important measure of health-related quality of life (HRQoL) and can complement efficacy and safety results. PATIENTS AND METHODS In KEYNOTE-564, 994 patients were randomly assigned to receive pembrolizumab 200 mg (n = 496) or placebo (n = 498) intravenously every 3 weeks for ≤17 cycles. Patients who received ≥1 dose of treatment and completed ≥1 HRQoL assessment were included in this analysis. HRQoL end points were assessed using the EORTC QLQ-C30, FKSI-DRS, and EQ VAS. Prespecified and exploratory PRO end points were mean change from baseline in EORTC QLQ-C30 GHS/QoL score, EORTC QLQ-C30 physical function subscale score, and FKSI-DRS score. RESULTS No clinically meaningful difference in least squares mean scores for pembrolizumab versus placebo were observed at week 52 for EORTC QLQ-C30 GHS/QoL (-2.5; 95% CI -5.2 to 0.1), EORTC QLQ-C30 physical functioning (-0.87; 95% CI -2.7 to 1.0), and FKSI-DRS (-0.7; 95% CI -1.2 to -0.1). Most PRO scores remained stable or improved for the EORTC QLQ-C30 GHS/QoL (pembrolizumab, 54.3%; placebo, 67.5%), EORTC QLQ-C30 physical functioning (pembrolizumab, 64.7%; placebo, 68.8%), and FKSI-DRS (pembrolizumab, 58.2%; placebo, 66.3%). CONCLUSIONS Adjuvant treatment with pembrolizumab did not result in deterioration of HRQoL. These findings together with the safety and efficacy findings support adjuvant pembrolizumab treatment following nephrectomy. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03142334.
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Affiliation(s)
- Toni K Choueiri
- Department of Medical Oncology, Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Piotr Tomczak
- Department of Medical Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Se Hoon Park
- Department of Hematology and Oncology, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea
| | - Balaji Venugopal
- Department of Medical Oncology, The Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, UK
| | - Stefan Symeonides
- Department of Medical Oncology, Edinburgh Cancer Centre, NHS Lothian, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jaroslav Hajek
- Department of Medical Oncology, Fakultní Nemocnice Ostrava, Ostrava, Czech Republic
| | - Thomas Ferguson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jae Lyun Lee
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul, South Korea
| | - Naomi Haas
- Division of Hematology and Oncology, Abramson Cancer Center, Philadelphia, PA, USA
| | - Piotr Sawrycki
- Chemotherapy Department, Wojewódzki Szpital Zespolony im. L. Rydygiera, Torun, Poland
| | - Naveed Sarwar
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Marine Gross-Goupil
- Department of Medical Oncology, University Hospital Bordeaux–Hôpital Saint-André, Bordeaux, France
| | | | - Mauricio Mahave
- Department of Oncology, Fundación Arturo López Pérez FALP, Santiago, Chile
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, Tokyo, Japan
| | | | | | | | - Lei Xu
- Merck & Co., Inc., Rahway, NJ, USA
| | - Thomas Powles
- Department of Oncology, Royal Free Hospital NHS Trust, University College London, London, UK
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4
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Grünwald V, Powles T, Eto M, Kopyltsov E, Rha SY, Porta C, Motzer R, Hutson TE, Méndez-Vidal MJ, Hong SH, Winquist E, Goh JC, Maroto P, Buchler T, Takagi T, Burgents JE, Perini R, He C, Okpara CE, McKenzie J, Choueiri TK. Phase 3 CLEAR study in patients with advanced renal cell carcinoma: outcomes in subgroups for the lenvatinib-plus-pembrolizumab and sunitinib arms. Front Oncol 2023; 13:1223282. [PMID: 37664025 PMCID: PMC10471185 DOI: 10.3389/fonc.2023.1223282] [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: 05/15/2023] [Accepted: 07/11/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The phase 3 CLEAR study demonstrated that lenvatinib plus pembrolizumab significantly improved efficacy versus sunitinib as first-line treatment for patients with advanced renal cell carcinoma (RCC). Prognostic features including presence and/or site of baseline metastases, prior nephrectomy, and sarcomatoid features have been associated with disease and treatment success. This subsequent analysis explores outcomes in patients with or without specific prognostic features. Methods In CLEAR, patients with clear cell RCC were randomly assigned (1:1:1) to receive either lenvatinib (20 mg/day) plus pembrolizumab (200 mg every 3 weeks), lenvatinib (18 mg/day) plus everolimus (5 mg/day), or sunitinib alone (50 mg/day, 4 weeks on, 2 weeks off). In this report, progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were all assessed in the lenvatinib-plus-pembrolizumab and the sunitinib arms, based on baseline features: lung metastases, bone metastases, liver metastases, prior nephrectomy, and sarcomatoid histology. Results In all the assessed subgroups, median PFS was longer with lenvatinib-plus-pembrolizumab than with sunitinib treatment, notably among patients with baseline bone metastases (HR 0.33, 95% CI 0.21-0.52) and patients with sarcomatoid features (HR 0.39, 95% CI 0.18-0.84). Median OS favored lenvatinib plus pembrolizumab over sunitinib irrespective of metastatic lesions at baseline, prior nephrectomy, and sarcomatoid features. Of interest, among patients with baseline bone metastases the HR for survival was 0.50 (95% CI 0.30-0.83) and among patients with sarcomatoid features the HR for survival was 0.91 (95% CI 0.32-2.58); though for many groups, median OS was not reached. ORR also favored lenvatinib plus pembrolizumab over sunitinib across all subgroups; similarly, complete responses also followed this pattern. Conclusion Efficacy outcomes improved following treatment with lenvatinib-plus-pembrolizumab versus sunitinib in patients with RCC-irrespective of the presence or absence of baseline lung metastases, baseline bone metastases, baseline liver metastases, prior nephrectomy, or sarcomatoid features. These findings corroborate those of the primary CLEAR study analysis in the overall population and support lenvatinib plus pembrolizumab as a standard of care in 1L treatment for patients with advanced RCC. Clinical trial registration ClinicalTrials.gov, identifier NCT02811861.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Medical Oncology and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - Thomas Powles
- Barts Cancer Institute and the Royal Free Hospital, Queen Mary University of London, London, United Kingdom
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Evgeny Kopyltsov
- State Institution of Healthcare Regional Clinical Oncology Dispensary, Omsk, Russia
| | - Sun Young Rha
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’, Bari, Italy
| | - Robert Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - María José Méndez-Vidal
- Department of Oncology, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC) Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eric Winquist
- Department of Oncology, University of Western Ontario, London, ON, Canada
| | - Jeffrey C. Goh
- ICON Research, South Brisbane & University of Queensland, St Lucia, QLD, Australia
| | - Pablo Maroto
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Tomas Buchler
- Department of Oncology, Charles University and Thomayer University Hospital, Prague, Czechia
| | - Toshio Takagi
- Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Joseph E. Burgents
- Global Clinical Development, Merck & Co., Inc., Rahway, NJ, United States
| | - Rodolfo Perini
- Clinical Research, Merck & Co., Inc., Rahway, NJ, United States
| | - Cixin He
- Biostatistics, Eisai Inc., Nutley, NJ, United States
| | | | - Jodi McKenzie
- Clinical Research, Eisai Inc., Nutley, NJ, United States
| | - Toni K. Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Saliby RM, El Zarif T, Bakouny Z, Shah V, Xie W, Flippot R, Denize T, Kane MH, Madsen KN, Ficial M, Hirsch L, Wei XX, Steinharter JA, Harshman LC, Vaishampayan UN, Severgnini M, McDermott DF, Mary Lee GS, Xu W, Van Allen EM, McGregor BA, Signoretti S, Choueiri TK, McKay RR, Braun DA. Circulating and Intratumoral Immune Determinants of Response to Atezolizumab plus Bevacizumab in Patients with Variant Histology or Sarcomatoid Renal Cell Carcinoma. Cancer Immunol Res 2023; 11:1114-1124. [PMID: 37279009 PMCID: PMC10526700 DOI: 10.1158/2326-6066.cir-22-0996] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023]
Abstract
Renal cell carcinoma (RCC) of variant histology comprises approximately 20% of kidney cancer diagnoses, yet the optimal therapy for these patients and the factors that impact immunotherapy response remain largely unknown. To better understand the determinants of immunotherapy response in this population, we characterized blood- and tissue-based immune markers for patients with variant histology RCC, or any RCC histology with sarcomatoid differentiation, enrolled in a phase II clinical trial of atezolizumab and bevacizumab. Baseline circulating (plasma) inflammatory cytokines were highly correlated with one another, forming an "inflammatory module" that was increased in International Metastatic RCC Database Consortium poor-risk patients and was associated with worse progression-free survival (PFS; P = 0.028). At baseline, an elevated circulating vascular endothelial growth factor A (VEGF-A) level was associated with a lack of response (P = 0.03) and worse PFS (P = 0.021). However, a larger increase in on-treatment levels of circulating VEGF-A was associated with clinical benefit (P = 0.01) and improved overall survival (P = 0.0058). Among peripheral immune cell populations, an on-treatment decrease in circulating PD-L1+ T cells was associated with improved outcomes, with a reduction in CD4+PD-L1+ [HR, 0.62; 95% confidence interval (CI), 0.49-0.91; P = 0.016] and CD8+PD-L1+ T cells (HR, 0.59; 95% CI, 0.39-0.87; P = 0.009) correlated with improved PFS. Within the tumor itself, a higher percentage of terminally exhausted (PD-1+ and either TIM-3+ or LAG-3+) CD8+ T cells was associated with worse PFS (P = 0.028). Overall, these findings support the value of tumor and blood-based immune assessments in determining therapeutic benefit for patients with RCC receiving atezolizumab plus bevacizumab and provide a foundation for future biomarker studies for patients with variant histology RCC receiving immunotherapy-based combinations.
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Affiliation(s)
- Renee Maria Saliby
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, 02215, USA
| | - Valisha Shah
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Wanling Xie
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Ronan Flippot
- Department of Cancer Medicine, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Thomas Denize
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - M. Harry Kane
- Yale Center of Cellular and Molecular Oncology, Yale School of Medicine, New Haven, CT 06511, USA
| | - Katrine N. Madsen
- Yale Center of Cellular and Molecular Oncology, Yale School of Medicine, New Haven, CT 06511, USA
| | - Miriam Ficial
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Laure Hirsch
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Xiao X. Wei
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - John A. Steinharter
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
- Larner College of Medicine, University of Vermont, Burlington, VT, 05405, USA
| | - Lauren C. Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
- Surface Oncology, Cambridge MA 02139, USA
| | - Ulka N. Vaishampayan
- University of Michigan/Karmanos Cancer Institute, Wayne State University, Detroit, MI, 48201 USA
| | - Mariano Severgnini
- Center for Immuno-Oncology Immune Assessment Laboratory at the Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - David F. McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Gwo-Shu Mary Lee
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Wenxin Xu
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Eliezer M. Van Allen
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Bradley A. McGregor
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
| | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - David A. Braun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02115, USA
- Yale Center of Cellular and Molecular Oncology, Yale School of Medicine, New Haven, CT 06511, USA
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6
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Choueiri TK, Powles T, Albiges L, Burotto M, Szczylik C, Zurawski B, Yanez Ruiz E, Maruzzo M, Suarez Zaizar A, Fein LE, Schutz FA, Heng DYC, Wang F, Mataveli F, Chang YL, van Kooten Losio M, Suarez C, Motzer RJ. Cabozantinib plus Nivolumab and Ipilimumab in Renal-Cell Carcinoma. N Engl J Med 2023; 388:1767-1778. [PMID: 37163623 PMCID: PMC10257898 DOI: 10.1056/nejmoa2212851] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The efficacy and safety of treatment with cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced renal-cell carcinoma are unknown. METHODS In this phase 3, double-blind trial, we enrolled patients with advanced clear-cell renal-cell carcinoma who had not previously received treatment and had intermediate or poor prognostic risk according to the International Metastatic Renal-Cell Carcinoma Database Consortium categories. Patients were randomly assigned to receive 40 mg of cabozantinib daily in addition to nivolumab and ipilimumab (experimental group) or matched placebo in addition to nivolumab and ipilimumab (control group). Nivolumab (3 mg per kilogram of body weight) and ipilimumab (1 mg per kilogram) were administered once every 3 weeks for four cycles. Patients then received nivolumab maintenance therapy (480 mg once every 4 weeks) for up to 2 years. The primary end point was progression-free survival, as determined by blinded independent review according to Response Evaluation Criteria in Solid Tumors, version 1.1, and was assessed in the first 550 patients who had undergone randomization. The secondary end point was overall survival, assessed in all patients who had undergone randomization. RESULTS Overall, 855 patients underwent randomization: 428 were assigned to the experimental group and 427 to the control group. Among the first 550 patients who had undergone randomization (276 in the experimental group and 274 in the control group), the probability of progression-free survival at 12 months was 0.57 in the experimental group and 0.49 in the control group (hazard ratio for disease progression or death, 0.73; 95% confidence interval, 0.57 to 0.94; P = 0.01); 43% of the patients in the experimental group and 36% in the control group had a response. Grade 3 or 4 adverse events occurred in 79% of the patients in the experimental group and in 56% in the control group. Follow-up for overall survival is ongoing. CONCLUSIONS Among patients with previously untreated, advanced renal-cell carcinoma who had intermediate or poor prognostic risk, treatment with cabozantinib plus nivolumab and ipilimumab resulted in significantly longer progression-free survival than treatment with nivolumab and ipilimumab alone. Grade 3 or 4 adverse events were more common in the experimental group than in the control group. (Funded by Exelixis; COSMIC-313 ClinicalTrials.gov number, NCT03937219.).
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Affiliation(s)
- Toni K Choueiri
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Thomas Powles
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Laurence Albiges
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Mauricio Burotto
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Cezary Szczylik
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Bogdan Zurawski
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Eduardo Yanez Ruiz
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Marco Maruzzo
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Alberto Suarez Zaizar
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Luis E Fein
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fabio A Schutz
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Daniel Y C Heng
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fong Wang
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Fabio Mataveli
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Yu-Lin Chang
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Maximiliano van Kooten Losio
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Cristina Suarez
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
| | - Robert J Motzer
- From the Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (T.K.C.); the Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free NHS Trust, London (T.P.); the Department of Cancer Medicine, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France (L.A.); Bradford Hill Clinical Research Center, Santiago (M.B.), and James Lind Centro de Investigación del Cáncer, Temuco (E.Y.R.) - both in Chile; the Postgraduate Medical Center, Department of Oncology, European Health Center, Otwock, Warsaw (C. Szczylik), and the Department of Outpatient Chemotherapy, Professor Franciszek Łukaszczyk Oncology Center, Bydgoszcz (B.Z.) - both in Poland; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IRCCS, Padua, Italy (M.M.); Consultorio de Medicina Especializada, Benito Juárez, Mexico City (A.S.Z.); Instituto de Oncología de Rosario, Rosario, Argentina (L.E.F.); Latin American Cooperative Oncology Group, Porto Alegre, and Beneficência Portuguesa de São Paulo, São Paulo - both in Brazil (F.A.S.); the Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada (D.Y.C.H.); Exelixis, Alameda, CA (F.W., F.M., Y.-L.C.); Bristol Myers Squibb, Boudry, Switzerland (M.K.L.); the Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona (C. Suarez); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (R.J.M.)
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7
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Choueiri TK, Eto M, Motzer R, De Giorgi U, Buchler T, Basappa NS, Méndez-Vidal MJ, Tjulandin S, Hoon Park S, Melichar B, Hutson T, Alemany C, McGregor B, Powles T, Grünwald V, Alekseev B, Rha SY, Kopyltsov E, Kapoor A, Alonso Gordoa T, Goh JC, Staehler M, Merchan JR, Xie R, Perini RF, Mody K, McKenzie J, Porta CG. Lenvatinib plus pembrolizumab versus sunitinib as first-line treatment of patients with advanced renal cell carcinoma (CLEAR): extended follow-up from the phase 3, randomised, open-label study. Lancet Oncol 2023; 24:228-238. [PMID: 36858721 DOI: 10.1016/s1470-2045(23)00049-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND In the primary analysis of the CLEAR study, lenvatinib plus pembrolizumab significantly improved progression-free survival and overall survival versus sunitinib in patients with advanced renal cell carcinoma (data cutoff Aug 28, 2020). We aimed to assess overall survival based on 7 months of additional follow-up. METHODS This is a protocol-prespecified updated overall survival analysis (data cutoff March 31, 2021) of the open-label, phase 3, randomised CLEAR trial. Patients with clear-cell advanced renal cell carcinoma who had not received any systemic anticancer therapy for renal cell carcinoma, including anti-vascular endothelial growth factor therapy, or any systemic investigational anticancer drug, were eligible for inclusion from 200 sites (hospitals and cancer centres) across 20 countries. Patients were randomly assigned (1:1:1) to receive lenvatinib (20 mg per day orally in 21-day cycles) plus pembrolizumab (200 mg intravenously every 21 days; lenvatinib plus pembrolizumab group), lenvatinib (18 mg per day orally) plus everolimus (5 mg per day orally; lenvatinib plus everolimus group [not reported in this updated analysis]) in 21-day cycles, or sunitinib (50 mg per day orally, 4 weeks on and 2 weeks off; sunitinib group). Eligible patients were at least 18 years old with a Karnofsky performance status of 70 or higher. A computer-generated randomisation scheme was used, and stratification factors were geographical region and Memorial Sloan Kettering Cancer Center prognostic groups. The primary endpoint was progression-free survival assessed by independent imaging review according to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1). In this Article, extended follow-up analyses for progression-free survival and protocol-specified updated overall survival data are reported for the intention-to-treat population. No safety analyses were done at this follow-up. This study is closed to new participants and is registered with ClinicalTrials.gov, NCT02811861. FINDINGS Between Oct 13, 2016, and July 24, 2019, 1417 patients were screened for inclusion in the CLEAR trial, of whom 1069 (75%; 273 [26%] female, 796 [74%] male; median age 62 years [IQR 55-69]) were randomly assigned: 355 (33%) patients (255 [72%] male and 100 [28%] female) to the lenvatinib plus pembrolizumab group, 357 (33%) patients (275 [77%] male and 82 [23%] female) to the sunitinib group, and 357 (33%) patients to the lenvatinib plus everolimus group (not reported in this updated analysis). Median follow-up for progression-free survival was 27·8 months (IQR 20·3-33·8) in the lenvatinib plus pembrolizumab group and 19·4 months (5·5-32·5) in the sunitinib group. Median progression-free survival was 23·3 months (95% CI 20·8-27·7) in the lenvatinib plus pembrolizumab group and 9·2 months (6·0-11·0) in the sunitinib group (stratified hazard ratio [HR] 0·42 [95% CI 0·34-0·52]). Median overall survival follow-up was 33·7 months (IQR 27·4-36·9) in the lenvatinib plus pembrolizumab group and 33·4 months (26·7-36·8) in the sunitinib group. Overall survival was improved with lenvatinib plus pembrolizumab (median not reached [95% CI 41·5-not estimable]) versus sunitinib (median not reached [38·4-not estimable]; HR 0·72 [95% CI 0·55-0·93]). INTERPRETATION Efficacy benefits of lenvatinib plus pembrolizumab over sunitinib were durable and clinically meaningful with extended follow-up. These results support the use of lenvatinib plus pembrolizumab as a first-line therapy for patients with advanced renal cell carcinoma. FUNDING Eisai and Merck Sharp & Dohme.
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Affiliation(s)
- Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Robert Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Naveen S Basappa
- Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - María José Méndez-Vidal
- Department of Medical Oncology, Hospital Universitario Reina Sofía, Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Sergei Tjulandin
- Department of Clinical Pharmacology and Chemotherapy, N N Blokhin National Medical Research Center for Oncology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Se Hoon Park
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bohuslav Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Thomas Hutson
- Department of Medical Oncology, Texas Oncology-Baylor Charles A Sammons Cancer Center, Dallas, TX, USA
| | - Carlos Alemany
- Department of Hematology and Oncology, AdventHealth Cancer Institute, Orlando, FL, USA
| | - Bradley McGregor
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Powles
- Department of Oncology, The Royal Free NHS Trust, London, England, UK; Department of Oncology, Barts Cancer Institute, Queen Mary Institute of London, London, UK
| | - Viktor Grünwald
- Clinic for Urology and Clinic for Medical Oncology, University Hospital Essen, Essen, Germany
| | - Boris Alekseev
- Department of Onco-urology, P A Hertsen Moscow Cancer Research Institute, Moscow, Russia
| | - Sun Young Rha
- Department of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Evgeny Kopyltsov
- State Institution of Healthcare "Regional Clinical Oncology Dispensary", Omsk, Russia
| | - Anil Kapoor
- Division of Urology, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Teresa Alonso Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jeffrey C Goh
- ICON Research, South Brisbane, QLD, Australia; Department of BioMedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael Staehler
- Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jaime R Merchan
- Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Ran Xie
- Biostatistics, Eisai, Nutley, NJ, USA
| | | | - Kalgi Mody
- Clinical Research, Eisai, Nutley, NJ, USA
| | | | - Camillo G Porta
- Interdisciplinary Department of Medicine, University of Bari 'A Moro', Bari, Italy
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Larkin J, Oya M, Martignoni M, Thistlethwaite F, Nathan P, Ornstein MC, Powles T, Beckermann KE, Balar AV, McDermott D, Gupta S, Philips GK, Gordon MS, Uemura H, Tomita Y, Wang J, Michelon E, di Pietro A, Choueiri TK. Avelumab Plus Axitinib as First-Line Therapy for Advanced Renal Cell Carcinoma: Long-Term Results from the JAVELIN Renal 100 Phase Ib Trial. Oncologist 2022; 28:333-340. [PMID: 36576173 PMCID: PMC10078905 DOI: 10.1093/oncolo/oyac243] [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: 07/01/2022] [Accepted: 10/06/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Progression-free survival was significantly longer in patients who received avelumab plus axitinib versus sunitinib as first-line treatment for advanced renal cell carcinoma (aRCC) in a randomized phase III trial. We report long-term safety and efficacy of avelumab plus axitinib as first-line treatment for patients with aRCC from the JAVELIN Renal 100 phase Ib trial (NCT02493751). MATERIALS AND METHODS In this open-label, multicenter, phase Ib study, patients with untreated aRCC received avelumab 10 mg/kg every 2 weeks plus axitinib 5 mg twice daily or with axitinib for 7 days followed by avelumab plus axitinib. Safety and efficacy were assessed in all patients receiving at least one dose of avelumab or axitinib. RESULTS Overall, 55 patients were enrolled and treated. Median follow-up was 55.7 months (95% CI, 54.5-58.7). Treatment-related adverse events of any grade or grade ≥3 occurred in 54 (98.2%) and 34 (61.8%) patients, respectively. The confirmed objective response rate was 60.0% (95% CI, 45.9-73.0), including complete response in 10.9% of patients. Median duration of response was 35.9 months (95% CI, 12.7-52.9); the probability of response was 65.8% (95% CI, 46.7-79.4) at 2 years. Median progression-free survival was 8.3 months (95% CI, 5.3-32.0). Median overall survival was not reached (95% CI, 40.8-not estimable); the 5-year overall survival rate was 57.3% (95% CI, 41.2-70.5). CONCLUSION Five-year follow-up for combination treatment with avelumab plus axitinib in previously untreated patients with aRCC showed long-term clinical activity with no new safety signals, supporting use of this regimen within its approved indication in clinical practice (Clinicaltrials.gov NCT02493751).
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Affiliation(s)
- James Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Mototsugu Oya
- Department of Urology, Keio University Hospital, Tokyo, Japan
| | | | - Fiona Thistlethwaite
- The Christie NHS Foundation Trust, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Paul Nathan
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Moshe C Ornstein
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Powles
- Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - Kathryn E Beckermann
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arjun V Balar
- Department of Medicine, Perlmutter Cancer Center at NYU Langone Health, New York, NY, USA
| | - David McDermott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sumati Gupta
- Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - George K Philips
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Michael S Gordon
- Division of Cancer Research, HonorHealth Research Institute, Scottsdale, AZ, USA
| | - Hirotsugu Uemura
- Department of Medicine, Kindai University Hospital, Osaka, Japan
| | - Yoshihiko Tomita
- Department of Urology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Jing Wang
- Biostatistics, Pfizer, Cambridge, MA, USA
| | | | | | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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9
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Apolo AB, Powles T, Escudier B, Burotto M, Zhang J, Simsek B, Scheffold C, Motzer RJ, Choueiri TK. Nivolumab plus ipilimumab plus cabozantinib triplet combination for patients with previously untreated advanced renal cell carcinoma: Results from a discontinued arm of the phase III CheckMate 9ER trial. Eur J Cancer 2022; 177:63-71. [PMID: 36327527 PMCID: PMC9750497 DOI: 10.1016/j.ejca.2022.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The phase III CheckMate 9ER trial originally included a nivolumab plus ipilimumab plus cabozantinib triplet arm, which was discontinued early due to the evolving treatment landscape for first-line advanced renal cell carcinoma (aRCC). We report an exploratory analysis of patients randomised to the triplet regimen before enrolment discontinuation. METHODS Patients with clear-cell aRCC received nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) Q3W for four cycles with once-daily cabozantinib (40 mg), then nivolumab (240 mg) Q2W plus once-daily cabozantinib (40 mg). CheckMate 9ER primary (progression-free survival [PFS] by blinded independent central review [BICR]) and key secondary (overall survival [OS], objective response rate [ORR] by BICR, and safety) endpoints were applied, along with investigator-assessed PFS and ORR. RESULTS Fifty patients were randomised to the triplet regimen. After a median follow-up of 39.1 months (range, 33.4-44.5), median PFS (95% CI) was 9.9 (5.7-16.8) months by BICR and 13.9 (7.3-24.7) months by investigator; median OS (95% CI) was 37.0 (31.8-not estimable) months. ORR (95% CI) was 44.0% (30.0-58.7; complete response, 8.0%) by BICR and 48.0% (33.7-62.6; all partial responses) by investigator. Grade 3-4 treatment-related adverse events (TRAEs) occurred in 84.0%, most commonly alanine aminotransferase increased (20.0%), aspartate aminotransferase increased (16.0%), and hepatotoxicity (16.0%). Grade 3-4 hepatic immune-mediated AEs occurred in 40.0%. There were no grade 5 TRAEs. CONCLUSIONS These results suggest that the nivolumab plus ipilimumab plus cabozantinib triplet combination has clinical activity in patients with previously untreated aRCC, although monitoring of overlapping toxicities will be important in future studies of this regimen. CLINICALTRIALS gov registration: NCT03141177.
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Affiliation(s)
- Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Thomas Powles
- Department of Genitourinary Oncology, Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust, London, UK
| | - Bernard Escudier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Joshua Zhang
- Department of Clinical Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Burcin Simsek
- Department of Global Biometrics and Data Science, Bristol Myers Squibb, Princeton, NJ, USA
| | | | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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Choueiri TK, Kluger H, George S, Tykodi SS, Kuzel TM, Perets R, Nair S, Procopio G, Carducci MA, Castonguay V, Folefac E, Lee CH, Hotte SJ, Miller WH, Saggi SS, Lee CW, Desilva H, Bhagavatheeswaran P, Motzer RJ, Escudier B. FRACTION-RCC: nivolumab plus ipilimumab for advanced renal cell carcinoma after progression on immuno-oncology therapy. J Immunother Cancer 2022; 10:jitc-2022-005780. [PMID: 36328377 PMCID: PMC9639138 DOI: 10.1136/jitc-2022-005780] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role and sequencing of combination immuno-oncology (IO) therapy following progression on or after first-line IO therapy has not been well-established. The Fast Real-time Assessment of Combination Therapies in Immuno-ONcology (FRACTION) program is an open-label, phase 2 platform trial designed to evaluate multiple IO combinations in patients with advanced renal cell carcinoma (aRCC) who progressed during or after prior IO therapy. Here, we describe the results for patients treated with nivolumab plus ipilimumab. For enrollment in track 2 (reported here), patients with histologically confirmed clear cell aRCC, Karnofsky performance status ≥70%, and life expectancy ≥3 months who had previously progressed after IO (anti-programmed death 1 (PD-1), anti-programmed death-ligand 1 (PD-L1), or anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4)) therapy were eligible. Previous treatment with anti-CTLA-4 therapy plus anti-PD-1/PD-L1 therapy precluded eligibility for enrollment in the nivolumab plus ipilimumab arm. Patients were treated with nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for four doses, followed by nivolumab 480 mg every 4 weeks for up to 2 years or until progression, toxicity, or protocol-specified discontinuation. The primary outcome measures were objective response rate (ORR), duration of response (DOR), and progression-free survival (PFS) rate at 24 weeks. Secondary outcomes were safety and tolerability up to 2 years. Overall survival (OS) was a tertiary/exploratory endpoint. Overall, 46 patients were included with a median follow-up of 33.8 months. The ORR was 17.4% (95% CI, 7.8 to 31.4) with eight (17.4%) patients achieving partial response. Stable disease was achieved in 19 (41.3%) patients, while 14 (30.4%) had progressive disease. Median DOR (range) was 16.4 (2.1+ to 27.0+) months. The PFS rate at 24 weeks was 43.2%, and median OS was 23.8 (95% CI, 13.2 to not reached) months. Grade 3-4 immune-mediated adverse events were reported in seven (15.2%) patients. No treatment-related deaths were reported. Patients with aRCC treated with nivolumab plus ipilimumab may derive durable clinical benefit after progression on previous IO therapies, including heavily pretreated patients, with a manageable safety profile that was consistent with previously published safety outcomes. These outcomes contribute to the knowledge of optimal sequencing of IO therapies for patients with aRCC with high unmet needs. TRIAL REGISTRATION NUMBER NCT02996110.
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Affiliation(s)
- Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Harriet Kluger
- Department of Medical Oncology, Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Scott S Tykodi
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Timothy M Kuzel
- Division of Hematology/Oncology/Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Ruth Perets
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Suresh Nair
- Department of Hematology/Oncology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Giuseppe Procopio
- Division of Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael A Carducci
- Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Vincent Castonguay
- Department of Medicine, CHU de Quebec-Universite Laval, Montreal, Quebec, Canada
| | - Edmund Folefac
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chung-Han Lee
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sebastien J Hotte
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Wilson H Miller
- Division of Oncology, Department of Medicine, McGill University, Montreal, Québec, Canada
- Department of Medicine, Division of Experimental Medicine, Jewish General Hospital, Montreal, Québec, Canada
| | - Shruti Shally Saggi
- Department of Global Regulatory Science, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Chung-Wei Lee
- Department of Clinical Trials, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Heshani Desilva
- Department of Global Drug Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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Choueiri TK, Porta C, Suárez C, Hainsworth J, Voog E, Duran I, Reeves J, Czaykowski P, Castellano D, Chen J, Sedarati F, Powles T. Randomized Phase II Trial of Sapanisertib ± TAK-117 vs. Everolimus in Patients With Advanced Renal Cell Carcinoma After VEGF-Targeted Therapy. Oncologist 2022; 27:1048-1057. [PMID: 36146944 PMCID: PMC9732228 DOI: 10.1093/oncolo/oyac192] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sapanisertib, a dual mTORC1/2 inhibitor, may offer more complete inhibition of the PI3K/AKT/mTOR pathway than mTORC1 inhibitors, such as everolimus. This phase II study evaluated the efficacy and safety of single-agent sapanisertib and sapanisertib plus the PI3Kα inhibitor TAK-117, vs. everolimus in patients with advanced clear cell renal cell carcinoma (ccRCC) that had progressed on or after VEGF-targeted therapy. MATERIALS AND METHODS Patients with histologically confirmed, advanced ccRCC were randomized 1:1:1 to receive single-agent everolimus 10 mg once daily, single-agent sapanisertib 30 mg once weekly, or sapanisertib 4 mg plus TAK-117 200 mg, both once daily for 3 days/week, in 28-day cycles. The primary endpoint was progression-free survival (PFS). RESULTS Ninety-five patients were treated with everolimus or sapanisertib (n = 32 each), or sapanisertib plus TAK-117 (n = 31). There were no significant differences in PFS among the 3 groups or across any subgroups. Median PFS was 3.8 months with everolimus vs. 3.6 months with sapanisertib (HR, 1.33; 95% CI, 0.75-2.36), and 3.1 months with sapanisertib plus TAK-117 (HR, 1.37; 95% CI, 0.75-2.52). No significant differences in overall survival were seen among groups. Overall response rate was 16.7%, 0%, and 7.1%, respectively. Discontinuations due to treatment-emergent adverse events were 15.6%, 28.1%, and 29.0%. CONCLUSION Sapanisertib with or without TAK-117 was less tolerable and did not improve efficacy vs. everolimus in patients with advanced ccRCC who had relapsed after or were refractory to VEGF-targeted therapies. Dual mTORC1/2 inhibition may not be an effective therapeutic approach for these patients.
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Affiliation(s)
- Toni K Choueiri
- Corresponding author: Toni K. Choueiri, MD, Jerome and Nancy Kohlberg Professor of Medicine, Department of Medicine and Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. Tel: +1 617 632 3000;
| | - Camillo Porta
- Present address: University of Bari Aldo Moro, Bari, Italy
| | - Cristina Suárez
- Medical Oncology, Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Eric Voog
- Centre Jean Bernard/Clinique Victor Hugo, Institut Inter-régional de Cancérologie, Le Mans, France
| | - Ignacio Duran
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - James Reeves
- Florida Cancer Specialists/Sarah Cannon Research Institute, Fort Myers, FL, USA
| | | | - Daniel Castellano
- i+12 Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jingjing Chen
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Farhad Sedarati
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Thomas Powles
- Barts Cancer Institute, Royal Free NHS Trust, St. Bartholomew’s Hospital, London, UK
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Büttner FA, Winter S, Stühler V, Rausch S, Hennenlotter J, Füssel S, Zastrow S, Meinhardt M, Toma M, Jerónimo C, Henrique R, Miranda-Gonçalves V, Kröger N, Ribback S, Hartmann A, Agaimy A, Stöhr C, Polifka I, Fend F, Scharpf M, Comperat E, Wasinger G, Moch H, Stenzl A, Gerlinger M, Bedke J, Schwab M, Schaeffeler E. A novel molecular signature identifies mixed subtypes in renal cell carcinoma with poor prognosis and independent response to immunotherapy. Genome Med 2022; 14:105. [PMID: 36109798 PMCID: PMC9476269 DOI: 10.1186/s13073-022-01105-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/10/2022] [Indexed: 12/30/2022] Open
Abstract
Background Renal cell carcinoma (RCC) is a heterogeneous disease comprising histologically defined subtypes. For therapy selection, precise subtype identification and individualized prognosis are mandatory, but currently limited. Our aim was to refine subtyping and outcome prediction across main subtypes, assuming that a tumor is composed of molecular features present in distinct pathological subtypes. Methods Individual RCC samples were modeled as linear combination of the main subtypes (clear cell (ccRCC), papillary (pRCC), chromophobe (chRCC)) using computational gene expression deconvolution. The new molecular subtyping was compared with histological classification of RCC using the Cancer Genome Atlas (TCGA) cohort (n = 864; ccRCC: 512; pRCC: 287; chRCC: 65) as well as 92 independent histopathologically well-characterized RCC. Predicted continuous subtypes were correlated to cancer-specific survival (CSS) in the TCGA cohort and validated in 242 independent RCC. Association with treatment-related progression-free survival (PFS) was studied in the JAVELIN Renal 101 (n = 726) and IMmotion151 trials (n = 823). CSS and PFS were analyzed using the Kaplan–Meier and Cox regression analysis. Results One hundred seventy-four signature genes enabled reference-free molecular classification of individual RCC. We unambiguously assign tumors to either ccRCC, pRCC, or chRCC and uncover molecularly heterogeneous tumors (e.g., with ccRCC and pRCC features), which are at risk of worse outcome. Assigned proportions of molecular subtype-features significantly correlated with CSS (ccRCC (P = 4.1E − 10), pRCC (P = 6.5E − 10), chRCC (P = 8.6E − 06)) in TCGA. Translation into a numerical RCC-R(isk) score enabled prognosis in TCGA (P = 9.5E − 11). Survival modeling based on the RCC-R score compared to pathological categories was significantly improved (P = 3.6E − 11). The RCC-R score was validated in univariate (P = 3.2E − 05; HR = 3.02, 95% CI: 1.8–5.08) and multivariate analyses including clinicopathological factors (P = 0.018; HR = 2.14, 95% CI: 1.14–4.04). Heterogeneous PD-L1-positive RCC determined by molecular subtyping showed increased PFS with checkpoint inhibition versus sunitinib in the JAVELIN Renal 101 (P = 3.3E − 04; HR = 0.52, 95% CI: 0.36 − 0.75) and IMmotion151 trials (P = 0.047; HR = 0.69, 95% CI: 0.48 − 1). The prediction of PFS significantly benefits from classification into heterogeneous and unambiguous subtypes in both cohorts (P = 0.013 and P = 0.032). Conclusion Switching from categorical to continuous subtype classification across most frequent RCC subtypes enables outcome prediction and fosters personalized treatment strategies.
Supplementary Information The online version contains supplementary material available at 10.1186/s13073-022-01105-y.
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Denize T, Hou Y, Pignon JC, Walton E, West DJ, Freeman GJ, Braun DA, Wu CJ, Gupta S, Motzer RJ, Atkins MB, McDermott D, Choueiri TK, Shukla SA, Signoretti S. Transcriptomic Correlates of Tumor Cell PD-L1 Expression and Response to Nivolumab Monotherapy in Metastatic Clear Cell Renal Cell Carcinoma. Clin Cancer Res 2022; 28:4045-4055. [PMID: 35802667 PMCID: PMC9481706 DOI: 10.1158/1078-0432.ccr-22-0923] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE PD-L1 expression on tumor cells (TC) is associated with response to anti-PD-1-based therapies in some tumor types, but its significance in clear cell renal cell carcinoma (ccRCC) is uncertain. We leveraged tumor heterogeneity to identify molecular correlates of TC PD-L1 expression in ccRCC and assessed their role in predicting response to anti-PD-1 monotherapy. EXPERIMENTAL DESIGN RNA sequencing was performed on paired TC PD-L1 positive and negative areas isolated from eight ccRCC tumors and transcriptomic features associated with PD-L1 status were identified. A cohort of 232 patients with metastatic ccRCC from the randomized CheckMate-025 (CM-025) trial was used to confirm the findings and correlate transcriptomic profiles with clinical outcomes. RESULTS In both the paired samples and the CM-025 cohort, TC PD-L1 expression was associated with combined overexpression of immune- and cell proliferation-related pathways, upregulation of T-cell activation signatures, and increased tumor-infiltrating immune cells. In the CM-025 cohort, TC PD-L1 expression was not associated with clinical outcomes. A molecular RCC subtype characterized by combined overexpression of immune- and cell proliferation-related pathways (previously defined by unsupervised clustering of transcriptomic data) was enriched in TC PD-L1 positive tumors and displayed longer progression-free survival (HR, 0.32; 95% confidence interval, 0.13-0.83) and higher objective response rate (30% vs. 0%, P = 0.04) on nivolumab compared with everolimus. CONCLUSIONS Both TC-extrinsic (immune-related) and TC-intrinsic (cell proliferation-related) mechanisms are likely intertwined in the regulation of TC PD-L1 expression in ccRCC. The quantitation of these transcriptional programs may better predict benefit from anti-PD-1-based therapy compared with TC PD-L1 expression alone in ccRCC.
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Affiliation(s)
- Thomas Denize
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Yue Hou
- Translational Immunogenomics Laboratory, Dana-Farber Cancer Institute, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jean-Christophe Pignon
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily Walton
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Destiny J. West
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | - Gordon J. Freeman
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David A. Braun
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Catherine J. Wu
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - David McDermott
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Toni K. Choueiri
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Sachet A. Shukla
- Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Hematopoietic Biology and Malignancy, The University of Texas M.D. Anderson Cancer Center, Houston, TX
- Corresponding authors: Sabina Signoretti, M.D., Brigham and Women’s Hospital, Thorn Building 504A, 75 Francis Street; Boston, MA 02115, +1 617-525-7437, , Sachet A. Shukla, Ph.D. Hematopoietic Biology and Malignancy, University of Texas MD Anderson Cancer Center, Houston, TX, USA, +1 515-708-1252,
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA
- Corresponding authors: Sabina Signoretti, M.D., Brigham and Women’s Hospital, Thorn Building 504A, 75 Francis Street; Boston, MA 02115, +1 617-525-7437, , Sachet A. Shukla, Ph.D. Hematopoietic Biology and Malignancy, University of Texas MD Anderson Cancer Center, Houston, TX, USA, +1 515-708-1252,
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14
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Tomita Y, Larkin J, Venugopal B, Haanen J, Kanayama H, Eto M, Grimm MO, Fujii Y, Umeyama Y, Huang B, Mariani M, di Pietro A, Choueiri TK. Association of C-reactive protein with efficacy of avelumab plus axitinib in advanced renal cell carcinoma: long-term follow-up results from JAVELIN Renal 101. ESMO Open 2022; 7:100564. [PMID: 36037566 PMCID: PMC9588905 DOI: 10.1016/j.esmoop.2022.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background C-reactive protein (CRP) is an important prognostic and predictive factor in advanced renal cell carcinoma (aRCC). We report the association of CRP levels at baseline and early after treatment with efficacy of avelumab plus axitinib or sunitinib from the phase III JAVELIN Renal 101 trial. Patients and methods Patients were categorized into normal (baseline CRP <10 mg/l), normalized (baseline CRP ≥10 mg/l and ≥1 CRP value decreased to <10 mg/l during 6-week treatment), and non-normalized (CRP ≥10 mg/l at baseline and during 6-week treatment) CRP groups. Progression-free survival and best overall response from the second interim analysis and overall survival (OS) from the third interim analysis were assessed. Results In the avelumab plus axitinib and sunitinib arms, respectively, 234, 51, and 108 patients and 232, 36, and 128 patients were categorized into normal, normalized, and non-normalized CRP groups. In respective CRP groups, objective response rates [95% confidence interval (CI)] were 56.0% (49.4% to 62.4%), 66.7% (52.1% to 79.2%), and 45.4% (35.8% to 55.2%) with avelumab plus axitinib and 30.6% (24.7% to 37.0%), 41.7% (25.5% to 59.2%), and 19.5% (13.1% to 27.5%) with sunitinib; complete response rates were 3.8%, 11.8%, and 0.9% and 3.0%, 0%, and 1.6%, respectively. Median progression-free survival (95% CI) was 15.2 months (12.5-21.0 months), not reached (NR) [11.1 months-not estimable (NE)], and 7.0 months (5.6-9.9 months) with avelumab plus axitinib and 11.2 months (8.4-13.9 months), 11.2 months (6.7-13.8 months), and 4.2 months (2.8-5.6 months) with sunitinib; median OS (95% CI) was NR (42.2 months-NE), NR (30.4 months-NE), and 23.0 months (18.4-33.1 months) and NR (39.0 months-NE), 39.8 months (21.7-NE), and 19.1 months (16.3-25.3 months), respectively. Multivariate analyses demonstrated that normalized or non-normalized CRP levels were independent factors for the prediction of objective response rate or OS, respectively, with avelumab plus axitinib. Conclusions In patients with aRCC, CRP levels at baseline and early after treatment may predict efficacy with avelumab plus axitinib. C-reactive protein is an important prognostic and predictive factor in advanced renal cell carcinoma. The association between C-reactive protein levels and the efficacy of avelumab plus axitinib or sunitinib was evaluated. C-reactive protein levels at baseline and early after treatment might predict efficacy with avelumab plus axitinib.
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Affiliation(s)
- Y Tomita
- Department of Urology, Department of Molecular Oncology, Niigata University Graduate School of Medicine, Niigata, Japan.
| | - J Larkin
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - B Venugopal
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Haanen
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - M Eto
- Department of Urology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - M-O Grimm
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Y Fujii
- Pfizer R&D Japan, Tokyo, Japan
| | | | | | | | | | - T K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, USA
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15
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Nivolumab plus cabozantinib versus sunitinib in first-line treatment for advanced renal cell carcinoma (CheckMate 9ER): long-term follow-up results from an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:888-898. [DOI: 10.1016/s1470-2045(22)00290-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/26/2022] [Accepted: 05/11/2022] [Indexed: 12/22/2022]
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16
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Motzer RJ, Choueiri TK, McDermott DF, Powles T, Vano YA, Gupta S, Yao J, Han C, Ammar R, Papillon-Cavanagh S, Saggi SS, McHenry MB, Ross-Macdonald P, Wind-Rotolo M. Biomarker analysis from CheckMate 214: nivolumab plus ipilimumab versus sunitinib in renal cell carcinoma. J Immunother Cancer 2022; 10:jitc-2021-004316. [PMID: 35304405 PMCID: PMC8935174 DOI: 10.1136/jitc-2021-004316] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The phase 3 CheckMate 214 trial demonstrated higher response rates and improved overall survival with nivolumab plus ipilimumab versus sunitinib in first-line therapy for advanced clear-cell renal cell carcinoma (RCC). An unmet need exists to identify patients with RCC who are most likely to benefit from treatment with nivolumab plus ipilimumab. METHODS In exploratory analyses, pretreatment levels of programmed death ligand 1 were assessed by immunohistochemistry. Genomic and transcriptomic biomarkers (including tumor mutational burden and gene expression signatures) were also investigated. RESULTS Biomarkers previously associated with benefit from immune checkpoint inhibitor-containing regimens in RCC were not predictive for survival in patients with RCC treated with nivolumab plus ipilimumab. Analysis of gene expression identified an association between an inflammatory response and progression-free survival with nivolumab plus ipilimumab. CONCLUSIONS The exploratory analyses reveal relationships between molecular biomarkers and provide supportive data on how the inflammation status of the tumor microenvironment may be important for identifying predictive biomarkers of response and survival with combination immunotherapy in patients with RCC. Further validation may help to provide biomarker-driven precision treatment for patients with RCC.
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Affiliation(s)
- Robert J Motzer
- Kidney Cancer Section, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Yann-Alexandre Vano
- Medical Oncology, Hôpital Européen Georges Pompidou, APHP-Centre, Université de Paris, Paris, France.,Inflammation, Complement and Cancer, Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Saurabh Gupta
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | - Jin Yao
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | - Celine Han
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | - Ron Ammar
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - Shruti S Saggi
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | - M Brent McHenry
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - Megan Wind-Rotolo
- Translational Medicine, Bristol Myers Squibb Co, Princeton, New Jersey, USA
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17
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Choueiri TK, Albiges L, Atkins MB, Bakouny Z, Bratslavsky G, Braun DA, Haas NB, Haanen JB, Hakimi AA, Jewett MA, Jonasch E, Kaelin WG, Kapur P, Labaki C, Lewis B, McDermott DF, Pal SK, Pels K, Poteat S, Powles T, Rathmell WK, Rini BI, Signoretti S, Tannir NM, Uzzo RG, Hammers HJ. From Basic Science to Clinical Translation in Kidney Cancer: A Report from the Second Kidney Cancer Research Summit. Clin Cancer Res 2022; 28:831-839. [PMID: 34965942 PMCID: PMC9223120 DOI: 10.1158/1078-0432.ccr-21-3238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
The second Kidney Cancer Research Summit was held virtually in October 2020. The meeting gathered worldwide experts in the field of kidney cancer, including basic, translational, and clinical scientists as well as patient advocates. Novel studies were presented, addressing areas of unmet need related to different topics. These include novel metabolic targets, promising immunotherapeutic regimens, predictive genomic and transcriptomic biomarkers, and variant histologies of renal cell carcinoma (RCC). With the development of pioneering technologies, and an unprecedented commitment to kidney cancer research, the field has tremendously evolved. This perspective aims to summarize the different sessions of the conference, outline major advances in the understanding of RCC and discuss current challenges faced by the field.
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Affiliation(s)
- Toni K. Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michael B. Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gennady Bratslavsky
- Department of Urology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York
| | - David A. Braun
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi B. Haas
- Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John B.A.G. Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Ari Hakimi
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A.S. Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William G. Kaelin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Payal Kapur
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - David F. McDermott
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kevin Pels
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - W. Kimryn Rathmell
- Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Brian I. Rini
- Department of Medicine, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nizar M. Tannir
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert G. Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Hans J. Hammers
- Division of Hematology-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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18
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McGregor BA, Xie W, Adib E, Stadler WM, Zakharia Y, Alva A, Michaelson MD, Gupta S, Lam ET, Farah S, Nassar AH, Wei XX, Kilbridge KL, Harshman L, Signoretti S, Sholl L, Kwiatkowski DJ, McKay RR, Choueiri TK. Biomarker-Based Phase II Study of Sapanisertib (TAK-228): An mTORC1/2 Inhibitor in Patients With Refractory Metastatic Renal Cell Carcinoma. JCO Precis Oncol 2022; 6:e2100448. [PMID: 35171658 PMCID: PMC8865529 DOI: 10.1200/po.21.00448] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 01/10/2022] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Sapanisertib is a kinase inhibitor that inhibits both mammalian target of rapamycin complex 1 (mTORC1) and mTORC2. In this multicenter, single-arm phase II trial, we evaluated the efficacy of sapanisertib in patients with treatment-refractory metastatic renal cell carcinoma (mRCC; NCT03097328). METHODS Patients with mRCC of any histology progressing through standard therapy (including prior mTOR inhibitors) had baseline biopsy and received sapanisertib 30 mg by mouth once weekly until unacceptable toxicity or disease progression. The primary end point was objective response rate by RECIST 1.1. Tissue biomarkers of mTOR pathway activation were explored. RESULTS We enrolled 38 patients with mRCC (clear cell = 28; variant histology = 10) between August 2017 and November 2019. Twenty-four (63%) had received ≥ 3 prior lines of therapy; 17 (45%) had received prior rapalog therapy. The median follow-up was 10.4 (range 1-27.4) months. Objective response rate was two of 38 (5.3%; 90% CI, 1 to 15.6); the median progression-free survival (PFS) was 2.5 months (95% CI, 1.8 to 3.7). Twelve patients (32%) developed treatment-related grade 3 adverse events, with no grade 4 or 5 toxicities. Alterations in the mTOR pathway genes were seen in 5 of 29 evaluable patients (MTOR n = 1, PTEN n = 3, and TSC1 n = 1) with no association with response or PFS. Diminished or loss of PTEN expression by immunohistochemistry was seen in 8 of 21 patients and trended toward shorter PFS compared with intact PTEN (median 1.9 v 3.7 months; hazard ratio 2.5; 95% CI, 0.9 to 6.7; P = .055). CONCLUSION Sapanisertib had minimal activity in treatment-refractory mRCC independent of mTOR pathway alterations. Additional therapeutic strategies are needed for patients with refractory mRCC.
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Affiliation(s)
| | | | - Elio Adib
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
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19
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Gulati S, Labaki C, Karachaliou GS, Choueiri TK, Zhang T. OUP accepted manuscript. Oncologist 2022; 27:125-134. [PMID: 35641205 PMCID: PMC8895741 DOI: 10.1093/oncolo/oyab056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/03/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shuchi Gulati
- Division of Hematology and Oncology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Georgia Sofia Karachaliou
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Corresponding author: Tian Zhang, Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
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20
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Abstract
The COVID-19 pandemic has broadly impacted biomedical research and health care. Here we discuss current challenges for the cancer research community as they apply to early career investigators (ECIs). We propose a series of collaborative initiatives aimed to sustain ECIs and preserve and accelerate the ability to innovate with long-lasting impact.
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Affiliation(s)
- Ross L Levine
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - W Kimryn Rathmell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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