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Minami K, Osawa T, Kojima T, Hara T, Eto M, Takeuchi A, Nakai Y, Ueda K, Ozawa M, Uemura M, Ohba K, Tamura K, Shindo T, Nakagomi H, Takahashi A, Anai S, Yokomizo A, Morizane S, Kimura T, Shimazui T, Miyauchi Y, Mitsuzuka K, Hara H, Yoshimura K, Shiina H, Ito YM, Murai S, Nishiyama H, Shinohara N, Kitamura H. Efficacy and safety of axitinib for metastatic renal cell carcinoma: Real-world data on patients with renal impairment. Urol Oncol 2023; 41:458.e9-458.e19. [PMID: 37798145 DOI: 10.1016/j.urolonc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Limited information is currently available on the efficacy and safety of axitinib for metastatic renal cell carcinoma (mRCC) patients with renal impairment. Therefore, the present study investigated the efficacy and toxicity of axitinib in patients with chronic kidney disease. METHODS Post-hoc analyses were performed on a Japanese multicenter cohort study of 477 mRCC patients who received axitinib followed by 1 or 2 regimens of systemic antiangiogenic therapy between January 2012 and December 2016. Differences in clinical characteristics and the efficacy and safety of axitinib were assessed based on pretreatment renal function. RESULTS Patients were categorized into the following 5 renal function groups according to baseline renal function: estimated glomerular filtration rate (eGFR) ≥60 ml/min (n = 133), 45 ml/min ≤eGFR <60 ml/min (n = 153), 30 ml/min ≤eGFR< 45 ml/min (n = 130), eGFR <30 ml/min (n = 45), and dialysis (n = 16). Median progression-free survival (PFS) (95% confidence interval [CI]) in the 5 groups was 11 (8-16), 14 (11-19), 14 (10-19), 12 (8-24), and 6 (3-NR) months, respectively (p = 0.781). After adjustments for treatment-related confounders, the renal function group was not a significant prognostic factor for PFS. Objective response rates in the 5 groups were 22%, 23%, 23%, 18%, 20%, and 38%, respectively (p = 0.468). Regarding adverse events of all grades, hypertension (p = 0.0006) and renal and urinary disorders (p < 0.0001) were more frequently observed in the eGFR <30 ml/min group than in the other groups. CONCLUSIONS Since renal function at the initiation of treatment with axitinib does not adversely affect the efficacy of VEGF-TKI therapy, clinicians do not need to avoid its administration to mRCC patients with impaired renal function in consideration of the risk of progression to end-stage renal disease.
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Affiliation(s)
- Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takahiro Kimura
- Department of Urology, The Jikei University, School of Medicine, Tokyo, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | | | | | - Hiroaki Hara
- Department of Urology, Shinshu University Hospital, Matsumoto, Japan
| | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Youichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Toyama University Hospital, Toyama, Japan
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Rodríguez-Fuentes ME, Pérez-Sayáns M, Carreras-Presas CM, Marichalar-Mendia X, Bagán-Debón L, López-López R. Prevalence of acute oral mucosal damage secondary to the use of systemic antineoplastics: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:385-395. [PMID: 36585342 DOI: 10.1016/j.oooo.2022.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of acute oral mucosal toxicities in non-irradiated patients treated with systemic antineoplastics agents. The secondary objective was to find out differences in its prevalence among the different types of systemic antineoplastics. STUDY DESIGN A systematic review and meta-analysis was performed. Articles from 2010 to July 2022 were retrieved and included if patients were adults undergoing oral assessment after administration of commercially available systemic antineoplastics. Data was extracted and pooled proportions were estimated using random-effect model method (Der Simonian and Lair). RESULTS Eighty-two articles were included in the study. The overall prevalence of acute oral mucosal damage across studies was 38.2% (95% CI: 33.1%-43.3%). The prevalence was 42.9% (95% CI: 32.8%-53%) in patients treated with chemotherapy alone, 38% (95% CI: 29.1%-47%) in patients treated with a combination of chemotherapy and targeted therapies, and 32.1% (95% CI: 26.8%-37.5%) in targeted therapies alone-treated patients. No statistically significant differences were found in the prevalence of oral mucosal toxicities between the different types of systemic antineoplastic treatments. CONCLUSIONS Oral mucosal toxicity is a major side effect in non-irradiated cancer patients undergoing systemic antineoplastics.
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Affiliation(s)
- Manuel Eros Rodríguez-Fuentes
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain.
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain.
| | | | - Xabier Marichalar-Mendia
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Leticia Bagán-Debón
- Department of Stomatology, Faculty of Medicine and Dentistry-INCLIVA, Valencia, Spain
| | - Rafael López-López
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Medical Oncology Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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3
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Saly DL, Eswarappa MS, Street SE, Deshpande P. Renal Cell Cancer and Chronic Kidney Disease. Adv Chronic Kidney Dis 2021; 28:460-468.e1. [PMID: 35190112 DOI: 10.1053/j.ackd.2021.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
The association between chronic kidney disease (CKD) and renal cell carcinoma (RCC) is bidirectional and multifactorial. Risk factors such as hypertension, diabetes mellitus, obesity, and smoking increase the risk of both CKD and RCC. CKD can lead to RCC via an underlying cystic disease or oxidative stress. RCC can cause CKD because of the tumor itself, surgical reduction of renal mass (either partial or radical nephrectomy), and perioperative acute kidney injury. Medical therapies such as immune checkpoint inhibitors and vascular endothelial growth factor inhibitors can lead to acute kidney injury and resultant CKD. Clinicians need to be aware of the complex, bidirectional interplay between both diseases.
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Mielczarek Ł, Brodziak A, Sobczuk P, Kawecki M, Cudnoch-Jędrzejewska A, Czarnecka AM. Renal toxicity of targeted therapies for renal cell carcinoma in patients with normal and impaired kidney function. Cancer Chemother Pharmacol 2021; 87:723-742. [PMID: 33768301 PMCID: PMC8110505 DOI: 10.1007/s00280-021-04260-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/13/2021] [Indexed: 12/11/2022]
Abstract
The introduction of novel targeted therapies during the last 2 decades has led to a significant improvement in patients' clinical outcomes with renal cell carcinoma. However, this improvement came at the price of a whole new spectrum of adverse events, including renal toxicity. Systemic treatment of patients with kidney neoplasms who often present with impairment of kidney function, even prior to treatment, poses an increasing diagnostic and therapeutic challenge for clinicians. Common lifestyle-related comorbidities, i.e., hypertension and diabetes, may contribute to further impairment of kidney function. The lack of official guidelines and the exclusion of patients with reduced kidney function from the clinical trials of recently approved drugs complicate the issue even further. Early detection and correct management of renal toxic effects are crucial to preserve kidney function and ensure the optimal administration of life-prolonging therapies. This review presents detailed information on the renal toxicities of three groups of drugs commonly used in renal cell carcinoma treatment: tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and immune checkpoint inhibitors. We outline the incidence and underlying mechanisms of renal adverse effects with a focus on patients on renal replacement therapy, as well as present suggestions for their management.
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Affiliation(s)
- Łukasz Mielczarek
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Anna Brodziak
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Paweł Sobczuk
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Kawecki
- Department of Oncology and Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland.
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Díaz-González Á, Sanduzzi-Zamparelli M, da Fonseca LG, Di Costanzo GG, Alves R, Iavarone M, Leal C, Sacco R, Matilla AM, Hernández-Guerra M, Aballay Soteras G, Wörns MA, Pinter M, Varela M, Ladekarl M, Chagas AL, Mínguez B, Arenas JI, Granito A, Sánchez-Torrijos Y, Rojas Á, Rodríguez de Lope C, Alvares-da-Silva MR, Pascual S, Rimassa L, Lledó JL, Huertas C, Sangro B, Giannini EG, Delgado M, Vergara M, Perelló C, Lue A, Sala M, Gallego A, Coll S, Hernáez T, Piñero F, Pereira G, França A, Marín J, Anders M, Mello V, Lozano M, Nault JC, Menéndez J, García Juárez I, Bruix J, Reig M. International and multicenter real-world study of sorafenib-treated patients with hepatocellular carcinoma under dialysis. Liver Int 2020; 40:1467-1476. [PMID: 32170821 DOI: 10.1111/liv.14436] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Information on safety and efficacy of systemic treatment in patients with hepatocellular carcinoma (HCC) under dialysis are limited due to patient exclusion from clinical trials. Thus, we aimed to evaluate the rate, prevalence, tolerability, and outcome of sorafenib in this population. METHODS We report a multicenter study comprising patients from Latin America and Europe. Patients treated with sorafenib were enrolled; demographics, dose modifications, adverse events (AEs), treatment duration, and outcome of patients undergoing dialysis were recorded. RESULTS As of March 2018, 6156 HCC patients were treated in 44 centres and 22 patients were concomitantly under dialysis (0.36%). The median age was 65.5 years, 40.9% had hepatitis C, 75% had Child-Pugh A, and 85% were Barcelona Clinic Liver Cancer-C. The median time to first dose modification, treatment duration and overall survival rate were 2.4 months (interquartile ranges [IQR], 0.8-3.8), 10.8 months (IQR, 4.5-16.9), and 17.5 months (95% CI, 7.2-24.5), respectively. Seventeen patients required at least 1 dose modification. The main causes of first dose modification were asthenia/worsening of Eastern Cooperative Oncology Group-Performance Status and diarrhoea. At the time of death or last follow-up, four patients were still on treatment and 18 had discontinued sorafenib: 14 were due to tumour progression, 2 were sorafenib-related, and 2 were non-sorafenib-related AE. CONCLUSIONS The outcomes observed in this cohort seem comparable to those in the non-dialysis population. Thus, to the best of our knowledge, this is the largest and most informative dataset regarding systemic treatment outcomes in HCC patients undergoing dialysis.
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Affiliation(s)
- Álvaro Díaz-González
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Marco Sanduzzi-Zamparelli
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Leonardo G da Fonseca
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | | | | | - Massimo Iavarone
- CRC "A. M. and A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Cassia Leal
- Gastroenterology and Hepatology Department, Federal Hospital of State Servants and Fluminense Federal University (Hospital Universitário Antônio Pedro), Río de Janeiro, Brazil
| | - Rodolfo Sacco
- Gastroenterology and Metabolic Diseases, Pisa University Hospital, Pisa, Italy
| | - Ana M Matilla
- Digestive Diseases Department, University General Hospital Gregorio Marañón, Madrid, Spain
| | | | - Gabriel Aballay Soteras
- Liver Transplant Unit, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires Autonomous City, Argentina
| | - Marcus-Alexander Wörns
- First Department of Medicine, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Vienna Liver Cancer Study Group, AKH & Medical University of Vienna, Vienna, Austria
| | - María Varela
- Liver Unit, Central University Hospital of Asturias, Institute of Oncology of Asturias (IUOPA), Foundation for Biosanitary Research and Innovation of the Principality of Asturias (FINBA), Oviedo, Spain
| | - Morten Ladekarl
- Department of Oncology, Aarhus University Hospital, and Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aarhus, Denmark
| | - Aline L Chagas
- Division of Clinical Gastroenterology and Hepatology, Department of Gastroenterology, University of São Paulo School of Medicine, Cancer Institute of the State of São Paulo, Sao Paulo, Brazil
| | - Beatriz Mínguez
- Liver Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Vall d'Hebron Institut of Research, Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Autonomous University of Barcelona, Barcelona, Spain
| | - Juan I Arenas
- Digestive Diseases Department, Donostia University Hospital, San Sebastián, Spain
| | - Alessandro Granito
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Yolanda Sánchez-Torrijos
- UCM Digestive Diseases and Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Institute of Biomedicine of Seville (IBiS), SeLiver Group, Virgen del Rocío/CSIC/US, Sevilla, Spain
| | - Ángela Rojas
- UCM Digestive Diseases and Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Institute of Biomedicine of Seville (IBiS), SeLiver Group, Virgen del Rocío/CSIC/US, Sevilla, Spain
| | - Carlos Rodríguez de Lope
- Digestive Diseases Department, Marqués de Valdecilla University Hospital, Marqués de Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Mario R Alvares-da-Silva
- GI/Liver Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sonia Pascual
- Hepatic Unit, Gastroenterology Service, General University Hospital of Alicante, Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Alicante, Spain
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - José L Lledó
- Gastroenterology and Liver Diseases department, Ramón y Cajal University Hospital, Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Madrid, Spain
| | - Carlos Huertas
- Digestive Diseases Department, Doctor Josep Trueta University Hospital, Girona, Spain
| | - Bruno Sangro
- Liver Unit, University of Navarra Clinic, Health Research Institute of Navarra (IDISNA), Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Pamplona, Spain
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS-San Martino Policlinico Hospital, University of Genoa, Genoa, Italy
| | - Manuel Delgado
- Digestive Diseases Department, La Coruña University Hospital, A Coruña, Spain
| | - Mercedes Vergara
- Liver Unit, Digestive Diseases Department, Parc Taulí University Hospital, Parc Taulí I3PT Research and Innovation Institute, Autonomous University of Barcelona, Sabadell, Spain
| | - Christie Perelló
- Liver Unit, Puerta de Hierro University Hospital, Puerta de Hierro Majadahonda Health Research Institute (IDIPHISA), Madrid, Spain
| | - Alberto Lue
- Digestive Diseases Department, Hepatology Unit and Liver Transplant, Lozano Blesa Clinical University Hospital, Zaragoza, Spain
| | - Margarita Sala
- Liver Unit, Digestive Diseases Department, Germans Trias i Pujol University Hospital, Center for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Badalona, Spain
| | - Adolfo Gallego
- Digestive Diseases Department, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Susanna Coll
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Tania Hernáez
- Digestive Diseases Department, San Pedro Hospital, Logroño, Spain
| | - Federico Piñero
- Liver Unit, Austral University Hospital, Buenos Aires, Argentina
| | - Gustavo Pereira
- Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, Ministry of Health, Río de Janeiro, Brazil
| | - Alex França
- Liver Unit, Department of Medicine, Federal University of Sergipe, Sergipe, Brazil
| | - Juan Marín
- Pablo Tobón Uribe Hospital, Medellín, Colombia
| | - Margarita Anders
- Liver Diseases and Liver Transplant Unit, German Hospital, Buenos Aires, Argentina
| | - Vivianne Mello
- Multidisciplinary Assistance in Oncology (AMO) Clinic, Salvador, Brazil
| | - Mar Lozano
- Digestive Diseases Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Jean C Nault
- Cordeliers Research Center, Sorbonne University, Inserm, USPC, Paris Descartes University, Paris Diderot University, Paris 13 University, Functional Genomics of Solid Tumors Laboratory, Jean Verdier Hospital, Paris-Seine-Saint University Hospital -Denis, Public Assistance Hospitals of Paris, Bondy, France
| | - Josemaría Menéndez
- Liver Transplant and Liver Diseases Unit, Central Hospital of the Armed Forces (Military Hospital), Montevideo, Uruguay
| | - Ignacio García Juárez
- Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, City of Mexico, Mexico
| | - Jordi Bruix
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | - María Reig
- Barcelona Clínic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
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Klajer E, Garnier L, Goujon M, Schlurmann-Constans F, Mery B, Nguyen Tan Hon T, Mouillet G, Calcagno F, Thiery-Vuillemin A. Targeted and immune therapies among patients with metastatic renal carcinoma undergoing hemodialysis: A systemic review. Semin Oncol 2020; 47:103-116. [PMID: 32522380 DOI: 10.1053/j.seminoncol.2020.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with severe renal impairment or undergoing hemodialysis are usually excluded from clinical trials. Available data regarding safety and activity of systemic therapies (ST) in hemodialyzed patients are scarce. METHODS Clinical data were searched through PubMed database until April 2020 according to PRISMA criteria. Efficacy, safety and pharmacokinetic (PK) assessment of ST were reported. RESULTS Among 270 references, 56 reports were evaluated in full text: 41 were included for efficacy and 42 for safety analysis (sunitinib n = 68, bevacizumab n = 6, everolimus n = 28, temsirolimus n = 17, sorafenib n = 55, axitinib n = 13, pazopanib n = 13, nivolumab n = 18, cabozantinib n = 0, lenvatinib n = 0, and ipilimumab n = 0). Twelve of the reports included PK assessment among dialyzed patients. Hemodialysis did not seem to modify the expected efficacy and safety of each compound among patients undergoing hemodialysis. PK assessments were not modified in comparison with a population not undergoing dialysis. CONCLUSION Targeted and Immune therapies seem to be effective and can be used among patients undergoing hemodialysis. Due to frailty and comorbidities associated to chronic hemodialysis enhanced vigilance for these therapies within this specific population is recommended. Dedicated prospective clinical trials would definitely help to obtain data with a higher level of evidence.
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Affiliation(s)
- Elodie Klajer
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France; Université de Franche-Comté, Besançon cedex, France.
| | - Louis Garnier
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France
| | - Morgan Goujon
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France
| | | | - Benoite Mery
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, St Priest en Jarez, France
| | | | - Guillaume Mouillet
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France; Methodology and Quality of Life in Oncology Unit, CHRU Jean Minjoz, Besançon cedex, France
| | - Fabien Calcagno
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France
| | - Antoine Thiery-Vuillemin
- Department of Medical Oncology, CHRU Jean Minjoz, Besançon cedex, France; Université de Franche-Comté, Besançon cedex, France; INSERM, Besançon cedex France
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7
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Takayama T, Kubo T, Yamazaki M, Takeshima S, Komatsubara M, Kameda T, Kamei J, Sugihara T, Fujisaki A, Ando S, Kurokawa S, Fujimura T. Sunitinib versus sorafenib for patients with advanced renal cell carcinoma with renal impairment before the immune-oncology therapy era. Jpn J Clin Oncol 2019; 49:1164-1171. [PMID: 31665407 DOI: 10.1093/jjco/hyz127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/01/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The efficacy and safety of sunitinib versus sorafenib in patients with advanced renal cell carcinoma with renal impairment remains poorly documented. PATIENTS AND METHODS We assessed the efficacy and safety of sunitinib and sorafenib in patients with advanced renal cell carcinoma with an estimated glomerular filtration rate of 15-60 mL/min/1.73 m2 by reviewing the medical records of patients treated at Jichi Medical University Hospital, Japan, between May 2008 and August 2016. RESULTS Twenty-seven patients were treated with sunitinib and 14 with sorafenib. Median progression-free survival in sunitinib- and sorafenib-treated patients was comparable, at 6.6 vs 5.8 months, respectively (HR, 1.618; 95% CI, 0.689-3.798; P = 0.2691). Median overall survival was also comparable, at 65.9 vs 58.0 months (HR, 0.985; 95% CI, 0.389-2.479; P = 0.9748). Grade 3 or higher adverse events were significantly more frequent in the sunitinib-treated than sorafenib-treated patients (P = 0.0357). Compared to pre-treatment values, estimated glomerular filtration rate at the discontinuation of treatment was not decreased in either group. In contrast, estimated glomerular filtration rate was decreased on long-term treatment, particularly in previously nephrectomized patients. CONCLUSIONS Sunitinib and sorafenib had similar efficacy in patients with advanced renal cell carcinoma and severe renal impairment. Although renal function was not markedly impaired in either group, close attention to decreased renal function may be necessary in previously nephrectomized patients on long-term treatment.
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Affiliation(s)
- Tatsuya Takayama
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Taro Kubo
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Masahiro Yamazaki
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Saki Takeshima
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Maiko Komatsubara
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Tomohiro Kameda
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Akira Fujisaki
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Shinsuke Kurokawa
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329--0498, Japan
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8
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Fujita K, Matsumoto N, Ishida H, Kubota Y, Iwai S, Shibanuma M, Kato Y. Decreased Disposition of Anticancer Drugs Predominantly Eliminated via the Liver in Patients with Renal Failure. Curr Drug Metab 2019; 20:361-376. [PMID: 30947665 PMCID: PMC6700602 DOI: 10.2174/1389200220666190402143125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 12/20/2022]
Abstract
Background: Evidence has revealed that renal impairment can affect the systemic exposure of drugs which are predominantly eliminated via the liver. The modulation of drug-metabolizing enzymes and transporters expressed in the liver and/or small intestine by diverse entities, including uremic toxins, in systemic circulation of patients with severe renal failure is considered as the cause of atypical pharmacokinetics, which sometimes induce undesirable adverse events that are especially critical for drugs with narrow therapeutic window such as anticancer drugs. A dosing strategy for anticancer drugs in these patients needs to be established. Methods: The effects of renal impairment on the systemic exposure and safety of anticancer drugs were summarized. The proposed mechanisms for the alterations in the pharmacokinetics of these anticancer drugs were also discussed. Results: Changes in pharmacokinetics and clinical response were reported in 9 out of 10 cytotoxic anticancer drugs investigated, although available information was limited and sometimes controversial. Systemic exposure of 3 out of 16 tyrosine kinase inhibitors was higher in patients with severe renal failure than that in patients with normal kidney function. An increase in systemic exposure of anticancer drugs in patients with renal impairment is likely to be observed for substrates of OATP1B1, despite the limited evidence. Conclusion: The molecular basis for the effect of uremia on non-renal drug elimination still needed to be clarified with further studies to generate generalizable concepts, which may provide insights into establishing better clinical usage of anticancer drugs, i.e. identifying patients at risk and dose adjustment.
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Affiliation(s)
- Kenichi Fujita
- Division of Cancer Cell Biology, Department of Pharmaceutical Sciences, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
| | - Natsumi Matsumoto
- Department of Healthcare and Regulatory Sciences, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan.,Breast and Imaging Center, St. Marianna University School of Medicine, 6-7-2 Manpukuji, Asao-ku, Kawasaki 2158520, Japan
| | - Hiroo Ishida
- Department of Medical Oncology, Showa University School of Medicine, 1-5- 8 Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
| | - Yutaro Kubota
- Department of Medical Oncology, Showa University School of Medicine, 1-5- 8 Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
| | - Shinichi Iwai
- Department of Healthcare and Regulatory Sciences, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
| | - Motoko Shibanuma
- Division of Cancer Cell Biology, Department of Pharmaceutical Sciences, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
| | - Yukio Kato
- Molecular Pharmacotherapeutics, Faculty of Pharmacy, Kanazawa University, Kakuma-machi, Kanazawa 9201192, Japan
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9
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Morinaga R, Kawahara T, Miyoshi Y, Yao M, Uemura H. Longer Control of Nivolumab in Metastatic Renal Cell Carcinoma Patients with End-Stage Kidney Disease on Dialysis. Case Rep Oncol 2019; 12:608-612. [PMID: 31543776 PMCID: PMC6738248 DOI: 10.1159/000501768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction Nivolumab has been introduced for metastatic renal cell carcinoma (mRCC) as a second-line therapy for years. However, despite widespread evidence of its utility, few reports have described the efficacy of nivolumab for mRCC patients on hemodialysis. Case Presentation A 68-year-old man with a 20-year history of dialysis due to chronic glomerulotubular nephritis was referred to our department for bilateral renal tumors in 2015. In February 2015, contrast-enhanced CT revealed findings suggestive of RCC, so we performed right nephrectomy. The pathological diagnosis was clear cell carcinoma and papillary renal cell carcinoma. In July 2015, we consequently performed left nephrectomy, and the pathological diagnosis was metastatic RCC. In February 2016, because follow-up CT revealed a right adrenal tumor with time-dependent growth, sunitinib (25 mg/body) was introduced. In January 2017, although sunitinib had controlled the adrenal metastasis for 9 courses (11 months), liver metastasis was observed, so nivolumab was introduced as a second-line chemotherapy in March 2017. Nivolumab was able to control the mRCC for 15 months (32 courses). While CT showed no metastatic sites except for the liver and adrenal glands, his general condition gradually decreased, and he died in October 2018. Conclusion We herein report a patient with RCC on hemodialysis with long-term cancer control by nivolumab.
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Affiliation(s)
- Ryota Morinaga
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.,Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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10
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Management of targeted therapies in cancer patients with chronic kidney disease, or on haemodialysis: An Associazione Italiana di Oncologia Medica (AIOM)/Societa’ Italiana di Nefrologia (SIN) multidisciplinary consensus position paper. Crit Rev Oncol Hematol 2019; 140:39-51. [DOI: 10.1016/j.critrevonc.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/06/2023] Open
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11
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Safety and Efficacy of Nivolumab in Patients With Metastatic Renal Cell Carcinoma and End-stage Renal Disease at 2 Centers. Clin Genitourin Cancer 2019; 17:e772-e778. [PMID: 31101580 DOI: 10.1016/j.clgc.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There is scarce information regarding nivolumab treatment for metastatic renal cell carcinoma (mRCC) in patients with end-stage renal disease (ESRD). This study investigated the safety and efficacy of nivolumab in patients with mRCC and ESRD. MATERIALS AND METHODS This 2-center retrospective study evaluated 62 patients who were administered nivolumab for mRCC between June 2013 and August 2018. The ESRD group (n = 7) and non-ESRD group (n = 55) were compared in terms of their immune-related adverse events (irAEs), objective response rate, progression-free survival, and overall survival. RESULTS All 7 patients with ESRD were male (median age, 67 years; range, 52-73 years), and their median duration of nivolumab use was 6.0 months (range, 1.8-8.2 months). One patient experienced a partial response, and 4 patients had stable disease. The objective response rate was lower in the ESRD group than in the non-ESRD group (16.7% vs. 37.5%; P = .25). Relative to the non-ESRD group, the ESRD group had slightly lower rates of all irAEs (42.9% vs. 58.7%) and grade 3 or higher irAEs (14.3% vs. 21.7%). The irAEs in the ESRD group were skin rash (grade 1), diarrhea (grade 1), and severe fatigue (grade 3) after the first nivolumab infusion, which required treatment discontinuation. The Kapan-Meier curves revealed no significant differences between the ESRD and non-ESRD groups in terms of progression-free (P = .63) and overall survival (P = .62). CONCLUSION It may be possible to safely and effectively use nivolumab for select patients with mRCC and ESRD.
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12
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Tsimafeyeu I, Borisov P, Abdelgafur A, Leonenkov R, Novikova O, Guseva I, Demchenkova M, Mikhailova N, Semenov A, Yurmazov Z, Sivunova I, Ramazanova M, Gamayunov S, Kosov D, Bratslavsky G. Phase 2 Multicenter Single-Arm Study of Second-Line Axitinib in Favorable Risk Patients with Metastatic Renal Cell Carcinoma: FavorAx. Target Oncol 2019; 14:33-38. [PMID: 30607698 DOI: 10.1007/s11523-018-0613-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Targeted therapy with axitinib resulted in a greater objective response rate and prolonged progression-free survival (PFS) compared to sorafenib in patients with previously treated metastatic renal cell carcinoma (mRCC) in the phase 3 AXIS study, where 75% of patients had intermediate and poor International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk. OBJECTIVE In this phase 2 study (FavorAx), we assessed the activity of axitinib in mRCC patients with a favorable risk and history of prior vascular endothelial growth factor receptor (VEGFR)-directed therapy. PATIENTS AND METHODS Patients were required to have clear-cell mRCC, favorable risk according to IMDC criteria, and to have received first-line treatment with sunitinib or pazopanib. Prior treatment with other agents was not permitted. The primary endpoint of the study was 5 months PFS. Additional endpoints included response rate, safety, PFS, and overall survival (OS). RESULTS A total of 21 patients were enrolled, 62% of whom were male. The mean age was 60 years. Eleven (52%) patients had two or more metastatic sites. 67% and 33% of patients received first-line sunitinib or pazopanib, respectively, with a median PFS of 17 months [95% confidence interval (CI), 14-20]. After a median follow-up of 25 months, the median PFS was 19 months (95% CI, 15-23). The current study did achieve its primary endpoint based on the 5-month PFS of 100%. The median OS was not yet reached. The 18 months OS rate was 85.7%. The objective response rate was 33% and one patient achieved a complete response. Seven patients had dose escalation of axitinib and four patients had dose reduction. Grade 3 adverse events were observed in 19% of cases. There was no discontinuation of therapy due to toxicity. CONCLUSIONS The encouraging PFS and favorable safety profile observed in the FavorAx study support the administration of axitinib in mRCC patients with favorable IMDC risk and a history of prior sunitinib or pazopanib.
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Affiliation(s)
- Ilya Tsimafeyeu
- Kidney Cancer Research Bureau, Mayakovskogo pereulok, 2, 109147, Moscow, Russia.
| | - Pavel Borisov
- City Clinical Oncology Center, St. Petersburg, Russia
| | | | | | - Olga Novikova
- Khabarovsk Regional Cancer Center, Khabarovsk, Russia
| | | | | | | | | | | | - Irina Sivunova
- Kamchatka Regional Cancer Center, Petropavlovsk-Kamchatsky, Russia
| | | | | | - Dmitry Kosov
- Aston Health Contract Research Organization, Moscow, Russia
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13
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Masini C, Vitale MG, Maruzzo M, Procopio G, de Giorgi U, Buti S, Rossetti S, Iacovelli R, Atzori F, Cosmai L, Vignani F, Prati G, Scagliarini S, Guida A, Berselli A, Pinto C. Safety and Efficacy of Pazopanib in First-Line Metastatic Renal-Cell Carcinoma With or Without Renal Failure: CORE-URO-01 Study. Clin Genitourin Cancer 2018; 17:e150-e155. [PMID: 30396828 DOI: 10.1016/j.clgc.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pazopanib has been approved for first-line treatment of patients with metastatic renal-cell carcinoma on the basis of clinical trials that enrolled only patients with adequate renal function. Few data are available on the safety and efficacy of pazopanib in patients with renal insufficiency. This study investigated the effect of kidney function on treatment outcomes in such patients. PATIENTS AND METHODS We retrospectively analyzed data of metastatic renal-cell carcinoma patients treated with pazopanib from January 2010 to June 2016 with respect to renal function. Patients with Modification of Diet in Renal Disease ≤ 60 mL/min/1.73 m2 (group A) were compared to patients with Modification of Diet in Renal Disease > 60 mL/min/1.73 m2 (group B) in terms of progression-free survival, toxicities, response rates, and overall survival. RESULTS A total of 229 patients were included: 128 in group A and 101 in group B. Median progression-free survival was 14 months (95% confidence interval [CI], 9.4-18.5) and 17 months (95% CI, 11.4-22.8), and overall survival was 30.5 months (95% CI, 8-53) and 41.4 months (95% CI, 21-62) for group A and group B, respectively, with no significant difference (P = .6). No significant difference between the 2 groups was reported in the incidence of adverse events. Dose reductions were more frequent in group A patients (66% vs. 36%; P = .04). CONCLUSION Although the dose of pazopanib was reduced more frequently in patients with renal impairment, kidney function at therapy initiation does not adversely affect the safety and efficacy of pazopanib.
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Affiliation(s)
- Cristina Masini
- Medical Oncology Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy.
| | | | | | - Giuseppe Procopio
- Medical Oncology Unit, Istituto Nazionale Tumori Milano, Milan, Italy
| | - Ugo de Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sabrina Rossetti
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, INT Fondazione G. Pascale (IRCCS), Naples, Italy
| | - Roberto Iacovelli
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), University of Verona, Verona, Italy
| | - Francesco Atzori
- Medical Oncology Unit, Department of Medical Sciences "M. Aresu," University of Cagliari, Cagliari, Italy
| | - Laura Cosmai
- Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Giuseppe Prati
- Day Hospital Oncology, Ospedale Civile di Guastalla, Reggio Emilia, Reggio Emilia, Italy
| | | | - Annalisa Guida
- University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
| | - Annalisa Berselli
- Medical Oncology Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
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14
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Efficacy of Nivolumab in a Patient with Metastatic Renal Cell Carcinoma and End-Stage Renal Disease on Dialysis: Case Report and Literature Review. Case Reports Immunol 2018; 2018:1623957. [PMID: 30009063 PMCID: PMC6020478 DOI: 10.1155/2018/1623957] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 01/05/2023] Open
Abstract
Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis poses a therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there is uncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity when using targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received prior antiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patient population, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCC and ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiological response, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and published retrospective case studies to review the management options for patients with mRCC and ESRD on dialysis.
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15
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Prognostic value of the Glasgow Prognostic Score for patients with metastatic renal cell carcinoma treated by cytoreductive nephrectomy. Int J Clin Oncol 2018; 23:539-546. [DOI: 10.1007/s10147-017-1221-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
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16
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Clinical pharmacology of anti-angiogenic drugs in oncology. Crit Rev Oncol Hematol 2017; 119:75-93. [PMID: 28916378 DOI: 10.1016/j.critrevonc.2017.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/14/2022] Open
Abstract
Abnormal vasculature proliferation is one of the so-called hallmarks of cancer. Angiogenesis inhibitor therapies are one of the major breakthroughs in cancer treatment in the last two decades. Two types of anti-angiogenics have been approved: monoclonal antibodies and derivatives, which are injected and target the extracellular part of a receptor, and protein kinase inhibitors, which are orally taken small molecules targeting the intra-cellular Adenosine Triphosphate -pocket of different kinases. They have become an important part of some tumors' treatment, both in monotherapy or in combination. In this review, we discuss the key pharmacological concepts and the major pitfalls of anti-angiogenic prescriptions. We also review the pharmacokinetic and pharmacodynamics profile of all approved anti-angiogenic protein kinase inhibitors and the potential role of surrogate markers and of therapeutic drug monitoring.
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17
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Bertolaso P, Gross-Goupil M, Molimard M, Cochin V, Ravaud A, Daste A. Drug Interaction With Sunitinib and the Evidence of Therapeutic Drug Monitoring: A Case Report and Review of the Literature. Clin Genitourin Cancer 2017; 15:e885-e887. [PMID: 28552572 DOI: 10.1016/j.clgc.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/18/2017] [Accepted: 05/01/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Pauline Bertolaso
- Department of Medical Oncology, Hôpital Saint-André, University Hospital-CHU Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint-André, University Hospital-CHU Bordeaux, France
| | - Mathieu Molimard
- Pharmacology Department, Université de Bordeaux INSERM U657, Bordeaux, France
| | - Valérie Cochin
- Department of Medical Oncology, Hôpital Saint-André, University Hospital-CHU Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, University Hospital-CHU Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, University Hospital-CHU Bordeaux, France.
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18
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Vallard A, Trone JC, Langrand-Escure J, Espenel S, Guy JB, Rancoule C, Xia Y, El Meddeb Hamrouni A, Ben Mrad M, Magné N. The world of targeted therapies in kidney cancers: pitfalls, tips and tricks. Onco Targets Ther 2017; 10:1375-1380. [PMID: 28424553 PMCID: PMC5344426 DOI: 10.2147/ott.s127919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In the past few years, metastatic renal cell carcinoma prognosis was improved by the development of molecular targeted therapies (TTs). At the metastatic stage, the tolerance to treatment is a major concern, not only because of the challenge of the efficacy/toxicity ratio improvement but also because of the importance of an optimal adherence to oral treatments. The present case series relates the issues of dealing with uncommon and sometimes never described side effects of sunitinib and sorafenib. The first case report deals with grade 3 vomiting during hemodialysis with concurrent administration of sunitinib. The second case is an iterative gout attack induced by sunitinib. The third case presents a grade 3 scalp dysesthesia with sorafenib. The fourth case includes an astonishing efficacy of metronomic (ie, low doses during a long period of time) bevacizumab in monotherapy. Multidisciplinary management and systematic reporting of unexpected efficacies and toxicities are needed to better understand TTs real therapeutic index. Although TTs revolutionized metastatic renal cell cancer prognosis, they also brought about previously unknown side effects. Identification and management of these off-target effects may be tricky, and therefore, comedication must be wisely chosen. As the physiopathology of these side effects is still unclear, multidisciplinary management and systematic reporting of toxicities are essential.
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Affiliation(s)
- Alexis Vallard
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Jane-Chloé Trone
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Julien Langrand-Escure
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Sophie Espenel
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Jean-Baptiste Guy
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Chloé Rancoule
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Yaoxiong Xia
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Anis El Meddeb Hamrouni
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Majed Ben Mrad
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France
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19
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Chen Y, Rini BI, Motzer RJ, Dutcher JP, Rixe O, Wilding G, Stadler WM, Tarazi J, Garrett M, Pithavala YK. Effect of Renal Impairment on the Pharmacokinetics and Safety of Axitinib. Target Oncol 2017; 11:229-34. [PMID: 26400730 DOI: 10.1007/s11523-015-0389-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Axitinib, an inhibitor of vascular endothelial growth factor (VEGF) receptors, is approved as second-line treatment for advanced renal cell carcinoma (RCC). Agents targeting the VEGF pathway may induce renal toxicities, which may be influenced by pre-existing renal dysfunction. OBJECTIVE The objective was to characterize axitinib pharmacokinetics and safety in patients with renal impairment. PATIENTS AND METHODS Effect of renal function (baseline creatinine clearance [CrCL]) on axitinib clearance was evaluated in a population pharmacokinetic model in 207 patients with advanced solid tumors who received a standard axitinib starting dose, and in 383 healthy volunteers. Axitinib safety according to baseline CrCL was assessed in previously treated patients with RCC (n = 350) who received axitinib in the phase 3 AXIS study. RESULTS Median axitinib clearance was 14.0, 10.7, 12.3, 7.81, and 12.6 L/h, respectively, in individuals with normal renal function (≥90 ml/min; n = 381), mild renal impairment (60-89 ml/min; n = 139), moderate renal impairment (30-59 ml/min; n = 64), severe renal impairment (15-29 ml/min; n = 5), and end-stage renal disease (<15 ml/min; n = 1). The population pharmacokinetic model adequately predicted axitinib clearance in individuals with severe renal impairment or end-stage renal disease. Grade ≥3 adverse events (AEs) were reported in 63 % of patients with normal renal function or mild impairment, 77 % with moderate impairment, and 50 % with severe impairment; study discontinuations due to AEs were 10 %, 11 %, and 0 %, respectively. CONCLUSIONS Axitinib pharmacokinetics and safety were similar regardless of baseline renal function; no starting-dose adjustment is needed for patients with pre-existing mild to severe renal impairment.
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Affiliation(s)
| | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | | | | | - Olivier Rixe
- University of New Mexico Cancer Center, Albuquerque, NM, USA
| | - George Wilding
- University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI, USA
| | | | | | | | - Yazdi K Pithavala
- Pfizer Oncology, San Diego, CA, USA.
- Clinical Pharmacology, Pfizer Inc, 10555 Science Center Drive, San Diego, CA, 92121, USA.
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20
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Czarnecka AM, Kawecki M, Lian F, Korniluk J, Szczylik C. Feasibility, efficacy and safety of tyrosine kinase inhibitor treatment in hemodialyzed patients with renal cell cancer: 10 years of experience. Future Oncol 2016; 11:2267-82. [PMID: 26260806 DOI: 10.2217/fon.15.112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Sine efficiency of tyrosine kinase inhibitor (TKI) therapy in dialyzed patients is still unclear we aim to analyze the outcome of treatment in such cohort. PATIENTS & METHODS We analyzed treatment outcomes of patients with clear cell renal cell carcinoma (ccRCC) with special focus on those who were also treated with hemodialysis and described treatment safety and progression-free survival of eight patients treated with TKIs and hemodialysis. DISCUSSION & CONCLUSION Our report supports statement that TKI treatment of dialyzed patients is safe and effective. ccRCC increases risk of developing renal insufficiency as well as end-stage renal disease that require dialysis. Introduction of multitargeted receptor kinase inhibitors (TKIs), including sunitinib, sorafenib and pazopanib significantly expanded life time expectancy of metastatic renal clear cell carcinoma. The advance also applies to patients with ccRCC and end-stage renal disease who undergo dialyses.
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Affiliation(s)
- Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Kawecki
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Fei Lian
- Emory University School of Medicine Atlanta, GA, USA
| | - Jan Korniluk
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
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Renal toxicity of anticancer agents targeting vascular endothelial growth factor (VEGF) and its receptors (VEGFRs). J Nephrol 2016; 30:171-180. [PMID: 27154025 DOI: 10.1007/s40620-016-0311-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 04/09/2016] [Indexed: 01/20/2023]
Abstract
Since angiogenesis plays a key role in tumor growth, progression and metastasization, anti-vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) agents have been developed over the years as anticancer agents, and have changed, for the better, the natural history of a number of cancer types. In the present review, the renal safety profile of presently available agents targeting either VEGF or VEGFRs will be discussed, together with the peculiarities related to their clinical use in patients with impaired renal function, or even in dialysis. Indeed, renal toxicity (especially, but not exclusively, hypertension and proteinuria) are quite commonly observed with these agents, and may be increased by the concomitant use of cytoxic chemotherapeutics. Despite all the above, kidney impairment or dialysis must not be regarded di per se as reasons not to administer or to stop an active anticancer treatment, especially considering the possibility of a significant survival improvement in many cancer patients treated with these agents.
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Omae K, Kondo T, Takagi T, Iizuka J, Kobayashi H, Hashimoto Y, Tanabe K. Use of mammalian target of rapamycin inhibitors after failure of tyrosine kinase inhibitors in patients with metastatic renal cell carcinoma undergoing hemodialysis: A single-center experience with four cases. Hemodial Int 2016; 20:E1-5. [PMID: 26833674 DOI: 10.1111/hdi.12390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We retrospectively identified patients with end-stage renal disease undergoing hemodialysis treated with the mammalian target of rapamycin inhibitors as a second- and/or third-line targeted therapy after treatment failure with the tyrosine kinase inhibitors for metastatic renal cell carcinoma. Patient medical records were reviewed to evaluate the response to therapies and treatment-related toxicities. Four patients were identified. All patients had undergone nephrectomy, and one had received immunotherapy before targeted therapy. Two patients had clear cell histology, and the other two had papillary histology. All patients were classified into the intermediate risk group according to the Memorial Sloan-Kettering Cancer Center risk model. All patients were treated with everolimus as a second- or third-line therapy, and two patients were treated with temsirolimus as a second- or third-line therapy after treatment failure with sorafenib or sunitinib. The median duration of everolimus therapy was 6.7 months, whereas that of temsirolimus was 9.5 months. All patients had stable disease as the best response during each period of therapy. There were no severe adverse events. The use of mammalian target of rapamycin inhibitors in patients who previously failed to respond to tyrosine kinase inhibitors appears to be feasible in patients with end-stage renal disease requiring hemodialysis.
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Affiliation(s)
- Kenji Omae
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan
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23
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Puente J, García Del Muro X, Pinto Á, Láinez N, Esteban E, Arranz JÁ, Gallardo E, Méndez MJ, Maroto P, Grande E, Suárez C. Expert Recommendations for First-Line Management of Metastatic Renal Cell Carcinoma in Special Subpopulations. Target Oncol 2015; 11:129-41. [PMID: 26706236 DOI: 10.1007/s11523-015-0408-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The availability of agents targeting the vascular endothelial growth factor or mammalian target of rapamycin [mTOR] pathways has provided new treatment options for patients with metastatic renal cell carcinoma (RCC). Based on the results of pivotal randomized clinical trials, specific recommendations have been established for management of these patients in first- and second-line settings. However, certain subgroups of patients may be excluded or under-represented in clinical trials, including patients with poor performance status, brain metastases, and cardiac or renal comorbidities, elderly patients, and those with non-clear cell histology. For these subpopulations, management recommendations have emerged from expanded access programs (EAPs), small phase II studies, retrospective analysis of clinical data, and expert opinion. This paper describes recommendations from an expert panel for the treatment of metastatic RCC in these subpopulations. The efficacy of targeted agents appears to be inferior in these patient subgroups relative to the general RCC population. Tyrosine kinase inhibitors (TKIs) and mTOR inhibitors can be administered safely to elderly patients and those with poor performance status, although dose and schedule modifications are often needed, and close monitoring and management of adverse events is essential. In addition to local surgical treatment and radiotherapy for brain metastases, systemic treatment with a TKI should be offered as part of multidisciplinary care.While there are currently no data from randomized trials, sunitinib has the greatest body of evidence, and it should be considered the first choice in patients with a good prognosis. Patients with an acute cardiac event within the previous 6 months, New York Heart Association grade III heart failure, or uncontrolled high blood pressure should not be treated with TKIs. In patients with mild or moderate renal failure, there are no contraindications to TKI treatment. TKIs can be administered to patients undergoing dialysis, but other, less nephrotoxic agents and other alternatives should always be considered.In managing RCC among patients with non-clear cell histology, sunitinib seems to be more effective than everolimus for the papillary subtype, but there are no clear data to guide treatment for other subtypes. In conclusion, individualized treatment approaches are needed to manage RCC in subpopulations that are underrepresented in registration clinical trials.
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Affiliation(s)
- Javier Puente
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Álvaro Pinto
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Nuria Láinez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Ángel Arranz
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Enrique Gallardo
- Department of Medical Oncology, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - María José Méndez
- Department of Medical Oncology, Hospital Reina Sofía, Córdoba, Spain
| | - Pablo Maroto
- Department of Medical Oncology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Grande
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Suárez
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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24
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Baseline chronic kidney disease is associated with toxicity and survival in patients treated with targeted therapies for metastatic renal cell carcinoma. Anticancer Drugs 2015; 26:866-71. [PMID: 26020808 DOI: 10.1097/cad.0000000000000253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the impact of baseline chronic kidney disease on targeted therapy (TT)-induced toxicities and survival in patients treated for metastatic renal cell carcinoma (mRCC). Data from patients receiving first-line TT from January 2006 to June 2012 were collected retrospectively. TT side effects, time to treatment failure (TTF), and overall survival (OS) were analyzed according to the baseline glomerular filtration rate (GFR) calculated using the modification diet in renal disease formula. Hundred and two patients treated with sunitinib (N=67), sorafenib (N=24), or temsirolimus (N=11) were included. Forty-two patients (41%) had baseline chronic kidney disease with GFR less than 60 ml/min/1.73 m. Patients with GFR less than 60 were more likely to encounter severe (grade 3-4) TT-induced toxicities (79 vs. 32%, P<0.0001). Moreover, renal function impairment was significantly associated with higher median TTF and OS (respectively, 12 vs. 6 months for TTF, P=0.003; and 33 vs. 13 months for OS, P=0.001). On multivariate analysis, GFR less than 60 was identified as the only factor associated with a higher rate of severe toxicity: odds ratio=4.74 (1.67-13.41), P=0.003. Severe toxicity (P=0.05) was identified as an independent prognostic factor for OS and TTF. Baseline chronic kidney disease was associated with higher TT-induced toxicities, which were identified as a prognostic factor of higher survival in mRCC treatment. These results suggest that GFR measurement could be used to optimize the efficacy of TT in patients treated for an mRCC.
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25
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Guida A, Masini C, Milella M, Di Lorenzo G, Santoni M, Prati V, Porta C, Cosmai L, Donati D, del Giovane C, Mighali P, Sabbatini R. Retrospective analysis on safety and efficacy of everolimus in treatment of metastatic renal cancer patients receiving dialysis. Future Oncol 2015; 11:3159-66. [PMID: 26544922 DOI: 10.2217/fon.15.256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIMS This retrospective study aimed to investigate safety and efficacy of everolimus in patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease requiring dialysis. PATIENTS & METHODS From November 2009 to December 2012, 11 mRCC patients undergoing dialysis were treated with everolimus after failure of anti-VEGF therapy at six Italian institutions. Patient characteristics, safety and outcomes were collected. RESULTS Progression-free survival and overall survival were determined using the Kaplan-Meier method. Median progression-free survival and overall survival were 9.01 and 15.7 months, respectively. No unexpected adverse events were reported. CONCLUSION Everolimus appears to be safe in mRCC patients with renal impairment or end-stage renal disease requiring dialysis. Larger prospective studies are required to confirm these findings.
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Affiliation(s)
- Annalisa Guida
- Department of Oncology, Hematology & Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
| | - Cristina Masini
- AO Santa Maria Nuova, Reggio Emilia, Italy.,Italian Nephro-Oncology Group/Gruppo Italiano di Oncologia Nefrologica (GION), Italy
| | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Di Lorenzo
- Department of Endocrinology & Medical Oncology, Genitourinary Cancer Section, University Federico II, Napoli, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti Umberto I, Ancona, Italy
| | - Veronica Prati
- Oncologia Medica a Direzione Universitaria, Fondazione del Piemonte per l'Oncologia, Istituto per la Ricerca e Cura del Cancan Candiolo, Torino, Italy
| | - Camillo Porta
- Italian Nephro-Oncology Group/Gruppo Italiano di Oncologia Nefrologica (GION), Italy.,Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Laura Cosmai
- Italian Nephro-Oncology Group/Gruppo Italiano di Oncologia Nefrologica (GION), Italy.,UO Nefrologia e Dialisi, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Donatella Donati
- Unità Operativa Oncologia, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Cinzia del Giovane
- Statistics Unit, Department of Clinical, Diagnostic & Public Health Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - Pasquale Mighali
- Department of Oncology, Hematology & Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
| | - Roberto Sabbatini
- Department of Oncology, Hematology & Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy.,Italian Nephro-Oncology Group/Gruppo Italiano di Oncologia Nefrologica (GION), Italy
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26
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Rebibo JD, Pfister C, Giwerc A, Defortescu G, Gouerant S, Di Fiore F, Nouhaud FX. [Prognostic factors for metastatic renal cell carcinoma treated with second-line targeted therapies]. Prog Urol 2015; 26:16-23. [PMID: 26455779 DOI: 10.1016/j.purol.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/23/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the prognostic value of clinical and biological features in patients treated with second-line targeted therapies (TT) for a metastatic renal cell carcinoma (mRCC). MATERIAL AND METHODS A retrospective study was performed including 60 patients treated with second-line TT from 2006 to 2013. Clinical and biological features were collected, including TT-induced toxicities, Heng and MSKCC prognostic scores, and renal function. Overall survival (OS) and progression-free survival (PFS) were assessed using univariate and multivariate analysis. RESULTS The median age was 61 years [39-81]. MSKCC and Heng scores were significantly prognostic for OS and PFS (P<0.05). Hypo-albuminemia, anemia and brain metastasis were associated with poorer OS and PFS (P<0.05). Severe induced toxicities had a prognostic impact with higher OS (26 months vs 10 months, P=0.003) and PFS (5 months vs 4 months, P=0.047). Renal function impairment at the initiation of the second line was also associated with higher survival (OS=24 months vs 9 months, P=0.035 and PFS=7 months vs 4 months, P=0.043). On multivariate analysis, induced toxicity was found as an independent factor of good prognosis for OS (HR=0.36; P=0.01). CONCLUSION Our results suggested that renal function impairment and TT-induced toxicities in the second line of treatment for mRCC have a potential prognostic interest as it had previously been reported for the first line of TT. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- J D Rebibo
- Service d'urologie et transplantation, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Pfister
- Service d'urologie et transplantation, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe de recherche d'oncologie normande (IRON), centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - A Giwerc
- Service d'urologie et transplantation, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Defortescu
- Service d'urologie et transplantation, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - S Gouerant
- Unité d'oncologie urologique et digestive, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service d'oncologie médicale, centre Henri-Becquerel, rue d'Amiens, 76000 Rouen, France
| | - F Di Fiore
- Équipe de recherche d'oncologie normande (IRON), centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Unité d'oncologie urologique et digestive, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service d'oncologie médicale, centre Henri-Becquerel, rue d'Amiens, 76000 Rouen, France
| | - F-X Nouhaud
- Service d'urologie et transplantation, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Équipe de recherche d'oncologie normande (IRON), centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Unité d'oncologie urologique et digestive, centre hospitalier et universitaire de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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27
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Nishida H, Fukuhara H, Yamagishi A, Sakurai T, Shibasaki T, Kawazoe H, Kato T, Tomita Y. Sequential molecularly targeted drug therapy including axitinib for a patient with end-stage renal failure and metastatic renal cell carcinoma. Hemodial Int 2015; 20:E1-4. [PMID: 26306562 DOI: 10.1111/hdi.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 62-year-old male patient with end-stage renal disease and metastatic renal cell carcinoma (RCC) was referred to our hospital. Sequential targeted therapy consisting of sorafenib, sunitinib, and everolimus was administered, but the patient's disease gradually progressed. Axitinib was subsequently administered at a decreased dose of 6 mg/day for 2 weeks, after which the dose was escalated to 10 mg/day. Axitinib therapy was maintained for a total of 6 months without severe adverse effects. Sequential molecularly targeted drug therapy including axitinib, with careful monitoring, is one possible treatment option for patients with metastatic RCC with renal impairment.
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Affiliation(s)
- Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Atsushi Yamagishi
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Toshihiko Sakurai
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Tomohiro Shibasaki
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Hisashi Kawazoe
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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28
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Poprach A, Bortlicek Z, Melichar B, Lakomy R, Svoboda M, Kiss I, Zemanova M, Fiala O, Kubackova K, Coufal O, Pavlik T, Dusek L, Vyzula R, Buchler T. Efficacy of sunitinib in patients with metastatic or unresectable renal cell carcinoma and renal insufficiency. Eur J Cancer 2015; 51:507-513. [DOI: 10.1016/j.ejca.2014.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/29/2014] [Accepted: 12/14/2014] [Indexed: 11/26/2022]
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Clinical pharmacokinetics of tyrosine kinase inhibitors: implications for therapeutic drug monitoring. Ther Drug Monit 2014; 35:562-87. [PMID: 24052062 DOI: 10.1097/ftd.0b013e318292b931] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The treatment of many malignancies has been improved in recent years by the introduction of molecular targeted therapies. These drugs interact preferentially with specific targets that are mutated and/or overexpressed in malignant cells. A group of such targets are the tyrosine kinases, against which a number of inhibitors (tyrosine kinase inhibitors, TKIs) have been developed. Imatinib, a TKI with targets that include the breakpoint cluster region-Abelson (bcr-abl) fusion protein kinase and mast/stem cell growth factor receptor kinase (c-Kit), was the first clinically successful drug of this type and revolutionized the treatment and prognosis of chronic myeloid leukemia and gastrointestinal stromal tumors. This success paved the way for the development of other TKIs for the treatment of a range of hematological malignancies and solid tumors. To date, 14 TKIs have been approved for clinical use and many more are under investigation. All these agents are given orally and are substrates of a range of drug transporters and metabolizing enzymes. In addition, some TKIs are capable of inhibiting their own transporters and metabolizing enzymes, making their disposition and metabolism at steady-state unpredictable. A given dose can therefore give rise to markedly different plasma concentrations in different patients, favoring the selection of resistant clones in the case of subtherapeutic exposure, and increasing the risk of toxicity if dosage is excessive. The aim of this review was to summarize current knowledge of the clinical pharmacokinetics and known adverse effects of the TKIs that are available for clinical use and to provide practical guidance on the implications of these data in patient management, in particular with respect to therapeutic drug monitoring.
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30
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Takagi T, Sugihara T, Yasunaga H, Horiguchi H, Fushimi K, Kondo T, Homma Y, Tanabe K. Cytoreductive nephrectomy for metastatic renal cell carcinoma: A population-based analysis of perioperative outcomes according to clinical stage. Int J Urol 2014; 21:770-5. [DOI: 10.1111/iju.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Toshio Takagi
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Toru Sugihara
- Department of Quantitative Health Sciences; Cleveland Clinic Foundation; Cleveland Ohio USA
- Department of Urology; The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Health Economics and Epidemiology Research; School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research; Clinical Research Center; National Hospital Organization Headquarters; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Care Informatics; Tokyo Medical and Dental University; Tokyo Japan
| | - Tsunenori Kondo
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Yukio Homma
- Department of Urology; The University of Tokyo; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
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31
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Kim KH, Kim HY, Kim HR, Sun JM, Lim HY, Lee HJ, Lee S, Bae WK, Rha SY. Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with renal insufficiency. Eur J Cancer 2014; 50:746-752. [PMID: 24332573 DOI: 10.1016/j.ejca.2013.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with metastatic renal cell carcinoma (mRCC) with renal insufficiency are generally excluded from clinical trials, despite their increasing numbers. Thus, we evaluated the efficacy and toxicity of sunitinib in such patients. PATIENTS AND METHODS Korean patients with mRCC with renal insufficiency who had received sunitinib as first-line treatment between January 2008 and May 2012 were included. Patient characteristics, clinical outcomes and toxicities were evaluated. Overall survival (OS) and progression-free survival (PFS) were determined according to the degree of renal impairment. RESULTS The median age of the 34 patients evaluated was 66 years, 90% had an Eastern Cooperative Oncology Group performance status of 0 or 1 and the median glomerular filtration rate was 46.5 mL min(-1) · 1.73 m(-2) (range, 21.1-59.5). The starting sunitinib dose was 37.5 and 50mg for 12 and 22 patients, respectively. A 4-weeks-on-2-weeks-off regimen was followed for 31 patients; a 2-weeks-on-2-weeks-off regimen, for one patient; and a daily regimen, for two patients. The best response was partial response in eight patients and stable disease in 12. Median OS and PFS times were 26.3 months (95% confidence interval [CI]: 17.1-35.3) and 12.2 months (95% CI: 10.2-13.2), respectively. Common non-haematologic adverse events (AEs) were stomatitis, rash, general oedema and fatigue. The most common AEs of ⩾ grade 3 severity were fatigue, neutropenia and thrombocytopenia. CONCLUSIONS In patients with mRCC with renal insufficiency, sunitinib was efficacious and did not cause increased toxicity. Thus, clinicians should not hesitate to treat patients with mRCC with renal insufficiency with sunitinib.
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Affiliation(s)
- Ki Hyang Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ho Young Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Hyo Jin Lee
- Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Suee Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University Medical Center, Busan, South Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanamdo, South Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
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32
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Fishman MN. Targeted therapy of kidney cancer: keeping the art around the algorithms. Cancer Control 2014; 20:222-32. [PMID: 23811706 DOI: 10.1177/107327481302000310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Therapy for metastatic kidney cancer is actively evolving, particularly in the results of registration drug trials that have led to the approval of vascular endothelial growth factor pathway drugs such as sorafenib, sunitinib, pazopanib, bevacizumab, and axitinib, with focus on patients with good- or intermediate-risk criteria and clear cell histology. Mammalian target of rapamycin (mTOR) drugs such as everolimus and temsirolimus pivotal trials emphasize experiences in the setting of prior treatment or high-risk features. Interferon and interleukin 2 also are part of the treatment algorithms. METHODS The results of pivotal trials and the underlying context for the development of a cogent, cohesive treatment plan for an individual are reviewed, touching on decision points such as nephrectomy, metastasectomy, and medical initiation and discontinuation time points. RESULTS To the extent that these drug therapies are essential for achieving best outcomes for patients, these pivotal trial results and associated guidelines exist within a multidimensional, multidisciplinary context of many other disease features, comorbid features, and non-drug treatment decisions. Other dimensions include investigational targeted therapies, patient selection strategies, surgical strategies, and immunotherapies, some of which are in active development. CONCLUSIONS Clinicians should work toward the best use of drug sequencing and selection strategies based on core data derived from prospective randomized trials. To address individual patient needs, they should also recognize and emphasize individualized goals, to the extent that these are different from issues that were directly addressed in the trials.
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Affiliation(s)
- Mayer N Fishman
- Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL 33612, USA.
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33
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Syrios J, Kechagias G, Tsavaris N. Treatment of patients with metastatic renal cell carcinoma undergoing hemodialysis: case report of two patients and short literature review. BMC Nephrol 2013; 14:84. [PMID: 23587009 PMCID: PMC3637452 DOI: 10.1186/1471-2369-14-84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/09/2013] [Indexed: 12/18/2022] Open
Abstract
Background Renal cell carcinoma (RCC) may involve both kidneys. When bilateral nephrectomy is necessary renal replacement therapy is mandatory. Treating such patients with sequential therapy based on cytokines, antiangiogenic factors and mammalian target of rapamycin (mTOR) inhibitors is challenging. Case presentation The first case, a 50-year-old Caucasian female, underwent a radical right nephrectomy for RCC. Twelve years later she underwent a radical left nephrectomy along with total hysterectomy including bilateral salpingo-oophorectomy for RCC involving the right kidney and ovary. Hemodialysis was necessary because of bilateral nephrectomy. She relapsed with pulmonary metastases and enlarged mediastinal lymph nodes and received cytokine based therapy along with bevacizumab. Therapy was discontinued despite the partial response because of hemorrhagic gastritis. Therapy was switched to an antiangiogenic factor but the patient manifested a parietal brain hematoma and stopped therapy. Subsequently disease relapsed with malignant pleural effusion and pulmonary nodules and a mammalian target of rapamycin inhibitor was administered which was withdrawn only at patient’s deteriorating performance status. The patient died of the disease 13 years after the initial diagnosis of RCC. The second case, a 51-year-old, Caucasian male, underwent a radical right nephrectomy for a chromophobe RCC. Six months later he underwent a radical left nephrectomy for RCC that proved to be a clear cell RCC. Due to bilateral nephrectomy hemodialysis was obligatory. Following disease recurrence at the anatomical bed of the right kidney therapy with antiangiogenic factor was administered which led to disease regression. However the patient experienced a left temporal-occipital brain hematoma. A radical excision of the recurrence which histologically proved to be a chromophobe RCC was not achieved and the patient received mTOR inhibitor which led to disease complete response. Nine years after the initial diagnosis of RCC he is disease free and leads an active life. Conclusion Patients with RCC are in significant risk to manifest bilateral disease. Renal insufficiency requiring hemodialysis poses therapeutic challenges. Clinicians must be aware of the antiangiogenic factors’ adverse effects, especially bleeding, that may manifest in higher frequency and more severe in this setting.
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The ineligible patient: how to treat patients not included in clinical studies. World J Urol 2013; 32:9-18. [DOI: 10.1007/s00345-013-1042-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/05/2013] [Indexed: 12/26/2022] Open
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Abstract
BACKGROUND Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, has demonstrated survival benefit in patients with metastatic renal cell carcinoma (mRCC); however, significant adverse events (AEs) have been associated with its use. The significant variation in the reported incidences of AEs has prompted this meta-analysis to quantify the risk and explore associated predictors. METHODS According to predefined selection criteria, a literature search identified 12 studies that were included in the analyses. RESULTS The meta-analysis included 5,658 patients; 66 % patients had prior systemic therapy whereas the remaining patients (34 %) received sunitinib in the first-line setting. For any grade toxicity, skin rash, fatigue, diarrhea, and mucositis were the most frequently encountered events (81, 52, 45, and 33 %, respectively). Anemia, neutropenia, or thrombocytopenia of any grade occurred in more than one-third of patients, although grades 3 or 4 were less common. Any grade raised by liver enzymes or serum creatinine occurred in 40 and 44 % of patients, respectively. Meta-regression analyses showed that study size was inversely related to the risk of experiencing fatigue, diarrhea, mucositis, anemia, and thrombocytopenia. In particular, the incidence of AEs was higher when sunitinib was used in pretreated versus naive patients; however, there was no significant difference between the two groups concerning the incidence of laboratory abnormalities. We addressed the limitations of reporting AEs in clinical studies. CONCLUSIONS The present meta-analysis quantified sunitinib-associated AEs. The derived estimates would be similar to that to be expected from the use of sunitinib in community practice in unselected patients with metastatic renal cell carcinoma (mRCC).
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Efficacy and safety of temsirolimus in Japanese patients with metastatic renal cell carcinoma on hemodialysis. Int J Clin Oncol 2012; 18:1054-9. [PMID: 23114786 DOI: 10.1007/s10147-012-0492-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 10/14/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND We retrospectively investigated the efficacy and safety of temsirolimus, an inhibitor of the mammalian target of rapamycin, in patients with metastatic renal cell carcinoma (mRCC) on hemodialysis (HD). METHODS This study included ten HD patients who were diagnosed with mRCC following radical nephrectomy and subsequently treated with temsirolimus between December 2010 and June 2012. Medical records of these patients were reviewed to evaluate the response to temsirolimus and treatment-related toxicities. RESULTS Baseline characteristics of the patients are as follows: median age was 61 years, five patients had a Karnofsky performance status of ≤80, and two, six, and two patients were classified into favorable, intermediate, and poor risk group, respectively, according to the Memorial Sloan-Kettering Cancer Center risk model. Initially, all patients received 25 mg intravenous temsirolimus weekly; however, dose modification was necessary in four patients, resulting in a relative dose intensity of 89.5 % throughout this study. All patients, except for one with progressive disease, were judged to have stable disease following treatment with temsirolimus. Six patients are still under treatment with temsirolimus, whereas four have stopped receiving temsirolimus because of the occurrence of progressive disease in three and that of adverse events (AEs) in one. Although all patients experienced AEs related to temsirolimus, severe AEs corresponding to ≥ grade 3 occurred in only four, including thrombocytopenia in two, anemia in one, and asthenia in one. CONCLUSIONS Treatment with temsirolimus is well tolerated and could provide comparatively favorable cancer control in Japanese mRCC patients undergoing HD.
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Procopio G, Sabbatini R, Porta C, Verzoni E, Galligioni E, Ortega C. Optimizing further treatment choices in short- and long-term responders to first-line therapy for patients with advanced renal cell carcinoma. Expert Rev Anticancer Ther 2012; 12:1089-1096. [DOI: 10.1586/era.12.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Masini C, Sabbatini R, Porta C, Procopio G, Di Lorenzo G, Onofri A, Buti S, Iacovelli R, Invernizzi R, Moscetti L, Aste MG, Pagano M, Grosso F, Lucia Manenti A, Ortega C, Cosmai L, Del Giovane C, Conte PF. Use of tyrosine kinase inhibitors in patients with metastatic kidney cancer receiving haemodialysis: a retrospective Italian survey. BJU Int 2012; 110:692-8. [PMID: 22364110 DOI: 10.1111/j.1464-410x.2012.10946.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Sunitinib and sorafenib are orally administered multikinase inhibitors approved for the treatment of advanced RCC. The limited pharmacokinetics data on sunitinib and sorafenib suggest that haemodialysis does not significantly alter plasma concentrations. In this retrospective study we define the safety and efficacy of tyrosine kinase inhibitors in patients with metastatic RCC (mRCC) and end-stage renal disease requiring haemodialysis. Even though the retrospective nature of this survey and the relatively small sample size represent major limitations, these data indicate that treatment with sunitinib and sorafenib in this cohort of patients is feasible with no unexpected toxicity and good efficacy, results similar to those in the general population of patients with mRCC. OBJECTIVE To investigate the safety and efficacy of tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease requiring haemodialysis (HD). PATIENTS AND METHODS Between July 2006 and December 2010, 24 patients undergoing HD were treated with sunitinib and/or sorafenib for mRCC in 14 Italian institutions. We retrospectively reviewed the medical records of these patients to evaluate the administered doses of TKIs, treatment-related toxicities and the clinical response to therapy. RESULTS Sunitinib was administered at 50 mg daily for 4-6 weeks in six patients, 37.5 mg daily for 4-6 weeks in seven patients (one patient subsequently increased the dose to 50 mg daily), 25 mg daily for 4-6 weeks in two patients and 12.5 mg daily for 4-6 weeks in one patient. Among the eight patients treated with sorafenib, four patients received 800 mg daily (400 mg every 12 h), three patients 400 mg daily and one patient 200 mg daily with a continuous schedule. The estimated median progression-free and overall survival periods of this cohort of patients were 10.3 months and 22.6 months, respectively. With regard to tolerability and safety, no unexpected adverse events were registered and no grade 4 haematological or non-haematological toxicities were reported. CONCLUSIONS Sunitinib and sorafenib treatment is not contraindicated in patients with mRCC undergoing HD. The outcome of this patient population is similar to that observed in patients with normal renal function treated with TKIs. These results merit further confirmation by a larger prospective trial.
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Affiliation(s)
- Cristina Masini
- Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy.
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Shaw GL, Hussain M, Nair R, Bycroft J, Beltran L, Green JS, Powles T, Peters JL. Performing Cytoreductive Nephrectomy following Targeted Sunitinib Therapy for Metastatic Renal Cell Carcinoma: A Surgical Perspective. Urol Int 2012; 89:83-8. [DOI: 10.1159/000338057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/12/2012] [Indexed: 11/19/2022]
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Safety and efficacy of molecularly targeted agents in patients with metastatic kidney cancer with renal dysfunction. Anticancer Drugs 2011; 22:794-800. [PMID: 21799472 DOI: 10.1097/cad.0b013e328346af0d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple molecularly targeted agents (MTAs) have been approved for the management of metastatic renal cell carcinoma (mRCC). Sunitinib and mammalian target of rapamycin inhibitors (temsirolimus, everolimus) are primarily metabolized in the liver, whereas the metabolism of bevacizumab is unclear. There are limited data on the toxicity profile and the efficacy of these agents in patients with renal insufficiency (RI). This is clinically relevant, especially as about one-third of patients with mRCC have renal dysfunction. The primary objective was to assess the safety and efficacy of targeted agents in patients with mRCC with RI. Medical records of patients with mRCC at Wayne State University, started on sunitinib, temsirolimus, everolimus, or bevacizumab, were reviewed. Patients with a calculated creatinine clearance of less than or equal to 60 ml/min were deemed to have RI. Data on safety and efficacy of MTA therapy were collected and analyzed with respect to renal function. RI was observed in 33% of our patients with mRCC. The incidence of toxicities, responses, time to progression, and overall survival were not significantly different in patients with RI compared with patients with normal renal function. Patients with RI had larger median increases in blood pressure with sunitinib and bevacizumab, increased incidence of thyroid dysfunction with sunitinib, and increased incidence of rash and dose interruptions with mammalian target of rapamycin inhibitors, than did patients with normal renal function. In conclusion, RI was commonly observed in our patients with mRCC. Molecularly targeted agents are well tolerated, and efficacy seems to be maintained in patients with RI. Vigilant monitoring of hypertension would be recommended for patients receiving sunitinib and bevacizumab.
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Thiery-Vuillemin A, Montange D, Kalbacher E, Maurina T, Nguyen T, Royer B, Bouchet S, Bazan F, Curtit E, Pivot X. Impact of sunitinib pharmacokinetic monitoring in a patient with metastatic renal cell carcinoma undergoing hemodialysis. Ann Oncol 2011; 22:2152-2154. [DOI: 10.1093/annonc/mdr343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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O'Donnell PH. Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with severe renal impairment or on haemodialysis. BJU Int 2011; 108:1284-5. [PMID: 21418138 DOI: 10.1111/j.1464-410x.2011.10179.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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