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Albigès L, Bellera C, Branchoux S, Arnaud M, Gouverneur A, Néré S, Gaudin AF, Durand-Zaleski I, Négrier S. Real-World Treatment Patterns and Effectiveness of Patients With Advanced Renal Cell Carcinoma: A Nationwide Observational Study. Clin Genitourin Cancer 2024; 22:295-304.e6. [PMID: 38105152 DOI: 10.1016/j.clgc.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Treatment landscape for advanced renal cell carcinoma (aRCC) has evolved quickly and few data about the real-world treatment patterns are available. This study aimed at describing the real-world treatment patterns and effectiveness of all systemic treatments available for aRCC in first and second-line treatment. MATERIALS AND METHODS A cohort of patients initiating a first-line systemic treatment for aRCC in 2016 was extracted from the French nationwide healthcare insurance system database (SNDS). The first-line treatment initiation date constituted the index date and patients were followed until death, loss to follow-up, or December 31, 2019, whichever occurred first. aRCC was identified using hospital diagnosis, long-term disease, or renal biopsy before index date. All analyses were performed for first and second-line treatment. Overall survival (OS) and time-to-next treatment or death (TNT-D) were estimated using Kaplan-Meier approach. RESULTS In 2016, 1629 patients initiated a first-line treatment for aRCC. Most of them were male (75.9%) and the median age was 67 years. Most of patients (91.7%) had received a tyrosine kinase inhibitor as first-line treatment, mainly sunitinib (64.4%), and 53.5% received a second-line, among which 43.7% nivolumab. Median OS (95% confidence interval [CI]) was 20.7 (95% CI:18.2-22.4) months from first-line treatment initiation and 15.4 (13.9-17.5) months from second-line treatment initiation. Median TNT-D were respectively 9.3 (9.7-12.1) months and 6.9 (5.9-7.7) months. CONCLUSION This study highlights the limited survival of aRCC patients These results provide a valuable baseline and highlight the need for innovation, such as immune checkpoint inhibitor-based combinations that have recently became first-line standard of care.
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Affiliation(s)
| | - Carine Bellera
- Department of Clinical Epidemiology and Clinical Research, Institut Bergonié, Bordeaux, France
| | - Sébastien Branchoux
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
| | | | | | - Sonia Néré
- Department of Medical Affairs, Bristol Myers Squibb, Rueil-Malmaison, France
| | - Anne-Françoise Gaudin
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
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Sofia D, Zhou Q, Shahriyari L. Mathematical and Machine Learning Models of Renal Cell Carcinoma: A Review. Bioengineering (Basel) 2023; 10:1320. [PMID: 38002445 PMCID: PMC10669004 DOI: 10.3390/bioengineering10111320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
This review explores the multifaceted landscape of renal cell carcinoma (RCC) by delving into both mechanistic and machine learning models. While machine learning models leverage patients' gene expression and clinical data through a variety of techniques to predict patients' outcomes, mechanistic models focus on investigating cells' and molecules' interactions within RCC tumors. These interactions are notably centered around immune cells, cytokines, tumor cells, and the development of lung metastases. The insights gained from both machine learning and mechanistic models encompass critical aspects such as signature gene identification, sensitive interactions in the tumors' microenvironments, metastasis development in other organs, and the assessment of survival probabilities. By reviewing the models of RCC, this study aims to shed light on opportunities for the integration of machine learning and mechanistic modeling approaches for treatment optimization and the identification of specific targets, all of which are essential for enhancing patient outcomes.
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Affiliation(s)
| | | | - Leili Shahriyari
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA 01003, USA; (D.S.); (Q.Z.)
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Xu K, Tang H, Xiong J, Ban X, Duan Y, Tu Y. Tyrosine kinase inhibitors and atherosclerosis: A close but complicated relationship. Eur J Pharmacol 2023:175869. [PMID: 37369295 DOI: 10.1016/j.ejphar.2023.175869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
Targeted cancer therapies have revolutionized the treatment of the disease in the past decade. The tyrosine kinase inhibitor (TKI) class of drugs is a widely used option for treating various cancers. Despite numerous advances, clinical and experimental studies have demonstrated the atherosclerosis-inducing properties of these drugs that can cause adverse cardiovascular events. TKIs also have an atherosclerosis-preventing role in patients with cancer through different mechanisms under various conditions, suggesting that specific drugs play different roles in atherosclerosis regulation. Given these contradictory properties, this review summarizes the outcomes of previously performed clinical and basic experiments and shows how the targeted effects of novel TKIs affect atherosclerosis. Future collaborative efforts are warranted to enhance our understanding of the association between TKIs and atherosclerosis.
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Affiliation(s)
- Ke Xu
- Department of Cardiology, The First Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Hao Tang
- Department of Cardiology, The First Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Jie Xiong
- Department of Cardiology, The Second Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Xiaofang Ban
- Department of Cardiology, The Second Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Yuchen Duan
- Department of Cardiology, The First Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Yingfeng Tu
- Department of Cardiology, The First Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China.
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4
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van Laar SA, Gombert-Handoko KB, Groenwold RHH, van der Hulle T, Visser LE, Houtsma D, Guchelaar HJ, Zwaveling J. Real-World Metastatic Renal Cell Carcinoma Treatment Patterns and Clinical Outcomes in The Netherlands. Front Pharmacol 2022; 13:803935. [PMID: 35401238 PMCID: PMC8983834 DOI: 10.3389/fphar.2022.803935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/18/2022] [Indexed: 12/28/2022] Open
Abstract
The number of treatment options for patients with metastatic renal cell carcinoma (mRCC) has significantly grown in the last 15 years. Although randomized controlled trials are fundamental in investigating mRCC treatment efficacy, their external validity can be limited. Therefore, the efficacy of the different treatment options should also be evaluated in clinical practice. We performed a chart review of electronic health records using text mining software to study the current treatment patterns and outcomes. mRCC patients from two large hospitals in the Netherlands, starting treatment between January 2015 and May 2020, were included. Data were collected from electronic health records using a validated text mining tool. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method. Most frequent first-line treatments were pazopanib (n = 70), sunitinib (n = 34), and nivolumab with ipilimumab (n = 28). The overall median PFS values for first-line treatment were 15.7 months (95% confidence interval [95%CI], 8.8-20.7), 16.3 months (95%CI, 9.3-not estimable [NE]) for pazopanib, and 6.9 months (95% CI, 4.4-NE) for sunitinib. The overall median OS values were 33.4 months (95%CI, 28.1-50.9 months), 39.3 months (95%CI, 29.5-NE) for pazopanib, and 28.1 months (95%CI, 7.0-NE) for sunitinib. For nivolumab with ipilimumab, median PFS and median OS were not reached. Of the patients who finished first- and second-line treatments, 64 and 62% received follow-up treatments, respectively. With most patients starting on pazopanib and sunitinib, these real-world treatment outcomes were most likely better than in pivotal trials, which may be due to extensive follow-up treatments.
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Affiliation(s)
- S A van Laar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - K B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - R H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - T van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - L E Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.,Department of Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - D Houtsma
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands
| | - H J Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - J Zwaveling
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
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García del Muro X, Durán I, Perez-gracia JL, Ángel Climent M, Mellado B, Virizuela JA, Castellano DE, González del Alba A, Carbonero I, Álvarez-fernández C, García-donas J, Gil-martin M, Hernández AG. Molecular biomarkers of prognosis in advanced renal cell carcinoma patients treated with Pazopanib plus interferon alpha (INF-2A) in a phase I/IIstudy by the Spanish Oncology Genitourinary Group. Clin Genitourin Cancer 2022. [DOI: 10.1016/j.clgc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
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Abstract
Since the outcome of treatments, particularly immunotherapeutic interventions, depends on the tumor immune micro-environment (TIM), several experimental and computational tools such as flow cytometry, immunohistochemistry, and digital cytometry have been developed and utilized to classify TIM variations. In this project, we identify immune pattern of clear cell renal cell carcinomas (ccRCC) by estimating the percentage of each immune cell type in 526 renal tumors using the new powerful technique of digital cytometry. The results, which are in agreement with the results of a large-scale mass cytometry analysis, show that the most frequent immune cell types in ccRCC tumors are CD8+ T-cells, macrophages, and CD4+ T-cells. Saliently, unsupervised clustering of ccRCC primary tumors based on their relative number of immune cells indicates the existence of four distinct groups of ccRCC tumors. Tumors in the first group consist of approximately the same numbers of macrophages and CD8+ T-cells and and a slightly smaller number of CD4+ T cells than CD8+ T cells, while tumors in the second group have a significantly high number of macrophages compared to any other immune cell type (P-value \documentclass[12pt]{minimal}
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\begin{document}$$<0.01$$\end{document}<0.01). The third group of ccRCC tumors have a significantly higher number of CD8+ T-cells than any other immune cell type (P-value \documentclass[12pt]{minimal}
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\begin{document}$$<0.01$$\end{document}<0.01), while tumors in the group 4 have approximately the same numbers of macrophages and CD4+ T-cells and a significantly smaller number of CD8+ T-cells than CD4+ T-cells (P-value \documentclass[12pt]{minimal}
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\begin{document}$$<0.01$$\end{document}<0.01). Moreover, there is a high positive correlation between the expression levels of IFNG and PDCD1 and the percentage of CD8+ T-cells, and higher stage and grade of tumors have a substantially higher percentage of CD8+ T-cells. Furthermore, the primary tumors of patients, who are tumor free at the last time of follow up, have a significantly higher percentage of mast cells (P-value \documentclass[12pt]{minimal}
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\begin{document}$$<0.01$$\end{document}<0.01) compared to the patients with tumors for all groups of tumors except group 3.
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Affiliation(s)
- Sumeyye Su
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA
| | - Shaya Akbarinejad
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA
| | - Leili Shahriyari
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA.
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Abstract
Since the outcome of treatments, particularly immunotherapeutic interventions, depends on the tumor immune micro-environment (TIM), several experimental and computational tools such as flow cytometry, immunohistochemistry, and digital cytometry have been developed and utilized to classify TIM variations. In this project, we identify immune pattern of clear cell renal cell carcinomas (ccRCC) by estimating the percentage of each immune cell type in 526 renal tumors using the new powerful technique of digital cytometry. The results, which are in agreement with the results of a large-scale mass cytometry analysis, show that the most frequent immune cell types in ccRCC tumors are CD8+ T-cells, macrophages, and CD4+ T-cells. Saliently, unsupervised clustering of ccRCC primary tumors based on their relative number of immune cells indicates the existence of four distinct groups of ccRCC tumors. Tumors in the first group consist of approximately the same numbers of macrophages and CD8+ T-cells and and a slightly smaller number of CD4+ T cells than CD8+ T cells, while tumors in the second group have a significantly high number of macrophages compared to any other immune cell type (P-value [Formula: see text]). The third group of ccRCC tumors have a significantly higher number of CD8+ T-cells than any other immune cell type (P-value [Formula: see text]), while tumors in the group 4 have approximately the same numbers of macrophages and CD4+ T-cells and a significantly smaller number of CD8+ T-cells than CD4+ T-cells (P-value [Formula: see text]). Moreover, there is a high positive correlation between the expression levels of IFNG and PDCD1 and the percentage of CD8+ T-cells, and higher stage and grade of tumors have a substantially higher percentage of CD8+ T-cells. Furthermore, the primary tumors of patients, who are tumor free at the last time of follow up, have a significantly higher percentage of mast cells (P-value [Formula: see text]) compared to the patients with tumors for all groups of tumors except group 3.
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Affiliation(s)
- Sumeyye Su
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA
| | - Shaya Akbarinejad
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA
| | - Leili Shahriyari
- Department of Mathematics and Statistics, University of Massachusetts Amherst, Amherst, MA, USA.
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8
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Géczi L, Bodoky G, Rokszin G, Fábián I, Torday L. Survival Benefits of Second-line Axitinib Versus Everolimus After First Line Sunitinib Treatment in Metastatic Renal Cell Carcinoma. Pathol Oncol Res 2020; 26:2201-2207. [PMID: 32291570 PMCID: PMC7471136 DOI: 10.1007/s12253-020-00809-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
Background Targeted therapies significantly improve clinical outcomes among patients with metastatic renal cell carcinoma (mRCC). Several new agents have been approved for first- and second-line use. However, there is a lack of compelling evidence comparing sequencing strategies, and available comparative data regarding the real-world effectiveness of different therapeutic sequences are limited. Materials and Methods We identified mRCC patients who initiated targeted therapy between January 1, 2008 and May 31, 2017 from the National Health Insurance Fund (NHIF) database of Hungary. Overall survival (OS) and duration of first-line treatment (DFT) were obtained for patients receiving sunitinib-everolimus, sunitinib-axitinib, or pazopanib-everolimus treatment sequences. OS of sunitinib-everolimus and sunitinib-axitinib sequences was also determined for patients having better or worse response to sunitinib first-line therapy. Results Median OS was significantly longer among patients treated with sunitinib-axitinib compared to those receiving sunitinib-everolimus. Median DFT was also significantly longer in the sunitinib-axitinib vs. sunitinib-everolimus group. Sunitinib-axitinib was associated with significantly longer median OS compared to sunitinib-everolimus in patients with better response to first-line sunitinib in the pooled sunitinib population. In patients with worse response to sunitinib, sunitinib-axitinib was associated with a trend towards greater OS compared to sunitinib-everolimus, but the difference did not reach statistical significance. Conclusions In this nationwide database analysis, mRCC patients treated with the sunitinib-axitinib sequence had significantly longer OS compared to those receiving sunitinib-everolimus therapy. The OS benefits of second-line axitinib were consistent among patients with better response to sunitinib defined by DFT values.
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Affiliation(s)
- Lajos Géczi
- Urogenital Tumors and Clinical Pharmacology Department, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
| | - György Bodoky
- Department of Oncology, Szent László Hospital, Albert Flórián út 5, 1097, Budapest, Hungary
| | - György Rokszin
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary
| | - Ibolya Fábián
- RxTarget Ltd, Bacsó Nándor út 10, 5000, Szolnok, Hungary.,University of Veterinary Medicine, István út 2, 1078, Budapest, Hungary
| | - László Torday
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
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Zhu G, Pei L, Yin H, Lin F, Li X, Zhu X, He W, Gou X. Profiles of tumor-infiltrating immune cells in renal cell carcinoma and their clinical implications. Oncol Lett 2019; 18:5235-5242. [PMID: 31612034 PMCID: PMC6781756 DOI: 10.3892/ol.2019.10896] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/30/2019] [Indexed: 02/05/2023] Open
Abstract
Tumor-infiltrating immune cells (TIICs) are crucial for the clinical outcome of renal cell carcinoma (RCC), as they regulate cancer progression. TIICs have therefore the potential to become novel targets of immunotherapies. The present study used CIBERSORT analytical tool, which is a deconvolution algorithm, to comprehensively analyze the composition of immune cells in RCC and normal tissues from The Cancer Genome Atlas (TCGA) cohort, and to determine the prognostic value of TIICs in RCC. A landscape of infiltrating immune cells was determined as containing 13 subpopulations of immune cells, with significant differences between normal and tumor tissues. Subsequently, Kaplan-Meier analysis and log-rank test were used to estimate the prognostic value of TIICs in RCC. The results demonstrated that a higher proportion of regulatory T cells (Tregs) [hazard ratio (HR)=1.596; 95% confidence interval (CI), 1.147–2.222; P=0.006] and follicular helper T cells (HR=1.516; 95% CI, 1.089–2.111; P=0.014) were associated with poor outcome in patients with RCC. Conversely, resting mast cells (HR=0.678; 95% CI, 0.487–0.943; P=0.021) and monocytes (HR=0.701; 95% CI, 0.503–0.977; P=0.036) were associated with a favorable prognosis in patients with RCC. Furthermore, the results from multivariate Cox regression analysis indicated that Tregs and monocytes represented independent risk factors for prognosis in patients with RCC. These findings demonstrated that gene profiling deconvolution by CIBERSORT served to determine the composition of immune cells infiltrated in RCC and may provide some crucial information for the development of immunotherapies.
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Affiliation(s)
- Gongmin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing 400016, P.R. China
| | - Lijiao Pei
- The State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hubin Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing 400016, P.R. China
| | - Fan Lin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing 400016, P.R. China
| | - Xinyuan Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing 400016, P.R. China
| | - Xin Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.,Chongqing Key Laboratory of Molecular Oncology and Epigenetics, Chongqing 400016, P.R. China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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Jammal N, Pan E, Hurwitz M, Abramovitz RB. Outcomes of combination therapy with tyrosine kinase inhibitors and immune checkpoint inhibitors in metastatic renal cell carcinoma – A retrospective study. J Oncol Pharm Pract 2019; 26:556-563. [DOI: 10.1177/1078155219854797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Renal cell carcinoma (RCC) is a highly vascularized and immunogenic tumor. At the time of this study, there was limited published data on the combination of tyrosine kinase inhibitors and immune checkpoint inhibitors in patients who were heavily pretreated. At our institution, providers have used these combinations in heavily pretreated patients. Methods We conducted a retrospective review of patients receiving this combination with the primary objectives of assessing duration of therapy and toxicities and a secondary objective of disease progression at six months. We included adult patients with confirmed mRCC receiving combination therapy (immune checkpoint inhibitors/tyrosine kinase inhibitors) any time after January 2015. Electronic medical records were reviewed for pertinent data and follow-up descriptive statistics were performed. Results Fifteen patients were on combination immune checkpoint inhibitors/tyrosine kinase inhibitors, with a median of three lines of previous therapy. The median duration of combination therapy was 7.2 months (range: 0.2 to 39.8) with 126 incidences of toxicities. The most frequent toxicity was fatigue (n = 15), followed by diarrhea (n = 8), anorexia (n = 7) and palmar-plantar erythrodysesthesia (n = 7). Overall, 9 (60%) patients experienced at least one grade 3 or 4 toxicity. Eight of 15 (53%) patients remained on therapy at the six-month mark and did not have progression confirmed by an oncologist. Of the 15 patients, 10 discontinued therapy due to progression, 2 due to intolerable side effects, 2 transitioned to end of life care, and 1 patient was still ongoing at the time of data collection. Conclusion Based on this review, it appears that combination tyrosine kinase inhibitors/immune checkpoint inhibitors therapy in pre-treated patients with mRCC is tolerable and beneficial.
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Affiliation(s)
| | - Eva Pan
- Yale-New Haven Hospital, New Haven, CT, USA
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11
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Labriola MK, Batich KA, Zhu J, McNamara MA, Harrison MR, Armstrong AJ, George DJ, Zhang T. Immunotherapy Is Changing First-Line Treatment of Metastatic Renal-Cell Carcinoma. Clin Genitourin Cancer 2019; 17:e513-e521. [PMID: 30858035 PMCID: PMC7004481 DOI: 10.1016/j.clgc.2019.01.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/05/2019] [Accepted: 01/25/2019] [Indexed: 02/06/2023]
Abstract
The incidence of renal-cell carcinoma has been increasing each year, with nearly one third of new cases diagnosed at advanced or metastatic stage. The advent of targeted therapies for metastatic renal-cell carcinoma (mRCC) has underscored the need to subtype tumors according to tumor-immune expression profiles that may more reliably predict treatment outcomes. Over the past 2 decades, several vascular endothelial growth factor (VEGF) and tyrosine kinase inhibitors have been the mainstay for first- and second-line treatment of mRCC. Very recently, immunotherapy checkpoint inhibitors have significantly changed the treatment landscape for patients with mRCC, particularly for first-line treatment of intermediate to poor risk mRCC patients. Now, combination immunotherapy as well as combinations of immunotherapy with targeted agents can significantly alter disease outcomes. The field of immuno-oncology for mRCC has unveiled a deeper understanding of the immunoreactivity inherent to these tumors, and as a result combination therapy is evolving as a first-line modality. This review provides a timeline of advances and controversies in first-line treatment of mRCC, describes recent advances in understanding the immunoreactivity of these tumors, and addresses the future of combination anti-VEGF and immunotherapeutic platforms.
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Affiliation(s)
- Matthew K Labriola
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Kristen A Batich
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Jason Zhu
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Megan A McNamara
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Michael R Harrison
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Andrew J Armstrong
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Daniel J George
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Durham, NC.
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12
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Okamura Y, Hinata N, Terakawa T, Furukawa J, Harada K, Nakano Y, Nakamura I, Inoue T, Ogawa T, Fujisawa M. External validation of nomograms for prediction of progression-free survival and liver toxicity in patients with advanced renal cell carcinoma treated with pazopanib. Int J Clin Oncol 2019; 24:698-705. [DOI: 10.1007/s10147-019-01401-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/19/2019] [Indexed: 01/09/2023]
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Isaacsson Velho P, Nardo M, Souza MCLDA, Bonadio RRCC, Marta GN, Muniz DQB, Bastos DA, Dzik C. Analysis of Efficacy and Toxicity Profile of First-Line Sunitinib or Pazopanib in Metastatic Clear Cell Renal Cell Carcinoma in the Brazilian Population. J Glob Oncol 2018; 4:1-10. [PMID: 30199304 PMCID: PMC7010438 DOI: 10.1200/jgo.18.00073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Sunitinib and pazopanib are multitargeted tyrosine kinase inhibitors (TKIs) that act against vascular endothelial growth factor receptors and are standard first-line treatment options for metastatic clear cell renal cell carcinoma (ccRCC). The Brazilian public health system diverges from the randomized clinical trials in the availability of first and subsequent lines of treatment and in clinical and demographic characteristics of patients. Therefore, it is essential to describe the history of advanced ccRCC during and after TKI treatment in this population. Methods We performed a retrospective analysis of patients with advanced ccRCC treated with a first-line TKI (either sunitinib or pazopanib) between February 2009 and March 2017 in a single academic Brazilian cancer center (Instituto do Câncer do Estado de São Paulo). Results Of the 222 patients, 109 were treated with sunitinib and 113 with pazopanib. The median duration of treatment and overall survival (OS) were 6.4 and 15.2 months for sunitinib and 6.7 and 14.2 months for pazopanib, respectively. Discontinuation of treatment occurred secondarily to progressive disease or death in 64.2% of patients using sunitinib and in 54.8% of patients using pazopanib. Adverse events were responsible for discontinuation of treatment in 28.4% of patients in the sunitinib group and in 22.1% in the pazopanib group. According to Memorial Sloan-Kettering Cancer Center risk categories, the OS was 32.9 months, 15.9 months, and 8.1 months for low risk, intermediate risk, and poor risk, respectively (hazard ratio, 1.72; 95% CI, 1.13 to 2.26; P < .001). Conclusion The use of TKI inhibitors as first-line treatment of metastatic RCC is effective and feasible in the Brazilian public health. However, the median OS of our population is considerably lower compared with the prospective trials that evaluated the same drugs.
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Affiliation(s)
- Pedro Isaacsson Velho
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Mirella Nardo
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Manoel Carlos Leonardi de Azevedo Souza
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Renata R C Colombo Bonadio
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Guilherme Nader Marta
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - David Q B Muniz
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Diogo Assed Bastos
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
| | - Carlos Dzik
- Pedro Isaacsson Velho, Johns Hopkins University, Baltimore, MD, and Hospital Moinhos de Vento, Porto Alegre; and Mirella Nardo, Manoel Carlos Leonardi de Azevedo Souza, Renata R.C. Colombo Bonadio, Guilherme Nader Marta, David Q.B. Muniz, Diogo Assed Bastos, and Carlos Dzik, Instituto do Cancer do Estado de Sao Paulo, São Paulo, Brazil
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