1
|
Méndez-Vidal MJ, Lázaro Quintela M, Lainez-Milagro N, Perez-Valderrama B, Suárez Rodriguez C, Arranz Arija JÁ, Peláez Fernández I, Gallardo Díaz E, Lambea Sorrosal J, González-del-Alba A. SEOM SOGUG clinical guideline for treatment of kidney cancer (2022). Clin Transl Oncol 2023; 25:2732-2748. [PMID: 37556095 PMCID: PMC10425490 DOI: 10.1007/s12094-023-03276-5] [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: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a "bridge" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.
Collapse
Affiliation(s)
- María José Méndez-Vidal
- Medical Oncology Department, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Martin Lázaro Quintela
- Medical Oncology Department, Hospital Alvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | - Nuria Lainez-Milagro
- Medical Oncology Department, Hospital Universitario de Navarra (HUN), Pamplona, Spain
| | | | | | | | | | | | - Julio Lambea Sorrosal
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | |
Collapse
|
2
|
Muñoz Martín AJ, Gallardo Díaz E, Crespo C, Masana Domenech R, Soto J, Arumi D, Fernandez S. Cost-effectiveness of apixaban versus other direct oral anticoagulants and low-molecular-weight-heparins for cancer associated venous thromboembolism in Spain. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18845 Background: Venous thromboembolism (VTE) causes substantial morbidity and mortality in patients with cancer. The guidelines for the treatment of VTE in cancer patients recommend low molecular weight heparins (LMWH) and direct oral anticoagulants (DOAC) for patients where major bleeding is a low risk factor. Several studies show that DOAC represent a convenient and effective treatment option in alternative to LMWH in patients with deep-vein thrombosis or pulmonary embolism. Even though some recent studies have compared the effectiveness of DOAC vs LMWH, there is no available a cost-effectiveness analysis (CEA) comparing the relative effectiveness and cost-effectiveness of apixaban, other DOAC and. LMWH. The study aim was to conduct a CEA of apixaban (API), edoxaban (EDO), rivaroxaban (RIVA) and LMWH for the treatment of cancer associated VTE in Spain. Methods: We developed a Markov model with 12 transition health states. The model has been face-validated by two oncologists from two different Spanish hospitals. The use of resources and costs were obtained from the 2021 Spanish Ministry of Health database, and the main references for obtaining the outcomes were derived from CARAVAGGIO, HOKUSAI-VTE, ADAM VTE and SELECT-D trials. Our model yielded the effectiveness score in terms of cost per life-year (LY) gained and cost per quality-adjusted for life-year (QALY) gained. The time horizon was 12 months. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness. Results: API showed the lowest 12-month cost (1943 €), and the highest amount of life years (0.79) and highest amount of QALY (0.55) gained. RIVA and EDO were less effective in terms of LY (0.76 and 0.74, respectively) and QALY (0.53 and 0.52, respectively) gained than LMWH (LY of 0.76 and QALY of 0.53), and less costly. The Incremental Cost-Effectiveness Ratio (ICER) scores in terms both of €/LY and €/QALY gained show that API is dominant over LMWH, RIVA and EDO. Conclusions: Our results suggest that API is more effective and more cost-effective than LMWH, RIVA or EDO with the 2021 Spanish healthcare costs. For interpretation of the results, reader must consider that the costs of resources analyzed in this paper may vary from country to country, and dabigatran was not included in the analysis since there are not cancer associated VTE clinical trials with dabigatran data to calculate CEA from.[Table: see text]
Collapse
Affiliation(s)
- Andres J. Muñoz Martín
- Hospital General Universitario Gregorio Marañón, Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Enrique Gallardo Díaz
- Department of Oncology, Parc Tauli Sabadell Hospital Universitari, Institut d’Investigatió i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | | | | | | |
Collapse
|
3
|
Mendez-Vidal MJ, Lozano R, Castro E, Romero-Laorden N, Rodriguez-Vida A, Lainez N, Hernandez A, Villatoro R, Zambrana F, Guzman JCV, García Domínguez R, Galvan Ruiz S, Escribano R, Gallardo Díaz E, Querol R, Luque R, Gonzalez del Alba A, Puente J, Olmos D, Lorente D. Treatment sequence in elderly metastatic castration-resistant prostate cancer (mCRPC) patients (pts) in a prospective cohort study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5053 Background: Abiraterone (Abi), enzalutamide (Enza) and docetaxel (Doc) are all valid first-line (1L) mCRPC treatment options. SIOG guidelines (Droz, Eur Urol 2017) recommend that fit elderly pts should receive the same treatment as younger patients. Evidence of the optimal treatment sequence in this patient subpopulation is lacking. Methods: We evaluated the outcome of elderly (≥ 75 years [yrs]) pts treated in the prospective PROREPAIR-B cohort study (NCT03075735). We assessed the impact of 1L treatment option (Doc vs Abi/Enza) on overall survival (OS) and progression-free survival (PFS) to 1L-therapy following PCWG2criteria. Uni- (UV) and multivariable (MV) cox-regression models were used. MV model covariates included local therapy, Gleason Score, stage IV at diagnosis, visceral metastases, ALP (≥ULN), LDH (≥ULN), haemoglobin (Hb; ≤LNL), albumin (≤LNL) and ECOG PS. Results: 419 pts were included in the study. Of these, 137 (32,7%) had age ≥ 75 yrs. 48 (35%) received docetaxel and 88 (64.2%) had Abi/Enza as first-line therapy. Of the 121 pts that progressed on 1L-therapy, 30 (24.8%) did not receive 2L therapy. Choice of 2L-therapy was: Doc in 37 (30,6%), Abi/Enza in 38 (31.4%), Cabazitaxel in 9 (7.4%) and Radium-223 in 7 (5.8%) pts. Pts treated with 1L-Doc had higher rates of visceral metastases (22.9% vs 5.7%; p=0.003), high ALP (68.8% vs 43.2%; p=0.004) and low Hb (12.5% vs 3.4%). PFS to 1L-therapy was longer for Abi/Enza than for Doc treated pts (9.6 vs 8.3m; HR: 0.52; p=0.001). The pattern of disease progression (PSA, radiographic, clinical) was similar in Doce and Abi/Enza treated pts. No difference between pts treated with initial Abi/Enza vs Doc was observed in OS (28.2 vs 24.8m; HR:1.18; p=0.474). No significant OS differences were observed in the MV model. Conclusions: No differences in OS were observed between treatment sequences starting with Doc vs Abi/Enza in pts ≥ 75 yrs. Pts treated with 1L-Doc had worse baseline prognostic features. Age should not be considered as a factor for treatment choice in elderly mCRPC pts based on treatment outcome.
Collapse
Affiliation(s)
| | - Rebeca Lozano
- Spanish National Cancer Research Centre, Madrid, Spain
| | - Elena Castro
- Spanish National Cancer Research Centre, Madrid, Spain
| | | | | | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Rosa Villatoro
- Hospital Costa del Sol, Oncology Department, Marbella, Spain
| | - Francisco Zambrana
- Medical Oncology Department, Infanta Sofía University Hospital, Madrid, Spain
| | | | | | - Saray Galvan Ruiz
- Medical Oncology Unit, Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Enrique Gallardo Díaz
- Department of Oncology, Parc Tauli Sabadell Hospital Universitari, Institut d’Investigatió i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Rosa Querol
- Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, A Coruña, Spain
| | - Raquel Luque
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - David Olmos
- Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Center, Madrid, Spain
| | - David Lorente
- Medical Oncology Department, Hospital Provincial de Castellón, Castellón De La Plana, Spain
| |
Collapse
|
4
|
GarcÃa-Donas J, Roldan JM, Lainez N, Castellano DE, González EE, Climent MA, Puente J, Rodriguez-Moreno JF, Alonso Gordoa T, Gonzalez del Alba A, Arranz JA, Santos M, Hernando Polo S, Domenech M, Rodriguez L, Herrador A, Sáez MI, Gallardo Díaz E, Gutierrez AM, Rodríguez-Antona C. Comprehensive molecular and immunohistochemical analysis of advanced renal cell carcinoma patients treated with mTOR inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Nuria Lainez
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | | | - Javier Puente
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Maria Santos
- Spanish National Cancer Research Center, Madrid, Spain
| | | | | | | | | | - M Isabel Sáez
- CRIS Cancer Foundation Prostate Cancer Research Group, Institute of Biomedical Research in Malaga/ CNIO-IBIMA Genitourinary Cancer Research Unit, H Universitarios Virgen de la Victoria y Regional de Málaga, Malaga, Spain
| | - Enrique Gallardo Díaz
- Department of Oncology, Parc Tauli Sabadell Hospital Universitari, Institut d’Investigatió i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | | |
Collapse
|
5
|
Cassinello J, Henríquez López I, Gonzalez del Alba A, González San Segundo C, López Torrecilla J, Gallardo Díaz E, Rodríguez Antolín A, Juárez Á, Unda M, Arranz Arija JA. Questionnaire to evaluate prostate cancer multidisciplinary committees in Spain. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e568 Background: Prostate Cancer (PC) management through Multidisciplinary Committees (MDC) has demonstrated some benefits that could be relevant in patient's outcomes. In Spain MDC are widely implemented although they are not homogeneous among hospitals. The aim of the study was to design a questionnaire to evaluate the functionality/effectiveness of PC MDC in Spain. Methods: The questionnaire was developed from a literature review (22 articles included) and validated by 9 opinion leaders (3 medical oncologists, 3 urologists and 3 radiation oncologists). Experts scored each questionnaire item regarding its ability to assess MDC functionality/effectiveness to obtain a final score of each hospital (from 0-minimum to 100-best functionality/effectiveness) used to classify them according to the cluster analysis (high/intermediate/low level of functionality/effectiveness). The questionnaire was distributed to different specialties by the Spanish Societies of Urological Cancer (URONCOR, GUO and SOGUG). Results: 218 physicians answered the questionnaire, 90 medical oncologists, 86 urologists and 42 radiation oncologists, from 109 hospitals with national representativeness. 91% of hospitals had a Urological MDC, 5% a PC MDC and 4% a General Tumour Committee. Core medical specialities (Urology, Medical Oncology, Radiation Oncology, Pathology, Radiology) were represented in > 80% of MDC. Only 9% MDC discussed the treatment of all patients with PC whereas in 60% of MDC less than 50% of the whole population of PC patients were evaluated. According to 95% of physicians, agreement in therapeutic strategies were reached in > 80% of cases discussed. A score was established that allowed the classification of MDC in each center according to its functionality into 3 clusters: 43% of centers fell in cluster 3 (high), 36% in cluster 2 (intermediate) and 21% in cluster 1 (low). Conclusions: Urological Cancer MDC is a widespread practice in Spain, which comprises a wide range of medical specialists that meet regularly to agree on therapeutic strategies for PC patients. Less than 50% of total PC patients are evaluated in Urological MDC. It is still necessary to improve some aspects allowing more hospitals to reach a higher level of functionality.
Collapse
Affiliation(s)
- Javier Cassinello
- Medical Oncology Service, Hospital de Guadalajara, Guadalajara, Spain
| | | | | | | | - José López Torrecilla
- Department of Radiation Oncology, General University Hospital of Valencia, Valencia, Spain
| | | | | | - Álvaro Juárez
- Department of Urology, Hospital del SAS de Jerez, Jerez De La Frontera, Spain
| | - Miguel Unda
- Department of Urology, Hospital de Basurto, Bilbao, Spain
| | | |
Collapse
|
6
|
Olmos VP, Ramos Gallo MJ, Rebollo MA, Ortega DB, Docampo LI, Romera-Villegas A, Díaz EG, Martín AM. [Management of venous thromboembolism in oncological patients: Spanish clinical practice guidelines. Consensus SEACV-SEOM]. Med Clin (Barc) 2015; 144 Suppl 1:3-15. [PMID: 25771086 DOI: 10.1016/s0025-7753(15)30012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vanessa Pachón Olmos
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM.
| | | | - Maite Antonio Rebollo
- Servicio de Oncología Médica, Institut Català d'Oncologia/Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | | | - Lara Iglesias Docampo
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | - Antonio Romera-Villegas
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Enrique Gallardo Díaz
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | - Andrés Muñoz Martín
- Servicio de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, España. Grupo de Trabajo Cáncer y Trombosis SEOM
| | | | | |
Collapse
|
7
|
Díaz EG, Montalto de Mecca M, Castro JA. Reactions of nifurtimox with critical sulfhydryl-containing biomolecules: their potential toxicological relevance. J Appl Toxicol 2004; 24:189-95. [PMID: 15211612 DOI: 10.1002/jat.970] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nifurtimox (Nfx) is a drug used in the treatment of Chagas' disease, an endemic parasitic disease from Latin American countries. It produces undesirable side-effects in patients, frequently forcing the treatment to be stopped. Its toxic mechanism is not fully understood. In this work we describe purely chemical reactions of Nfx with relevant cellular sulfhydryl (SH) compounds. The compounds tested were glutathione (GSH), cysteine (RSH), lipoic acid (LA) and coenzyme A (CoA). All reacted with Nfx to give nitrite (NO(-) (2)). The relative reaction rates were CoA>LA>GSH>RSH. In studies with GSH and RSH the formation of nitrite was accompanied by decreases in Nfx concentration and increases in the formation of a reaction product revealed by HPLC. We failed to show the presence of liver cytosolic GST (GSH transferase activity)-mediated formation of NO2- from Nfx. These NO(-) (2)-releasing processes occurred under in vivo conditions in Nfx-treated Sprague-Dawley male rats (240-260 g body weight) at a dose of 100 mg Nfx kg(-1) p.o. In urine samples NO(-) (2) excretion was accompanied by unchanged drug and two unidentified more polar metabolites detectable by HPLC. The Nfx reactions with critical SH from molecules such as GSH, RSH, LA and CoA, and potentially others containing SH residues (e.g. enzymes or structural proteins), might have toxicological relevance not only for the Nfx side-effects but also for the chemotherapeutic effects on Trypanosoma cruzi. In addition, Nfx reactions with GSH might be crucial in Nfx detoxification.
Collapse
Affiliation(s)
- E G Díaz
- Centro de Investigaciones Toxicológicas CITEFA/CONICET, J. B. de La Salle 4397, B1603ALO, V. Martelli, Buenos Aires, Argentina
| | | | | |
Collapse
|
8
|
Abstract
Three inverse serial digit detection tasks were evaluated with event-related brain potentials (ERPs) in 15 11-year-old children to determine how the increase of perceptual or memory demands could modify detection processing. Reaction times were significantly longer for the task that used visual blurring, compared to that with a greater memory demand. Difference-ERPs (target minus non-target conditions) showed three significant parietal components; one earlier positive peak at 162 ms interpreted as an index of working memory load; a same polarity 295 ms peak which probably represents a P3 analogous and a subsequent negative polarity component (520 ms) possibly involved with motor preparation. A fourth difference-component was a frontal positive peak at 680 ms, interpreted as related to task difficulty.
Collapse
|
9
|
Montalto de Mecca M, Rodríguez de Castro C, Díaz EG, Castro JA. [Ultrastructural alterations in colonic mucosa of nifurtimox treated rats]. Medicina (B Aires) 2001; 61:67-72. [PMID: 11265627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Nifurtimox (Nfx) is a chemotherapeutic agent used in the treatment of acute Chagas' disease. Clinical and experimental studies with this nitroheterocyclic compound evidenced serious undesirable side effects. These were correlated with Nfx nitroreduction to a nitroanion radical followed by superoxide anion generation through a redox cycling process. The aim of this study was to verify whether the oral administration of Nfx to Sprague Dawley male rats (100 mg.kg-1, p.o.) produced any observable ultrastructural alteration in the cells of the colonic mucosa. Results showed that 24 h after Nfx administration there were observable alterations in this type of cells. They essentially consisted of moderate dilatation of their endoplasmic reticulum and intense dilatation of their Golgi complex. Already 1 and 3 h after Nfx administration, the original compound reached a concentration of 9.7 +/- 2.9 and 7.0 +/- 1.7 nmol.g-1 respectively in the colonic tissue. Studies on Nfx nitroreductase activity of colonic mucosa as determined spectrophotometrically and by HPLC methods showed that the microsomal fraction (from 0.72 +/- 0.29 to 0.26 +/- 0.04 nmol Nfx.min-1.mg-1 protein) but not the cytosol had the ability to nitroreduce Nfx. The results obtained show a correlation between the ultrastructural localization of injury and that of nitroreductase activity. The intense deleterious effects of Nfx in the Golgi apparatus suggest the potential occurrence of alterations in the synthesis/storage of secretory products of the colonic mucosa.
Collapse
Affiliation(s)
- M Montalto de Mecca
- Centro de Investigaciones Toxicológicas (CEITOX-CITEFA-CONICET), Villa Martelli, J.B. de La Salle 4397, 1603 Villa Martelli, Provincia de Buenos Aires, Argentina
| | | | | | | |
Collapse
|