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Master VA, Schmeusser BN, Osunkoya AO, Palacios AR, Midenberg E, Yantorni L, Ogan K, Bilen MA. Neoadjuvant Nivolumab and Ipilimumab for Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus. J Immunother Precis Oncol 2022; 6:50-55. [PMID: 36751655 PMCID: PMC9888517 DOI: 10.36401/jipo-22-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
Renal cell carcinoma with level IV tumor thrombus is a condition necessitating aggressive surgical management. Many solid organ malignancies often benefit from neoadjuvant treatments for tumor debulking and improvement of surgical outcomes. However, neoadjuvant treatments for renal cell carcinoma have been limited by its resistance to traditional chemotherapy and radiation. Emerging treatment modalities, such as immunotherapies, are exciting new options that may be therapeutically effective. The combination of nivolumab and ipilimumab has exhibited success in managing metastatic renal cell carcinoma. Limited data exist for its use in nonmetastatic renal cell carcinoma with tumor thrombus. This case illustrates the use of nivolumab and ipilimumab combination therapy in delaying tumor growth, producing observable tumor thrombus histologic and radiologic treatment changes, and, most importantly, facilitating a less invasive surgical approach of a level IV renal cell carcinoma tumor thrombus.
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Affiliation(s)
- Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Adeboye O. Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
,Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Arnold R. Palacios
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren Yantorni
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet A. Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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Martini DJ, Olsen TA, Goyal S, Liu Y, Evans ST, Hitron EE, Russler GA, Yantorni L, Caulfield S, Brown JT, Goldman JM, Nazha B, Carthon BC, Harris WB, Kucuk O, Master VA, Bilen MA. Combination Immune Checkpoint Blockade Regimens for Previously Untreated Metastatic Renal Cell Carcinoma: The Winship Cancer Institute of Emory University Experience. J Immunother Precis Oncol 2022; 5:52-57. [PMID: 36034580 PMCID: PMC9390705 DOI: 10.36401/jipo-22-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Abstract
Introduction There are three combination immune checkpoint inhibitor (ICI)-based regimens in the first-line setting for metastatic renal cell carcinoma (mRCC). Currently, there is limited real-world data for clinical outcomes and toxicity in mRCC patients treated with first-line ICI-based regimens. Methods We performed a retrospective review of 49 mRCC patients treated with ICI-based combination regimens in the standard of care setting at the Winship Cancer Institute of Emory University from 2015-2020. We collected baseline data from the electronic medical record including demographic information and disease characteristics. Immune-related adverse events (irAEs) were collected from clinic notes and laboratory values. The primary clinical outcomes measured were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Results The median age was 65 years, and most patients (80%) were males. The majority were White (86%) and had clear cell RCC (83%). Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 (43%) or 1 (45%). Approximately one-half (49%) had at least three sites of distant metastatic disease. Most patients (88%) received nivolumab and ipilimumab. More than one-half (53%) of patients experienced an irAE, with 13 (27%) patients having treatment delayed and 18% discontinuing treatment for toxicity. The median OS was not reached, and the median PFS was 8.0 months per a Kaplan-Meier estimation. More than half of patients (53%) had a PFS > 6 months, and 22% had PFS > 1 year. The ORR was 33% for the entire cohort, and 7% of patients had a complete response. Conclusion We presented real-world efficacy and toxicity data for front-line ICI combination treatment regimens. The ORR and median PFS were lower in our cohort of patients compared to the available data in the clinical trial setting. This was likely because of more advanced disease in this study. Future studies should provide additional data that will allow comparisons between different ICI combination regimens for untreated mRCC.
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Affiliation(s)
- Dylan J Martini
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - T Anders Olsen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Subir Goyal
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Sean T Evans
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | | | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacqueline T Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jamie M Goldman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
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Hadadi A, Smith KER, Wan L, Brown JR, Russler G, Yantorni L, Caulfield S, Lafollette J, Moore M, Kucuk O, Carthon B, Nazha B, Liu Y, Bilen MA. Baseline basophil and basophil-to-lymphocyte status is associated with clinical outcomes in metastatic hormone sensitive prostate cancer. Urol Oncol 2022; 40:271.e9-271.e18. [DOI: 10.1016/j.urolonc.2022.03.016] [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: 10/17/2021] [Revised: 02/17/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
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Martini DJ, Evans ST, Liu Y, Shabto JM, Uner OE, Olsen TA, Brown JT, Russler GA, Yantorni L, Caulfield S, Goldman JM, Nazha B, Harris WB, Master VA, Kucuk O, Carthon BC, Bilen MA. Analysis of Toxicity and Clinical Outcomes in Full Versus Reduced Starting Dose Cabozantinib in Metastatic Renal Cell Carcinoma Patients. Clin Genitourin Cancer 2022; 20:53-59. [PMID: 34922840 PMCID: PMC8816843 DOI: 10.1016/j.clgc.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/09/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Full dose cabozantinib for metastatic renal cell carcinoma (mRCC) is 60 mg, but adverse events (AEs) may require dose reductions. Limited data exist comparing efficacy among cabozantinib doses. We compared AEs and clinical outcomes in mRCC patients treated with full vs. reduced starting cabozantinib dose. METHODS We performed a retrospective analysis of 87 mRCC patients treated with cabozantinib at Winship Cancer Institute from 2016 to 2019. Overall survival (OS), progression-free survival (PFS), and objective response (OR) rate measured clinical outcomes. AEs were collected from clinic notes and the most common were hypertension, mucositis/hand-foot skin reaction (HFSR), or gastrointestinal toxicity. Univariate analysis (UVA) between starting doses and AEs with clinical outcomes was performed using logistic regression model. Multivariable analysis was also performed using Cox proportional hazard model. RESULTS Most patients were men (71%) with clear-cell RCC (72%). The majority were IMDC intermediate (58%) or poor (35%) risk. One third received first-line cabozantinib and 64% had ≥3 baseline metastatic sites. Most patients (68%) required dose reduction from 60 mg or started at reduced dose without escalation. Reduced dose patients were more likely to have ≥3 distant metastatic sites (70% vs. 58%) and ≥2 prior lines of systemic therapy (50% vs. 40%) compared to full dose patients. UVA revealed a trend towards shorter OS (HR: 1.78, P = .095), PFS (HR: 1.50, P = .107), and lower chance of OR (HR:0.42, P = .149) among reduced dose patients. This trend did not hold in Multivariable analysis (OS HR: 1.20, P = .636; PFS HR: 1.23, P = .4662). Mucositis/HFSR and hypertension were significantly associated with improved outcomes in UVA. CONCLUSIONS Although we found a trend favoring full dose cabozantinib, this is likely due to worse baseline disease characteristics among patients starting on a reduced dose. Hypertension and mucositis/HFSR may be associated with improved outcomes. Larger studies are warranted to validate these findings.
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Affiliation(s)
- Dylan J. Martini
- Massachusetts General Hospital, Department of Medicine, Boston, MA, USA,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sean T. Evans
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Julie M. Shabto
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ogul E. Uner
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - T. Anders Olsen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jacqueline T. Brown
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA,Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Jamie M. Goldman
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wayne B. Harris
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bradley C. Carthon
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA,Corresponding Author: Dr. Mehmet A. Bilen, Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA. Phone: 404-778-3693,
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Martini DJ, Shabto JM, Goyal S, Liu Y, Olsen TA, Evans ST, Magod BL, Ravindranathan D, Brown JT, Yantorni L, Russler GA, Caulfield S, Goldman JM, Nazha B, Joshi SS, Kissick HT, Ogan KE, Harris WB, Kucuk O, Carthon BC, Master VA, Bilen MA. Body Composition as an Independent Predictive and Prognostic Biomarker in Advanced Urothelial Carcinoma Patients Treated with Immune Checkpoint Inhibitors. Oncologist 2021; 26:1017-1025. [PMID: 34342095 DOI: 10.1002/onco.13922] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/18/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Several immune checkpoint inhibitors (ICIs) are approved for the treatment of advanced urothelial carcinoma (UC). There are limited biomarkers for ICI-treated patients with UC. We investigated the association between body composition and clinical outcomes in ICI-treated UC patients. MATERIALS AND METHODS We conducted a retrospective analysis of 70 ICI-treated patients with advanced UC at Winship Cancer Institute from 2015 to 2020. Baseline computed tomography images within 2 months of ICI initiation were collected at mid-L3 and muscle and fat compartments (subcutaneous, intermuscular, and visceral) were segmented using SliceOMatic v5.0 (TomoVision, Magog, Canada). A prognostic body composition risk score (high: 0-1, intermediate: 2-3, or low-risk: 4) was created based on the β coefficient from the multivariate Cox model (MVA) following best-subset variable selection. Our body composition risk score was skeletal muscle index (SMI) + 2 × attenuated skeletal muscle (SM) mean + visceral fat index (VFI). Concordance statistics (C-statistics) were used to quantify the discriminatory magnitude of the predictive model. RESULTS Most patients (70%) were men and the majority received ICIs in the second- (46%) or third-line (21%) setting. High-risk patients had significantly shorter overall survival (OS; hazard ratio [HR], 6.72; p < .001), progression-free survival (HR, 5.82; p < .001), and lower chance of clinical benefit (odds ratio [OR], 0.02; p = .003) compared with the low-risk group in MVA. The C-statistics for our body composition risk group and myosteatosis analyses were higher than body mass index for all clinical outcomes. CONCLUSION Body composition variables such as SMI, SM mean, and VFI may be prognostic and predictive of clinical outcomes in ICI-treated patients with UC. Larger, prospective studies are warranted to validate this hypothesis-generating data. IMPLICATIONS FOR PRACTICE This study developed a prognostic body composition risk scoring system using radiographic biomarkers for patients with bladder cancer treated with immunotherapy. The study found that the high-risk patients had significantly worse clinical outcomes. Notably, the study's model was better at predicting outcomes than body mass index. Importantly, these results suggest that radiographic measures of body composition should be considered for inclusion in updated prognostic models for patients with urothelial carcinoma treated with immunotherapy. These findings are useful for practicing oncologists in the academic or community setting, particularly given that baseline imaging is routine for patients starting on treatment with immunotherapy.
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Affiliation(s)
- Dylan J Martini
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie M Shabto
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - T Anders Olsen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sean T Evans
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Benjamin L Magod
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Deepak Ravindranathan
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jacqueline T Brown
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, USA
| | - Jamie M Goldman
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Haydn T Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth E Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Wayne B Harris
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley C Carthon
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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Brown JT, Liu Y, Shabto JM, Martini D, Ravindranathan D, Hitron EE, Russler GA, Caulfield S, Yantorni L, Joshi SS, Kissick H, Ogan K, Nazha B, Carthon BC, Kucuk O, Harris WB, Master VA, Bilen MA. Modified Glasgow Prognostic Score associated with survival in metastatic renal cell carcinoma treated with immune checkpoint inhibitors. J Immunother Cancer 2021; 9:jitc-2021-002851. [PMID: 34326170 PMCID: PMC8323383 DOI: 10.1136/jitc-2021-002851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The modified Glasgow Prognostic Score (mGPS) is a composite biomarker that uses albumin and C reactive protein (CRP). There are multiple immune checkpoint inhibitor (ICI)-based combinations approved for metastatic renal cell carcinoma (mRCC). We investigated the ability of mGPS to predict outcomes in patients with mRCC receiving ICI. METHODS We retrospectively reviewed patients with mRCC treated with ICI as monotherapy or in combination at Winship Cancer Institute between 2015 and 2020. Overall survival (OS) and progression-free survival (PFS) were measured from the start date of ICI until death or clinical/radiographical progression, respectively. The baseline mGPS was defined as a summary score based on pre-ICI values with one point given for CRP>10 mg/L and/or albumin<3.5 g/dL, resulting in possible scores of 0, 1 and 2. If only albumin was low with a normal CRP, no points were awarded. Univariate analysis (UVA) and multivariate analysis (MVA) were carried out using Cox proportional hazard model. Outcomes were also assessed by Kaplan-Meier analysis. RESULTS 156 patients were included with a median follow-up 24.2 months. The median age was 64 years and 78% had clear cell histology. Baseline mGPS was 0 in 36%, 1 in 40% and 2 in 24% of patients. In UVA, a baseline mGPS of 2 was associated with shorter OS (HR 4.29, 95% CI 2.24 to 8.24, p<0.001) and PFS (HR 1.90, 95% CI 1.20 to 3.01, p=0.006) relative to a score of 0; this disparity in outcome based on baseline mGPS persisted in MVA. The respective median OS of patients with baseline mGPS of 0, 1 and 2 was 44.5 (95% CI 27.3 to not evaluable), 15.3 (95% CI 11.0 to 24.2) and 10 (95% CI 4.6 to 17.5) months (p<0.0001). The median PFS of these three cohorts was 6.7 (95% CI 3.6 to 13.1), 4.2 (95% CI 2.9 to 6.2) and 2.6 (95% CI 2.0 to 5.6), respectively (p=0.0216). The discrimination power of baseline mGPS to predict survival outcomes was comparable to the IMDC risk score based on Uno's c-statistic (OS: 0.6312 vs 0.6102, PFS: 0.5752 vs 0.5533). CONCLUSION The mGPS is prognostic in this cohort of patients with mRCC treated with ICI as monotherapy or in combination. These results warrant external and prospective validation.
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Affiliation(s)
- Jacqueline T Brown
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Julie M Shabto
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dylan Martini
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deepak Ravindranathan
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emilie Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Greta Anne Russler
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Pharmaceutical Services, Emory University, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shreyas Subhash Joshi
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Haydn Kissick
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Ogan
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley C Carthon
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wayne B Harris
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA .,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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7
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Martini DJ, Olsen TA, Goyal S, Liu Y, Evans ST, Magod B, Brown JT, Yantorni L, Russler GA, Caulfield S, Goldman JM, Nazha B, Kissick HT, Harris WB, Kucuk O, Carthon BC, Master VA, Bilen MA. Body Composition Variables as Radiographic Biomarkers of Clinical Outcomes in Metastatic Renal Cell Carcinoma Patients Receiving Immune Checkpoint Inhibitors. Front Oncol 2021; 11:707050. [PMID: 34307176 PMCID: PMC8299332 DOI: 10.3389/fonc.2021.707050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). Biomarkers for mRCC patients treated with ICI are limited, and body composition is underutilized in mRCC. We investigated the association between body composition and clinical outcomes in ICI-treated mRCC patients. METHODS We performed a retrospective analysis of 79 ICI-treated mRCC patients at Winship Cancer Institute from 2015-2020. Baseline CT images were collected at mid-L3 and segmented using SliceOMatic v5.0 (TomoVision). Density of skeletal muscle (SM), subcutaneous fat, inter-muscular fat, and visceral fat were measured and converted to indices by dividing by height(m)2 (SMI, SFI, IFI, and VFI, respectively). Total fat index (TFI) was defined as the sum of SFI, IFI, and VFI. Patients were characterized as high versus low for each variable at gender-specific optimal cuts using overall survival (OS) as the primary outcome. A prognostic risk score was created based on the beta coefficient from the multivariable Cox model after best subset variable selection. Body composition risk score was calculated as IFI + 2*SM mean + SFI and patients were classified as poor (0-1), intermediate (2), or favorable risk (3-4). Kaplan-Meier method and Log-rank test were used to estimate OS and PFS and compare the risk groups. Concordance statistics (C-statistics) were used to measure the discriminatory magnitude of the model. RESULTS Most patients were male (73%) and most received ICI as first (35%) or second-line (51%) therapy. The body composition poor-risk patients had significantly shorter OS (HR: 6.37, p<0.001), PFS (HR: 4.19, p<0.001), and lower chance of CB (OR: 0.23, p=0.044) compared to favorable risk patients in multivariable analysis. Patients with low TFI had significantly shorter OS (HR: 2.72, p=0.002), PFS (HR: 1.91, p=0.025), and lower chance of CB (OR: 0.25, p=0.008) compared to high TFI patients in multivariable analysis. The C-statistics were higher for body composition risk groups and TFI (all C-statistics ≥ 0.598) compared to IMDC and BMI. CONCLUSIONS Risk stratification using the body composition variables IFI, SM mean, SFI, and TFI may be prognostic and predictive of clinical outcomes in mRCC patients treated with ICI. Larger, prospective studies are warranted to validate this hypothesis-generating data.
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Affiliation(s)
- Dylan J. Martini
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Massachusetts General Hospital, Department of Medicine, Boston, MA, United States
| | - T. Anders Olsen
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Subir Goyal
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Sean T. Evans
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin Magod
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Northwestern University, Department of Medicine, Chicago, IL, United States
| | - Jacqueline T. Brown
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
| | - Greta Anne Russler
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamie M. Goldman
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Haydn T. Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Wayne B. Harris
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Bradley C. Carthon
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Department of Hematology and Medical Oncology, Atlanta, GA, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
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8
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Martini DJ, Goyal S, Liu Y, Evans ST, Olsen TA, Case K, Magod BL, Brown JT, Yantorni L, Russler GA, Caulfield S, Goldman JM, Nazha B, Harris WB, Kissick HT, Master VA, Kucuk O, Carthon BC, Bilen MA. Immune-Related Adverse Events as Clinical Biomarkers in Patients with Metastatic Renal Cell Carcinoma Treated with Immune Checkpoint Inhibitors. Oncologist 2021; 26:e1742-e1750. [PMID: 34156726 DOI: 10.1002/onco.13868] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/09/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are an important treatment for metastatic renal cell carcinoma (mRCC). These agents may cause immune-related adverse events (irAEs), and the relationship between irAEs and outcomes is poorly understood. We investigated the association between irAEs and clinical outcomes in patients with mRCC treated with ICIs. METHODS We performed a retrospective study of 200 patients with mRCC treated with ICIs at Winship Cancer Institute from 2015 to 2020. Data on irAEs were collected from clinic notes and laboratory values and grades were determined using Common Terminology Criteria in Adverse Events version 5.0. The association with overall survival (OS) and progression-free survival (PFS) was modeled by Cox proportional hazards model. Logistic regression models were used to define odds ratios (ORs) for clinical benefit (CB). Landmark analysis and extended Cox models were used to mitigate lead-time bias by treating irAEs as a time-varying covariate. RESULTS Most patients (71.0%) were male, and one-third of patients (33.0%) experienced at least one irAE, most commonly involving the endocrine glands (13.0%), gastrointestinal tract (10.5%), or skin (10.0%). Patients who experienced irAEs had significantly longer OS (hazard ratio [HR], 0.52; p = .013), higher chance of CB (OR, 2.10; p = .023) and showed a trend toward longer PFS (HR, 0.71; p = .065) in multivariate analysis. Patients who had endocrine irAEs, particularly thyroid irAEs, had significantly longer OS and PFS and higher chance of CB. In a 14-week landmark analysis, irAEs were significantly associated with prolonged OS (p = .045). Patients who experienced irAEs had significantly longer median OS (44.5 vs. 18.2 months, p = .005) and PFS (7.5 vs. 3.6 months, p = .003) without landmark compared with patients who did not. CONCLUSION We found that patients with mRCC treated with ICIs who experienced irAEs, particularly thyroid irAEs, had significantly improved clinical outcomes compared with patients who did not have irAEs. This suggests that irAEs may be effective clinical biomarkers in patients with mRCC treated with ICIs. Future prospective studies are warranted to validate these findings. IMPLICATIONS FOR PRACTICE This study found that early onset immune-related adverse events (irAEs) are associated with significantly improved clinical outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICIs). In this site-specific irAE analysis, endocrine irAEs, particularly thyroid irAEs, were significantly associated with improved clinical outcomes. These results have implications for practicing medical oncologists given the increasing use of ICIs for the treatment of mRCC. Importantly, these results suggest that early irAEs and thyroid irAEs at any time on treatment with ICIs may be clinical biomarkers of clinical outcomes in patients with mRCC treated with ICIs.
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Affiliation(s)
- Dylan J Martini
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Sean T Evans
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - T Anders Olsen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Case
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Benjamin L Magod
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jacqueline T Brown
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jamie M Goldman
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bassel Nazha
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wayne B Harris
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Haydn T Kissick
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley C Carthon
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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9
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Olsen TA, Martini DJ, Goyal S, Liu Y, Evans ST, Magod B, Brown JT, Yantorni L, Russler GA, Caulfield S, Goldman JM, Harris WB, Kucuk O, Carthon BC, Master VA, Nazha B, Bilen MA. Racial Differences in Clinical Outcomes for Metastatic Renal Cell Carcinoma Patients Treated With Immune-Checkpoint Blockade. Front Oncol 2021; 11:701345. [PMID: 34222024 PMCID: PMC8242950 DOI: 10.3389/fonc.2021.701345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immune-checkpoint-inhibitors (ICIs) have become the cornerstone of metastatic renal-cell-carcinoma (mRCC) therapy. However, data are limited regarding clinical outcomes by race. In this study, we compared the real-world outcomes between African American (AA) and Caucasian mRCC patients treated with ICIs. METHODS We performed a retrospective study of 198 patients with mRCC who received ICI at the Emory Winship Cancer Institute from 2015-2020. Clinical outcomes were measured by overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) defined as a complete or partial response maintained for at least 6 months per response evaluation criteria in solid tumors version 1.1. Univariate and multivariable analyses were carried out for OS and PFS by Cox proportional-hazard model and ORR by logistical-regression model. Descriptive statistics compared rates of immune-related adverse events (irAEs) and non-clear-cell-RCC (nccRCC) histology were assessed using Chi-square test. RESULTS Our cohort was comprised of 38 AA and 160 Caucasian patients. Most were diagnosed with clear-cell-RCC (ccRCC) (78%) and more than half received (57%) PD-1/PD-L1 monotherapy. Most patients were intermediate or poor-risk groups (83%). Comparing to Caucasians, our AA cohort contained more females and nccRCC cases. Kaplan-Meier method showed AAs had no statistically different median OS (17 vs 25 months, p=0.368) and PFS (3.1 vs 4.4 months, p=0.068) relative to Caucasian patients. On multivariable analysis, AA patients had significantly shorter PFS (HR=1.52, 95% CI: 1.01-2.3, p=0.045), similar ORR (OR=1.04, 95% CI: 0.42-2.57, p=0.936) and comparable OS (HR=1.09, 95% CI: 0.61-1.95, p=0.778) relative to Caucasians. CONCLUSIONS Our real-world analysis of ICI-treated mRCC patients showed that AAs experienced shorter PFS but similar OS relative to Caucasians. This similarity in survival outcomes is reassuring for the use of ICI amongst real-world patient populations, however, the difference in treatment response is poorly represented in early outcomes data from clinical trials. Thus, the literature requires larger prospective studies to validate these findings.
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Affiliation(s)
- T. Anders Olsen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Dylan J. Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Subir Goyal
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, United States
| | - Sean T. Evans
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Benjamin Magod
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Jacqueline T. Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Greta Anne Russler
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Sarah Caulfield
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pharmaceutical Services, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamie M. Goldman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Wayne B. Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
- Winship Cancer Institute of Emory University, Atlanta, GA, United States
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10
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Smith KER, Brown JT, Wan L, Liu Y, Russler G, Yantorni L, Caulfield S, Lafollette J, Moore M, Kucuk O, Carthon B, Nazha B, Bilen MA. Clinical Outcomes and Racial Disparities in Metastatic Hormone-Sensitive Prostate Cancer in the Era of Novel Treatment Options. Oncologist 2021; 26:956-964. [PMID: 34096667 DOI: 10.1002/onco.13848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/31/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Docetaxel (DOC) and abiraterone (ABI) in the upfront setting have separately improved clinical outcomes for metastatic hormone-sensitive prostate cancer (mHSPC), but there are no studies comparing drug efficacies or the influence of racial disparities. MATERIALS AND METHODS We performed a retrospective multicenter review from Winship Cancer Institute at Emory University and Georgia Cancer Center for Excellence at Grady Memorial Hospital (2014-2020) for patients with mHSPC treated with either upfront DOC or ABI. Outcomes evaluated were overall survival (OS), progression-free survival (PFS), and prostate-specific antigen complete response (PSA CR). RESULTS A total of 168 patients were included, consisting of 92 (54.8%) Black patients and 76 (45.2%) non-Black patients (69 White and 7 Asian or Hispanic). Ninety-four (56%) received DOC and 74 (44%) received ABI. Median follow-up time was 22.8 months with data last reviewed June 2020. For OS, there was no significant difference between ABI versus DOC and Black versus non-Black patients. For PFS, DOC was associated with hazard ratio (HR) 1.7 compared with ABI for all patients based on univariate association and HR 2.27 compared with ABI for Black patients on multivariable analysis. For PSA CR, Black patients were less likely to have a CR (odds ratio [OR] = 0.27). CONCLUSION ABI and DOC have similar OS with a trend toward better PFS for ABI in a cohort composed of 54% Black patients. Racial disparities were observed as prolonged PFS for Black patients treated with ABI, more so compared with all patients, and less PSA CR for Black patients. A prospective trial comparing available upfront therapies in a diverse racial population is needed to help guide clinical decision-making in the era of novel treatment options. IMPLICATIONS FOR PRACTICE Overall survival is similar for abiraterone and docetaxel when used as upfront therapy in metastatic hormone-sensitive prostate cancer in a cohort composed of 54% Black patients. There is a trend towards improved progression-free survival for abiraterone in all patients and Black patients. Non-Black patients were more likely to achieve prostate-specific antigen (PSA) complete response regardless of upfront therapy.
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Affiliation(s)
| | - Jacqueline Theresa Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Limeng Wan
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
| | - Greta Russler
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Jennifer Lafollette
- Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Melvin Moore
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bradley Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Grady Cancer Center for Excellence, Grady Memorial Hospital, Atlanta, Georgia, USA
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11
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Martini DJ, Kline MR, Liu Y, Shabto JM, Carthon BC, Russler GA, Yantorni L, Hitron EE, Caulfield S, Goldman JM, Harris WB, Kucuk O, Master VA, Bilen MA. Novel risk scoring system for metastatic renal cell carcinoma patients treated with cabozantinib. Cancer Treat Res Commun 2021; 28:100393. [PMID: 34029879 PMCID: PMC8405548 DOI: 10.1016/j.ctarc.2021.100393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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: 03/29/2021] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cabozantinib is an effective treatment for metastatic renal cell carcinoma (mRCC). The international mRCC database consortium (IMDC) criteria is the gold standard for risk stratification in mRCC. We created a risk scoring system specific for mRCC patients treated with cabozantinib. METHODS We conducted a retrospective review of 87 patients with mRCC treated with cabozantinib at Winship Cancer Institute from 2015 to 2019. Overall survival (OS) and progression free survival (PFS) were used to measure clinical outcomes. Upon variable selection in multivariable analysis (MVA), elevated baseline monocyte-to-lymphocyte ratio (MLR), sarcomatoid histologic component, ECOG PS > 1, and absence of bone metastases were each assigned 1 point. A three-group risk scoring system was then created: low (score=0-1), intermediate (score=2), and high risk (score=3-4). The Cox proportional hazard model and Kaplan-Meier method were used for survival analyses. RESULTS The median age was 62 years-old and the majority were males (71%) with clear-cell RCC (75%). Most (67%) received at least 1 prior line of systemic therapy. High risk and intermediate risk pts had significantly shorter OS (high risk HR: 13.84, p<0.001; intermediate risk HR: 3.50, p = 0.004) and PFS (high risk HR: 7.31, p<0.001; intermediate risk HR: 1.87, p = 0.053) compared to low risk patients in MVA. CONCLUSIONS RCC patients treated with cabozantinib may benefit from specific risk stratification criteria using RCC histology, ECOG PS, sites of metastatic disease, and MLR. These variables are easily accessible in the clinical setting and may be helpful to determine which mRCC patients may benefit from treatment with cabozantinib.
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Affiliation(s)
- Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Meredith R Kline
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Julie M Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Lauren Yantorni
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | | | - Sarah Caulfield
- Winship Cancer Institute of Emory University, Atlanta, GA, USA; Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jamie M Goldman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Wayne B Harris
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Omer Kucuk
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA; Winship Cancer Institute of Emory University, Atlanta, GA, USA.
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12
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Ravindranathan D, Russler GA, Yantorni L, Drusbosky LM, Bilen MA. Detection of Microsatellite Instability via Circulating Tumor DNA and Response to Immunotherapy in Metastatic Castration-Resistant Prostate Cancer: A Case Series. Case Rep Oncol 2021; 14:190-196. [PMID: 33776702 PMCID: PMC7983538 DOI: 10.1159/000512819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Pembrolizumab has been approved by the US Food and Drug Administration for the treatment of metastatic or unresectable solid tumors that are microsatellite instability-high (MSI-H) or mismatch repair deficient. Blood-based circulating tumor DNA (ctDNA) assays have been validated to identify tumors with MSI-H status without the need for tissue biopsy. We report 2 patients with metastatic castration-resistant prostate cancer (mCRPC) who had prior treatment with multiple lines of therapy and underwent ctDNA testing, which detected MSI-H status. Both patients were treated with pembrolizumab, resulting in an excellent clinical response measured with liquid biopsies before and after initiation of therapy, which demonstrated a significant reduction in somatic-variant allele frequency in addition to a decrease in prostate serum antigen levels.
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Affiliation(s)
- Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Greta Anne Russler
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Lauren Yantorni
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | | | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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