1
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Jardim DL, Gonçalves E Silva A, Pompeo ASFL, Sarkis AS, Cardoso APG, Sasse AD, Fay AP, Soares A, Pompeo ACL, Carneiro A, Kann AG, Fogassa C, De Freitas CH, Chade DC, Herchenhorn D, De Almeida DVP, Da Rosa DAR, Wiermann EG, Schutz FAB, Kater FR, De Moura F, Korkes F, Meyer F, De Oliveira FNG, Sabino F, Almeida GL, Avanço G, Guimaraes GC, Lemos GC, Carvalhal GF, Kim H, Morbeck IP, Campagnari JC, Rinck JA, Da Ponte JRT, Da Trindade KM, Atem L, Borges L, Nogueira LM, Batista LTEA, Maia MC, Sadi MV, Rocha MAA, Luz MDA, Smaletz O, Lages PSM, Matuda RMK, Reis RBD, Indio RF, Fernandes RDC, Cavallero SR, Souza VC, Busato W, Alfer W, Maluf F. "Non-metastatic, Castration-resistant Prostate Cancer: Diagnostic and Treatment Recommendations by an Expert Panel from Brazil". Clin Genitourin Cancer 2023; 21:e58-e69. [PMID: 36266221 DOI: 10.1016/j.clgc.2022.09.005] [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: 05/09/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC. METHODS A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented. RESULTS Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer. DISCUSSION Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings.
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Affiliation(s)
- Denis L Jardim
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil
| | | | - Alexandre Saad Fere Lima Pompeo
- Hospital Beneficência Portuguesa, Departamento de Uro-Oncologia, São Paulo, SP, Brasil; Grupo de Uro-Oncologia do Hcor, São Paulo, SP, Brasil
| | - Alvaro Sadek Sarkis
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil; Grupo Oncoclínicas, São Paulo, SP, Brasil; Latin American Cooperative Oncology Group (LACOG), Genitourinary Group
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Camilla Fogassa
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | - Daher Cezar Chade
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da USP, São Paulo, SP, Brasil
| | - Daniel Herchenhorn
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Fabio Roberto Kater
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando De Moura
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Fernando Korkes
- Grupo de uro-oncologia da Faculdade de Medicina do ABC, Santo André, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Meyer
- Sociedade Brasileira de Urologia, Curitiba, PR, Brasil; Hospital Universitário Cajuru, Curitiba, PR, Brasil; Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, PR, Brasil
| | - Fernando Nunes Galvao De Oliveira
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Clínica de Oncologia do Grupo CAM (CLION), Salvador, BA, Brasil
| | - Fernando Sabino
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Santa Lúcia, Brasília, DF, Brasil; Hospital Universitário de Brasília, Brasília, DF, Brasil
| | | | | | | | | | - Gustavo Franco Carvalhal
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil; Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Hanna Kim
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil
| | - Igor Protzner Morbeck
- Hospital Sírio Libanês, Sociedade Beneficente de Senhoras, São Paulo, SP, Brasil; Universidade Católica de Brasília, Brasília, DF, Brasil
| | - Joao Carlos Campagnari
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Clínica de Urologia e Nefrologia, São Paulo, SP, Brasil
| | | | | | - Karine Martins Da Trindade
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Rede D'Or, Fortaleza, CE, Brasil
| | | | - Leonardo Borges
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Lucas Mendes Nogueira
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | | | - Manuel Caitano Maia
- Latin American Cooperative Oncology Group (LACOG), Genitourinary Group; Hospital Porto Dias, Department of Medical Oncology, Belém, Pará, Brasil
| | | | | | - Murilo De Almeida Luz
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Erasto Gaertner, Curitiba, PR, Brasil
| | - Oren Smaletz
- Hospital Israelita Albert Einstein, Departamento de Oncologia, São Paulo, SP, Brasil
| | | | | | | | | | - Roni De Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; Irmandade da Santa Casa de Misericórdia de São Paulo - Hospital Central, São Paulo, SP, Brasil
| | - Sandro Roberto Cavallero
- Centro de Tratamento Oncológico (CTO), Belém, PA, Brasil; Hospital Adventista de Belém (HAB), Belém, PA, Brasil
| | - Vinicius Carrera Souza
- Instituto D'Or de Ensino e Pesquisa, Salvador, BA, Brasil; Rede D'Or, Salvador, BA, Brasil
| | - Wilson Busato
- Universidade do Vale do Itajai (UNIVALI), Itajai, SC, Brasil
| | - Wladimir Alfer
- Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil
| | - Fernando Maluf
- Hospital Beneficência Portuguesa, Departamento de Oncologia, São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, Departamento de Urologia, São Paulo, SP, Brasil.
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Maluf FC, Pereira FMT, Silva AG, Dettino ALA, Cardoso APG, Sasse AS, Soares A, Kann AG, Herchenhorn D, Jardim DLF, Cortés DEL, Kater FR, Morbeck IAP, Reolon JFN, Rinck JA, Zarbá JJ, Sade JP, da Trindade KM, Costa LAGA, Dos Santos LV, Maia MC, Siqueira MB, Gillessen S. Consensus on the Treatment and Follow-Up for Metastatic Castration-Resistant Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC). JCO Glob Oncol 2021; 7:559-571. [PMID: 33856891 PMCID: PMC8162971 DOI: 10.1200/go.20.00511] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries. METHODS A total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered. RESULTS Most of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy. CONCLUSION There was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.
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Affiliation(s)
- Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | | | - Adriano Gonçalves Silva
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Oncologia Clínica ICTr, Curitiba, Brazil
| | | | - Ana Paula Garcia Cardoso
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - André Seeke Sasse
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo Sonhe, Campinas, Brazil
| | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Centro Paulista de Oncologia, Oncoclínicas, São Paulo, Brazil
| | - Ariel Galapo Kann
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Daniel Herchenhorn
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil.,Instituto D'Or de ensino e pesquisa, Rio de Janeiro, Brazil
| | | | | | - Fábio Roberto Kater
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - Igor A Protzner Morbeck
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital Sírio Libanês, Brasília, Brazil.,Universidade Católica de Brasília, Brasília, Brazil
| | - João Francisco Navarro Reolon
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre, Brazil
| | - José Augusto Rinck
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Hospital AC Camargo, São Paulo, Brazil
| | - Juan Jose Zarbá
- Hospital Zenon Santillán, Nacional University of Tucumán, Tucumán, Argentina
| | - Juan Pablo Sade
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Instituto Alexander Fleming y de la Universidad Austral, Buenos Aires, Argentina
| | - Karine Martins da Trindade
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,IEP-Instituto de Ensino e Pesquisa Oncocentro, Fortaleza, Brazil
| | - Leonardo Atem G A Costa
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil
| | | | - Manuel Caitano Maia
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Centro de Oncologia do Paraná, Curitiba, Brazil
| | - Mariana Bruno Siqueira
- Latin American Oncology Group (LACOG), Porto Alegre, Brazil.,Grupo de oncologia D'Or, Rio de Janeiro, Brazil
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona and Università della Svizzera Italiana, Lugano, Switzerland.,Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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Salgia NJ, Bergerot PG, Maia MC, Dizman N, Hsu J, Gillece JD, Folkerts M, Reining L, Trent J, Highlander SK, Pal SK. Stool Microbiome Profiling of Patients with Metastatic Renal Cell Carcinoma Receiving Anti-PD-1 Immune Checkpoint Inhibitors. Eur Urol 2020; 78:498-502. [PMID: 32828600 DOI: 10.1016/j.eururo.2020.07.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [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: 03/30/2020] [Accepted: 07/11/2020] [Indexed: 12/16/2022]
Abstract
Preclinical models and early clinical data suggest an interplay between the gut microbiome and response to immunotherapy in solid tumors including metastatic renal cell carcinoma (mRCC). We sought to characterize the stool microbiome of mRCC patients receiving a checkpoint inhibitor (CPI) and to assess treatment-related changes in microbiome composition over the course of CPI therapy. Stool was collected from 31 patients before initiation of nivolumab (77%) or nivolumab plus ipilimumab (23%) therapy, of whom 58% experienced clinical benefit. Greater microbial diversity was associated with clinical benefit from CPI therapy (p = 0.001), and multiple species were associated with clinical benefit or lack thereof. Temporal profiling of the microbiome indicated that the relative abundance of Akkermansia muciniphila increased in patients deriving clinical benefit from CPIs. This study substantiates results from previous CPI-related microbiome profiling studies in mRCC. Temporal changes in microbiome composition suggest potential utility in modulating the microbiome for more successful CPI outcomes. PATIENT SUMMARY: We compared the composition and diversity of the gut microbiome in patients receiving immunotherapy for renal cell carcinoma. We found that higher microbial diversity is associated with better treatment outcomes. Treatment response is characterized by changes in microbial species over the course of treatment.
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Affiliation(s)
- Nicholas J Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Paulo G Bergerot
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Nazli Dizman
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - JoAnn Hsu
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - John D Gillece
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, AZ, USA
| | - Megan Folkerts
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, AZ, USA
| | - Lauren Reining
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, AZ, USA
| | - Jeffrey Trent
- Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Sarah K Highlander
- Pathogen and Microbiome Division, Translational Genomics Research Institute North, Flagstaff, AZ, USA.
| | - Sumanta K Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Soares A, Monteiro FSM, Maluf FC, Bastos DA, Jardim DL, Sasse AD, Gonçalves E Silva A, Fay AP, da Rosa DAR, Wierman E, Kater F, Schutz FA, de Oliveira FNG, Morbeck IAP, Rinck JA, da Trindade KM, Maia MC, Souza VC, da Silva Neto DCV, de Almeida E Paula F, Korkes F, Carvalhal GF, Nogueira L, de Carvalho Fernandes R, Dos Reis RB, Matheus WE, Busato WFS, da Costa WH, de Cássio Zequi S. Advanced renal cell carcinoma (RCC) management: an expert panel recommendation from the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG). J Cancer Res Clin Oncol 2020; 146:1829-1845. [PMID: 32410064 PMCID: PMC7256074 DOI: 10.1007/s00432-020-03236-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The outcome of RCC has improved considerably in the last few years, and the treatment options have increased. LACOG-GU and LARCG held a consensus meeting to develop guidelines to support the clinical decisions of physicians and other health professionals involved in the care of RCC patients. METHODS Eighty questions addressing relevant advanced RCC treatments were previously formulated by a panel of experts. The voting panel comprised 26 specialists from the LACOG-GU/LARCG. Consensus was determined as 75% agreement. For questions with less than 75% agreement, a new discussion was held, and consensus was determined by the majority of votes after the second voting session. RESULTS The recommendations were based on the highest level of scientific evidence or by the opinion of the RCC experts when no relevant research data were available. CONCLUSION This manuscript provides guidance for advanced RCC treatment according to the LACOG-GU/LARCG expert recommendations.
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Affiliation(s)
- Andrey Soares
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Morumbi, São Paulo, SP, 05652-900, Brazil.
- Centro Paulista de Oncologia/Oncoclínicas, Av. Brigadeiro Faria Lima, 4300-Vila Olímpia, São Paulo, SP, 01452-000, Brazil.
| | - Fernando Sabino Marques Monteiro
- Hospital Santa Lúcia, SHLS 716 Conjunto C, Brasília, DF, 70390-700, Brazil
- Hospital Universitário de Brasília, SGAN 605, Brasília, DF, 70840-901, Brazil
| | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Morumbi, São Paulo, SP, 05652-900, Brazil
- Hospital Santa Lúcia, SHLS 716 Conjunto C, Brasília, DF, 70390-700, Brazil
- Beneficência Portuguesa de São Paulo, R. Martiniano de Carvalho, 965-Bela Vista, São Paulo, SP, 01323-001, Brazil
| | - Diogo Assed Bastos
- Hospital Sírio-Libanês, R. Dona Adma Jafet, 91-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Denis Leonardo Jardim
- Hospital Sírio-Libanês, R. Dona Adma Jafet, 91-Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - André Deeke Sasse
- Grupo SOnHE, Av. Dr. Heitor Penteado, 1780-Taquaral, Campinas, SP, 13075-460, Brazil
| | - Adriano Gonçalves E Silva
- Instituto do Câncer e Transplante de Curitiba (ICTR), R. Myltho Anselmo da Silva, 870-Mercês, Curitiba, PR, 80510-130, Brazil
| | - André P Fay
- Escola de Medicina e Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6690-Prédio 60-Partenon, Porto Alegre, RS, 90610-000, Brazil
- Grupo Oncoclínicas, R. Tobias da Silva, 126-Moinhos do Vento, Porto Alegre, RS, 90570-020, Brazil
| | | | - Evanius Wierman
- Instituto de Oncologia do Paraná, R. Mateus Leme, 2631/B-Centro Cívico, Curitiba, PR, 80520-174, Brazil
| | - Fabio Kater
- Beneficência Portuguesa de São Paulo, R. Martiniano de Carvalho, 965-Bela Vista, São Paulo, SP, 01323-001, Brazil
| | - Fabio A Schutz
- Beneficência Portuguesa de São Paulo, R. Martiniano de Carvalho, 965-Bela Vista, São Paulo, SP, 01323-001, Brazil
| | | | | | - José Augusto Rinck
- AC Camargo Cancer Center, R. Professor Antônio Prudente, 211-Liberdade, São Paulo, SP, 01509-010, Brazil
| | - Karine Martins da Trindade
- Hospital São Carlos/Oncocentro, Av. Pontes Vieira, 2531-Dionísio Torres, Fortaleza, CE, 60135-237, Brazil
- Santa Casa de Misericórdia de Fortaleza, R. Barão do Rio Branco, s/n-Centro, Fortaleza, CE, 60025-060, Brazil
| | - Manuel Caitano Maia
- Centro de Oncologia do Paraná, Rodovia BR-277, 1437-Ecoville, Curitiba, PR, 82305-100, Brazil
| | - Vinicius Carrera Souza
- Oncologia D'Or., Av. São Rafael, 2152, 6 Andar, Hospital São Rafael, São Marcos, Salvador, BA, 41253-190, Brazil
| | | | - Felipe de Almeida E Paula
- Hospital Regional do Câncer de Presidente Prudente, Av. Coronel José Soares Marcondes, 2380-Vila Euclides, Presidente Prudente, SP, 19013-050, Brazil
| | - Fernando Korkes
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627-Morumbi, São Paulo, SP, 05652-900, Brazil
- ABC Medical School, Av. Príncipe de Gales, 821-Príncipe de Gales, Santo André, SP, 09060-650, Brazil
| | - Gustavo Franco Carvalhal
- Escola de Medicina e Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6690-Prédio 60-Partenon, Porto Alegre, RS, 90610-000, Brazil
| | - Lucas Nogueira
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110-Santa Efigência, Belo Horizonte, BH, 30130-100, Brazil
| | - Roni de Carvalho Fernandes
- Hospital Central da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112-Vila Buarque, São Paulo, SP, 01221-020, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, R. Dr. Cesário Mota Jr., 61-Vila Buarque, São Paulo, SP, 01221-020, Brazil
| | - Rodolfo Borges Dos Reis
- Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo, Av. Bandeirantes, 3900-Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Wagner Eduardo Matheus
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, R. Tessália Vieira de Camargo, 126-Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-887, Brazil
| | | | - Walter Henriques da Costa
- AC Camargo Cancer Center, R. Professor Antônio Prudente, 211-Liberdade, São Paulo, SP, 01509-010, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, R. Dr. Cesário Mota Jr., 61-Vila Buarque, São Paulo, SP, 01221-020, Brazil
- National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211-Liberdade, São Paulo, SP, 01509-010, Brazil
| | - Stênio de Cássio Zequi
- AC Camargo Cancer Center, R. Professor Antônio Prudente, 211-Liberdade, São Paulo, SP, 01509-010, Brazil
- National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, AC Camargo Cancer Center, R. Professor Antônio Prudente, 211-Liberdade, São Paulo, SP, 01509-010, Brazil
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Maia MC, Salgia M, Pal SK. Harnessing cell-free DNA: plasma circulating tumour DNA for liquid biopsy in genitourinary cancers. Nat Rev Urol 2020; 17:271-291. [PMID: 32203306 DOI: 10.1038/s41585-020-0297-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/11/2022]
Abstract
In the era of precision oncology, liquid biopsy techniques, especially the use of plasma circulating tumour DNA (ctDNA) analysis, represent a paradigm shift in the use of genomic biomarkers with considerable implications for clinical practice. Compared with tissue-based tumour DNA analysis, plasma ctDNA is more convenient to test, more readily accessible, faster to obtain and less invasive, minimizing procedure-related risks and offering the opportunity to perform serial monitoring. Additionally, genomic profiles of ctDNA have been shown to reflect tumour heterogeneity, which has important implications for the identification of resistant clones and selection of targeted therapy well before clinical and radiographic changes occur. Moreover, plasma ctDNA testing can also be applied to cancer screening, risk stratification and quantification of minimal residual disease. These features provide an unprecedented opportunity for early treatment of patients, improving the chances of treatment success.
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Affiliation(s)
- Manuel Caitano Maia
- Department of Medical Oncology, Centro de Oncologia do Paraná, Curitiba, PR, Brazil. .,Latin American Cooperative Oncology Group, Genitourinary Group, Porto Alegre, Brazil.
| | - Meghan Salgia
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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de Cássio Zequi S, da Costa WH, Korkes F, dos Reis RB, Busato WFS, Matheus WE, da Silva Neto DCV, de Almeida e Paula F, Carvalhal GF, Nogueira L, de Carvalho Fernandes R, Silva AGE, Sasse AD, Fay AP, Jardim DL, Bastos DA, da Rosa DAR, Wierman E, Kater F, Schutz FA, Maluf FC, de Oliveira FNG, Morbeck IAP, Rinck JA, da Trindade KM, Maia MC, Souza VC, Monteiro FSM, Soares A. Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery. Ther Adv Urol 2019; 11:1756287219872324. [PMID: 31523281 PMCID: PMC6734614 DOI: 10.1177/1756287219872324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Renal cell cancer (RCC) is one of the 10 most common cancers in the world,
and its incidence is increasing, whereas mortality is declining only in
developed countries. Therefore, two collaborative groups, The Latin American
Oncology Cooperative Group-Genitourinary Section (LACOG-GU) and the Latin
American Renal Cancer Group (LARCG), held a consensus meeting to develop
this guideline. Methods: Issues (134) related to the treatment of RCC were previously formulated by a
panel of experts. The voting panel comprised 26 specialists (urologists and
medical oncologists) from the LACOG-GU/LARCG. A consensus was reached if 75%
agreement was achieved. If there was less concordance, a new discussion was
undertaken, and a consensus was determined by the most votes after a second
voting session. Results: The expert meeting provided recommendations that were in line with the global
literature; 75.0% of the recommendations made by the panel of experts were
evidence-based level A, 22.5% of the recommendations were level B, and 2.5%
of the recommendations were level D. Conclusions: This review suggests recommendations for the surgical treatment of RCC
according to the LACOG-GU/LARCG experts.
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Affiliation(s)
| | | | - Fernando Korkes
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- ABC Medical School, Santo André, Brazil
| | | | | | | | | | | | - Gustavo Franco Carvalhal
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
| | - Lucas Nogueira
- Hospital das Clínicas da Universidade Federal
de Minas Gerais, Belo Horizonte, Brazil
| | - Roni de Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de
São Paulo, Brazil
- Hospital Central da Santa Casa de Misericórdia
de São Paulo, Brazil
| | | | | | - André P. Fay
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
- Grupo Oncoclínicas, Porto Alegre, Brazil
| | | | | | | | | | - Fabio Kater
- Beneficência Portuguesa de São Paulo,
Brazil
| | | | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Beneficência Portuguesa de São Paulo,
Brazil
- Hospital Santa Lúcia, Brasilia, Brazil
| | | | | | | | - Karine Martins da Trindade
- Hospital São Carlos/Oncocentro, Fortaleza,
Brazil
- Santa Casa de Misericórdia de Fortaleza,
Fortaleza, Brazil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Centro Paulista de Oncologia, São Paulo,
Brazil
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7
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Maia MC, Hansen A, Alves C, Salah S. Biomarkers in Non-Schistosomiasis-related squamous cell carcinoma of the urinary bladder: A review. Crit Rev Oncol Hematol 2019; 135:76-84. [DOI: 10.1016/j.critrevonc.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 10/04/2018] [Accepted: 01/17/2019] [Indexed: 01/23/2023] Open
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8
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Maia MC, Pereira AAL, Lage LV, Fraile NM, Vaisberg VV, Kudo G, Barroso-Sousa R, Bastos DA, Dzik C. Efficacy and Safety of Docetaxel in Elderly Patients With Metastatic Castration-Resistant Prostate Cancer. J Glob Oncol 2018; 4:1-9. [PMID: 30241182 PMCID: PMC6180794 DOI: 10.1200/jgo.2016.007807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/15/2022] Open
Abstract
Purpose Limited data are available about the tolerability and clinical outcomes of
elderly patients with metastatic castration-resistant prostate cancer
(mCRPC) who are treated with docetaxel. We evaluated the efficacy and safety
of docetaxel as first-line chemotherapy for patients with mCRPC who were
treated in our institution. Materials and Methods We retrospectively identified patients with mCRPC and a Karnosfky performance
status of 60% or greater treated with docetaxel on any schedule as
first-line chemotherapy between 2008 and 2013. The primary end point was a
comparison of median overall survival (OS) according to age in this
population. Secondary end points were comparisons of the rates of severe
toxicities, prostate-specific antigen (PSA) decline of 50% or greater, and
time to progression (TTP). Results were stratified by three age groups:
younger than 65 years, 65 to 74 years, and 75 years or older. Results Among the 197 patients included, 68 (34%) were younger than 65 years, 85
(43%) were 65 to 74 years, and 44 (22%) were 75 years or older. The mean
number of comorbidities was not different among groups (1.19
v 1.32 v 1.43; P =
.54). Patients younger than 65 years received a higher cumulative dose of
docetaxel (450 mg/m2v 382 mg/m2v 300 mg/m2; P = .004). The
rates of PSA decline of 50% or greater (41% v 47%
v 36.4%; P = .51) and the median TTP
(5.13 v 5.13 v 4.7 months;
P = .15) were comparable among all groups. The median
OS was longer in the group of patients younger than age 65 years (19.6
v 12.4 v 12.3 months;
P = .012). Rates of any grade 3 or higher adverse event
were not different among groups (63.2% v 71.8%
v 54.5%; P = .14). Conclusion Administration of docetaxel in elderly patients who had good performance
status was well tolerated. Rates of PSA decline and TTP were similar to
those of younger patients, but median survival was lower.
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Affiliation(s)
| | | | | | | | | | - Guilherme Kudo
- All authors: Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Carlos Dzik
- All authors: Universidade de São Paulo, São Paulo, Brazil
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9
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Bergerot PG, Bergerot CD, Dizman N, Zequi S, Fay A, Dara Y, Maia MC, Cotta BN, Gonçalves EP, Formiga MN, Tariki MS, Clavijo DA, Choueiri TK, Lopes G, Pal SK. Assessment of Treatment Patterns for Metastatic Renal Cell Carcinoma in Brazil. J Glob Oncol 2017; 4:1-8. [PMID: 29281478 PMCID: PMC6180782 DOI: 10.1200/jgo.17.00113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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
Background Although multiple therapies have emerged for the treatment of metastatic
renal cell carcinoma (mRCC), it is unclear whether application of these
agents is consistent in developed and developing countries. We sought to
determine patterns of care for mRCC in Brazil as a representative developing
country. Material and Methods A commercial database was used to acquire information pertaining to patients
with mRCC receiving treatment at private or public hospitals in Brazil
between March 2013 and October 2016. Basic clinical and demographic criteria
were available, as well as information to ascertain the International
Metastatic Renal Cell Carcinoma Database Consortium risk. Treatment-related
data across multiple lines of therapy were collected. Results Of 4,379 patients assessed, 3,990 (91%) had metastatic disease, and 26%, 48%,
and 26% of patients had good, intermediate, and poor International
Metastatic Renal Cell Carcinoma Database Consortium risk disease,
respectively. Although 3,149 patients (79%) received first-line therapy,
only 641 (20%) and 152 (5%) received second- and third-line therapy,
respectively. In the first-line setting, vascular endothelial growth
factor–directed agents represented the most commonly used therapy,
whereas in the second-line setting, vascular endothelial growth
factor– and mammalian target of rapamycin–directed agents were
used with similar frequency. Marked differences were seen in receipt of
systemic therapy on the basis of treatment in private or public
hospitals. Conclusion Relative to developed countries, marked attrition is noted between each
subsequent line of therapy in Brazil. Patterns of care also vary greatly in
private and public settings, pointing to financial constraints as a
potential cause for discordances in treatment.
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Affiliation(s)
- Paulo G Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Cristiane D Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Nazli Dizman
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Stenio Zequi
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Andre Fay
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Yash Dara
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Manuel Caitano Maia
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Brendan N Cotta
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Edna Prado Gonçalves
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Maria Nirvana Formiga
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Milena Shizue Tariki
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Diego Abreu Clavijo
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Toni K Choueiri
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Gilberto Lopes
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Sumanta K Pal
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
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10
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Abstract
Treatment options for metastatic clear cell renal cell carcinoma (ccRCC) have evolved markedly over the past decade, with multiple targeted therapies approved for the disease. In contrast, little improvement has been made in the management of metastatic non-clear cell RCC (nccRCC). Non-clear cell disease is an umbrella term that encompasses multiple biologically distinct entities, including but not limited to papillary, chromophobe, and sarcomatoid RCC. To date, prospective studies have largely explored treatments for ccRCC (e.g., VEGF- and mTOR-directed therapies) in trials that aggregate non-clear cell histologies. However, the studies do not acknowledge the varying biology of each non-clear cell subtype. Emerging studies in nccRCC should examine individual histologies and apply biologically relevant therapies. An example of this is SWOG 1500, a randomized phase II study that will compare a VEGF-inhibitor to one of three MET-directed therapies in patients with metastatic papillary RCC. Until the biologic diversity of nccRCC is appreciated, outcomes are likely to remain dismal.
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Affiliation(s)
- Tian Zhang
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jun Gong
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Manuel Caitano Maia
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- From the Department of Medical Oncology, Duke Cancer Institute, Durham, NC; Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
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11
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Abstract
The influx of multiple novel therapeutic options in the mRCC field has brought a challenge for treatment sequencing in this disease. In the past few years, cabozantinib, nivolumab and the combination of lenvatinib and everolimus have been approved in the second-line setting. As there is no direct comparison between these agents and the studies have failed to show improved benefit among a biomarker-selected patient population, appropriate patient selection based on clinical factors for individualized therapy is critical. Herein we provide a comprehensive overview of current data from each agent through the discussion of disease biology, clinical trials, potential biomarkers and distilling future perspectives in the field.
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Affiliation(s)
- Manuel Caitano Maia
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Meghan Salgia
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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12
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Maia MC, Bergerot PG, Dizman N, Hsu J, Jones J, Lanman RB, Banks KC, Pal SK. Association of Circulating Tumor DNA (ctDNA) Detection in Metastatic Renal Cell Carcinoma (mRCC) with Tumor Burden. Kidney Cancer 2017; 1:65-70. [PMID: 30334006 PMCID: PMC6179113 DOI: 10.3233/kca-170007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Indexed: 12/12/2022]
Abstract
Background: In a series of 224 patients with advanced renal cell carcinoma (RCC), we have previously reported circulating tumor DNA (ctDNA) detection in 79% of patients. Clinical factors associated with detection are unknown. Methods: Data was obtained from patients with radiographically confirmed stage IV RCC who received ctDNA profiling as a part of routine clinical care using a CLIA-certified platform evaluating 73 genes. Detailed clinical annotation was performed, including assessment of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, previous and current treatments and calculation of tumor burden using scan data most proximal to ctDNA assessment. Tumor burden was equated to the sum of longest diameter (SLD) of all measurable lesions. Results: Thirty-four patients were assessed (18 male and 16 female) with a median age of 62 (range, 34-84). Twenty-six patients, 4 patients and 4 patients had clear cell, sarcomatoid and papillary histologies, respectively. IMDC risk was good, intermediate and poor in 14, 19 and 1 patient, respectively. ctDNA was detected in 18 patients (53%) with a median of 2 genomic alterations (GAs) per patient. No associations were found between IMDC risk, histology or treatment type and presence/absence of ctDNA. However, patients with detectable ctDNA had a higher SLD compared to patients with no detectable ctDNA (8.81 vs 4.49 cm; P = 0.04). Furthermore, when evaluated as a continuous variable, number of GAs was correlated with SLD (P = 0.01). Conclusions: With the caveat of a limited sample size, it appears that SLD (a surrogate for tumor burden) is higher in mRCC patients with detectable ctDNA. Confirmation of these findings in larger series is ongoing and may suggest a capability for ctDNA to either complement or supplant radiographic assessment.
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Affiliation(s)
| | | | - Nazli Dizman
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | - JoAnn Hsu
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jeremy Jones
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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13
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Maia MC, Bergerot PG, Dizman N, Hsu J, Jones J, Choueiri TK, Sonpavde G, Lanman RB, Banks K, Pal SK. Association of circulating tumor DNA (ctDNA) detection in metastatic renal cell carcinoma (mRCC) with tumor burden. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
4582 Background: In a series of 224 pts with advanced RCC, we have previously reported ctDNA detection in 79% of pts (Pal SK et al ASCO GU 2017). Clinical factors associated with detection are unknown. Methods: Data was obtained from pts with radiographically confirmed stage IV RCC who received ctDNA profiling as a part of routine clinical care using a CLIAA-certified platform evaluating 73 genes. Detailed clinical annotation was performed, including assessment of Heng risk score, previous and current treatments and calculation of tumor burden using scan data most proximal to ctDNA assessment. Tumor burden was equated to the sum of longest diameter (SLD) of all measurable lesions. Results: 32 pts were assessed (M:F 19:13) with a median age of 62 (range, 34-84). 25 pts, 4 pts and 3 pts had clear cell, sarcomatoid and papillary histology, respectively. Heng risk was good, intermediate and poor in 13, 18 and 1 pt, respectively. Pts received a median of 2 lines of prior tx. Specifically, 4 pts were not on active therapy (tx), 16 pts were receiving VEGF-directed tx, 6 pts were receiving checkpoint inhibitors (CPIs) and 6 pts were receiving combined VEGF/CPI tx. ctDNA was detected in 16 pts (50%) with a median of 2 genomic alterations (GAs) per pt. No associations were found between Heng risk, histology or tx type and presence/absence of ctDNA. However, pts with detectable ctDNA had a higher SLD compared to pts with no detectable ctDNA (99.6 vs 50.0 mm; P = 0.041). Furthermore, when evaluated as a continuous variable, number of GAs was correlated with SLD (P = 0.023). TP53 and VHL alterations were the most frequent GAs in this series, each occurring in 25% of the cohort. All 3 pts with brain metastases had ctDNA detected. Conclusions: With the caveat of a limited sample size, it appears that SLD (a surrogate for tumor burden) is higher in mRCC pts with detectable ctDNA, and increasing SLD may be associated with a higher number of GAs. Further validation of these findings may help identify appropriate pts for ctDNA assessment and maximize yield in clinical practice.
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Affiliation(s)
| | | | - Nazli Dizman
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | | | - Toni K. Choueiri
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Guru Sonpavde
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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14
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Maia MC, Hansen AR. A comprehensive review of immunotherapies in prostate cancer. Crit Rev Oncol Hematol 2017; 113:292-303. [PMID: 28427519 DOI: 10.1016/j.critrevonc.2017.02.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer is the second most common malignant neoplasm in men worldwide and the fifth cause of cancer-related death. Although multiple new agents have been approved for metastatic castration resistant prostate cancer over the last decade, it is still an incurable disease. New strategies to improve cancer control are needed and agents targeting the immune system have shown encouraging results in many tumor types. Despite being attractive for immunotherapies due to the expression of various tumor associated antigens, the microenvironment in prostate cancer is relatively immunosuppressive and may be responsible for the failures of various agents targeting the immune system in this disease. To date, sipuleucel-T is the only immunotherapy that has shown significant clinical efficacy in this setting, although the high cost and potential trial flaws have precluded its widespread incorporation into clinical practice. Issues with patient selection and trial design may have contributed to the multiple failures of immunotherapy in prostate cancer and provides an opportunity to tailor future studies to evaluate these agents more accurately. We have reviewed all the completed immune therapy trials in prostate cancer and highlight important considerations for the next generation of clinical trials.
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Affiliation(s)
- Manuel Caitano Maia
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Av. Dr Arnaldo, 251, Cerqueira César, CEP 01246-000, São Paulo, Brazil.
| | - Aaron R Hansen
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON, Canada; Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir#3172, Toronto, ON, Canada
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15
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Gong J, Maia MC, Dizman N, Govindarajan A, Pal SK. Metastasis in renal cell carcinoma: Biology and implications for therapy. Asian J Urol 2016; 3:286-292. [PMID: 29264197 PMCID: PMC5730828 DOI: 10.1016/j.ajur.2016.08.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 12/11/2022] Open
Abstract
Although multiple advances have been made in systemic therapy for renal cell carcinoma (RCC), metastatic RCC remains incurable. In the current review, we focus on the underlying biology of RCC and plausible mechanisms of metastasis. We further outline evolving strategies to combat metastasis through adjuvant therapy. Finally, we discuss clinical patterns of metastasis in RCC and how distinct systemic therapy approaches may be considered based on the anatomic location of metastasis.
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Affiliation(s)
- Jun Gong
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Manuel Caitano Maia
- Division of Medical Oncology, Instituto Hemomed de Oncologia e Hematologia. Av. Arnolfo de Azevedo, 121 - Cerqueira César - CEP 01248-040, Sao Paulo, Brazil
| | - Nazli Dizman
- Department of Internal Medicine, Istanbul Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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16
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Albuquerque IF, Bondar NF, Carrigan R, Chen D, Cooper PS, Dai L, Denisov AS, Dobrovolsky AV, Dubbs T, Endler AM, Escobar CO, Foucher M, Golovtsov VL, Gottschalk H, Gouffon P, Grachev VT, Khanzadeev AV, Kubantsev MA, Kuropatkin NP, Lach J, Lang P, Li C, Li Y, Luksys M, Mahon JR, McCliment E, Morelos A, Newsom C, Maia MC, Samsonov VM, Schegelsky VA, Shi H, Smith VJ, Tang F, Terentyev NK, Timm S, Tkatch II, Uvarov LN, Vorobyov AA, Yan J, Zhao W, Zheng S, Zhong Y. New upper limit for the branching ratio of the Omega ---> Xi - gamma radiative decay. Int J Clin Exp Med 1994; 50:R18-R20. [PMID: 10017570 DOI: 10.1103/physrevd.50.r18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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18
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Maia MC. [Current aspects of modern surgery]. Hospital (Rio J) 1968; 74:669-87. [PMID: 5310110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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19
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Maia MC. [New aspects of contemporary surgery]. Hospital (Rio J) 1968; 74:667-87. [PMID: 5303754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Victor Toledo F, Barreto H, Preger A, Moreira SF, Maia MC. [Winslow's hiatal hernia]. Hospital (Rio J) 1968; 73:1867-78. [PMID: 5305592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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