Adverse Events of Cabozantinib as a Potential Prognostic Factor in Metastatic Renal Cell Carcinoma Patients: Real-World Experience in a Single-Center Retrospective Study

Cabozantinib, an oral inhibitor targeting MET, AXL, and VEGF receptors, has become a key component of a sequential treatment strategy for clear cell renal cell carcinoma (ccRCC). The purpose of this work is to show that effective management of adverse events (AEs) during cabozantinib treatment and achieving a balance between AEs and treatment efficacy is crucial to achieving therapeutic goals. In this retrospective study, involving seventy-one metastatic RCC (mRCC) patients receiving second or subsequent lines of cabozantinib at the Department of Genitourinary Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, we explored the impact of AEs on overall survival (OS) and progression-free survival (PFS). AEs were observed in 92% of patients. Hypothyroidism during treatment was significantly associated with prolonged OS and PFS (HR: 0.31; p < 0.001 and HR: 0.34; p < 0.001, respectively). The occurrence of hand-foot syndrome (HFS) was also linked to improved OS (HR: 0.46; p = 0.021). Patients experiencing multiple AEs demonstrated superior OS and PFS compared to those with one or no AEs (HR: 0.36; p < 0.001 and HR: 0.30; p < 0.001, respectively). Hypothyroidism and HFS serve as valuable predictive factors during cabozantinib treatment in ccRCC patients, indicating a more favorable prognosis.

Prognostic value of pan-immune-inflammation value and body mass index in geriatric patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors as first line treatment. A single-center retrospective study

Introduction

Geriatric patients with metastatic renal cell carcinoma (mRCC) are underrepresented in clinical trials. Evaluation of the efficacy of the treatment and assignation of individuals to proper prognostic groups is an absolute necessity to guarantee them the best possible care.

Material and methods

A total of 138 geriatric patients with mRCC treated with first-line tyrosine kinase inhibitors (TKIs) at the Maria Skłodowska-Curie National Research Institute of Oncology were retrospectively analyzed to determine whether the body mass index (BMI) and pan-immune-inflammation value (PIV) are prognostic values for overall survival (OS) and progression-free survival (PFS) in this type of cancer. For this purpose, Cox's proportional hazard model was used.

Results

The median duration of follow-up for surviving patients was 46.6 (95% CI: 17.4-75.8) months. The median OS and PFS were respectively 33.8 months (95% CI: 23.8-47.8) and 19.1 months (95% CI: 15.0-23.3). BMI (p = 0.034) and PIV (p < 0.001) were statistically significantly associated with OS, and PIV (p = 0.001) was statistically significantly associated with PFS. The risk of death for patients from the high-PIV group (cut-off point: 548) was 3.4 times higher than for those with lower PIV values. The corresponding risk of progression for patients from the high-PIV group was 2.2 times higher. The G8 geriatric screening tool was not identified as a prognostic factor.

Conclusions

Lower PIV and obesity are associated with longer OS in geriatric mRCC patients treated with TKIs in the first line. These factors may be considered while making treatment decisions if further studies show the same results.

Activity of cabozantinib in further line treatment of metastatic clear cell renal cell carcinoma. Real-world experience in a single-center retrospective study

Introduction

Cabozantinib is an oral inhibitor of MET, AXL, and vascular endothelial growth factor receptors. It has an immunomodulatory effect and may influence the tumor's microenvironment and make mutated cells more sensitive to immune-mediated killing. These properties have made cabozantinib an effective drug for first-line or subsequent-line treatment after progression of metastatic renal cell carcinoma (mRCC), even after immunotherapy.

Material and methods

Seventy-one patients with mRCC were treated with second or further lines of cabozantinib at the Department of Genitourinary Oncology, Maria Sklodowska-Curie National Research Institute of Oncology. This study retrospectively evaluated the effectiveness of cabozantinib in subsequent lines of treatment. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. The best overall response (BOR) to cabozantinib was the secondary endpoint. For this purpose, Cox's proportional hazard model was used.

Results

The median PFS was 11 months (5; 23) and the median OS was 16 months (10; 42) and differed significantly in the second and further lines of treatment. Progression in the second and further lines was observed in 28 (93%) and 27 (66%) patients, respectively (p = 0.006). Partial response as the BOR was observed in one patient (3%) in the second line and 13 patients (32%) in the further lines (p = 0.012).

Conclusions

Cabozantinib has antitumor effects in the second and further lines of treatment. In this study we observed high efficiency of cabozantinib in further lines of treatment.

Food Proteins as Precursors of Bioactive Peptides — Classification Into Families

The Bioactive Peptides (BIOPEP) database developed at the Department of Food Biochemistry, University of Warmia and Mazury in Olsztyn was used to determine the profiles of the potential biological activity of food proteins and to classify them into families. Proteins whose amino acid sequences contained fragments with a specified activity and which were a potential source of this activity were divided into families. Among the 44 biological activities of peptides included in the BIOPEP database, 23 were selected for analysis. The number of families was diversified. The largest families were composed of proteins — precursors of antihypertensive peptides and dipeptidyl aminopeptidase IV inhibitors as well as those activating ubiquitin-mediated proteolysis and opioid ones. Only a few proteins included in the database contained in their sequences fragments with the following activities: chemotactic, binding and transporting metals and metal ions, stimulating red blood cells synthesis, inducing contractions of smooth muscles, and hemolytic. Highly numerous families were divided into five sub-families according to the value of the frequency of occurrence of fragments exhibiting given activity (A parameter).

Computational Characterisation and Identification of Peptides for in silico Detection of Potentially Celiac-Toxic Proteins

This work reports on in silico analysis of celiac-toxic peptide occurrence in proteins. The toxic properties of celiac disease are linked to the presence of specific amino acid sequences and the properties of their environment. The analysed celiac-toxic peptides were found to be predominated by unordered structures of random coil and β-turns. Proline and glutamine-rich amino acid sequences from hydrophilic β-turns were exposed on the surface of the precursor proteins. The sequence motifs represented by gluten peptide epitopes or tetrapeptides with surroundings seem to represent an immunodominant structure. The application of MS BLAST software enabled identification of a few fragments with high degrees of identity to the toxic peptides in one protein sequence. Rich sources of celiac-disease-potentiating peptides were wheat gliadins, barley hordeins and rye secalins as well as low-molecular weight fractions of glutenin. In addition, amino acid sequences with a high degree of identity to the toxic peptides examined were detected in maize zein, oat avenin, protein of rice, yeast and chicken muscles, as well as β-casein and galanin.

Ex vivo digestion of carp muscle tissue – ACE inhibitory and antioxidant activities of the obtained hydrolysates

This paper reports that carp muscle tissue hydrolysates obtained after ex vivo digestion show the ACE inhibitory and antioxidative activities.

The effect of glycosylation on emulsifying and structural properties of bovine beta-casein

A number of attempts have been made to improve the functional properties of milk proteins by chemical modifications. One of such modifications is glycosylation which was carried out to determine the effect of covalent binding of glucose molecules to beta-casein (beta CN) on its emulsifying properties. It was found that up to six molecules of glucose were bound to one molecule of beta CN. Glycosylated beta CN produced smaller emulsion droplets than the intact beta CN. Increases in emulsion-forming and -stabilizing properties were observed. A prerequisite of proteins to form emulsions is their adsorption onto oil/water interface. Therefore the secondary structure of intact and glycosylated beta CN, both in solution and adsorbed onto a hydrophobic teflon/water interface also were studied by far-ultra violet circular dichroism (CD). It appeared, that after glycosylation the degree of helicity of intact beta CN decreased and the incorporation of glucose moieties most likely resulted in a type beta-turn formation after adsorption onto the interface.

Dephosphorylation-induced structural changes in beta-casein and its amphiphilic fragment in relation to emulsion properties

To promote the understanding of the relationship between emulsifying and molecular properties of proteins/peptides, intact beta-casein (betaCN) and its amphipathic fragment, i.e., betaCN (1-105/107) were dephosphorylated. Dephosphorylation was found not to change significantly their emulsifying properties. Since it is known that the structure of proteins can change upon adsorption onto an interface, the secondary structure of intact beta-casein, its amphipathic fragment, and their dephosphorylated forms, both in solution and after adsorption onto a hydrophobic teflon/water interface, were studied by far-UV circular dichroism spectroscopy. An increased content of secondary structure, especially alpha-helix, was found for all samples after adsorption onto teflon. Dephosphorylation increased the helix-forming propensity, especially for amphipathic fragment of beta-casein. No influence of the secondary structure properties on the emulsion-forming and -stabilizing properties was observed, but a relationship between the maximum surface load and the emulsion-stabilizing properties was found.

Some physico-chemical properties and structural changes of bovine beta-casein upon glycation

The studies on casein structure modification contribute to better understanding of the role of nonamino acid components in forming casein complexes and improving ways of protein functionality. The objective of the experiments was to explain the influence of bovine milk casein glycation on some physico-chemical properties and structural changes. From the the analysis of glycation rate curve the reaction of the first order range can be assumed during the first 24 h, turning to a mixed type afterwards. The isoelectric point and molecular weight of beta-casein increased after glycation and the electrophoretic mobility was slightly modified. The structural changes were also confirmed by different absorption spectra in UV and a better heat stability of the modified beta-casein. The findings showed higher solubility with modified beta-casein. The glycation caused changes in beta-casein, modifying its susceptibility to the trypsin hydrolysis.