Clinical genitourinary cancer最新文献

{"title":"","authors":"","doi":"10.1016/j.clgc.2024.102247","DOIUrl":"10.1016/j.clgc.2024.102247","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102247"},"PeriodicalIF":2.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ALK-Rearranged Renal Cell Carcinoma: A Study of Three Cases With Clinicopathologic Features and Effect of Postoperative Adjuvant Immunotherapy","authors":"Xinting Zhang ,&nbsp;Chaoran Ban ,&nbsp;Yupeng Chen ,&nbsp;Sheng Zhang ,&nbsp;Hong Chen","doi":"10.1016/j.clgc.2024.102266","DOIUrl":"10.1016/j.clgc.2024.102266","url":null,"abstract":"<div><h3>Background</h3><div>ALK-rearranged renal cell carcinoma (ALK-RCC) is a rare malignant epithelial tumor of the kidney. ALK-RCC has recently been listed in the 5^th edition of the World Health Organization (WHO) Classification of Tumors as a molecularly defined RCC subtype.</div></div><div><h3>Patients and Methods</h3><div>We describe retrospectively 3 ALK-RCCs from clinicopathologic, immunohistochemical (IHC), and molecular genetic aspects, along with postoperative adjuvant therapeutic regime and prognosis-related information.</div></div><div><h3>Results</h3><div>Two patients were female and one patient was male. Patients’ age ranged from 38 to 64 years (mean 51.3 years). Tumor size ranged from 32 mm to 89 mm (mean 55.3 mm, median 45 mm). All 3 tumors were diffusely positive for ALK protein. ALK fusion partners (TPM3 for case 1, VCL for case 2, and EML4 for case 3) were identified by next-generation sequencing. Histomorphologically, the tumors were heterogeneous, showing tubulocystic, papillary, trabecular, and solid growth patterns and polygonal to rhabdoid neoplastic cells. Cases 1 and 3 set in a mucinous background. Upon quantification of tumor-associated CD8⁺ T cells by IHC, tumor immune phenotypes (IPs) were defined as immune-desert in case 1, immune-inflamed in case 2, and immune-excluded in case 3. Follow-up for the 3 patients ranged from 18 to 129 months (mean, 59.3 months). Case 1 refused postoperative adjuvant therapy and was alive without disease at 129-month follow-up. Case 2 was postoperatively treated with a PD-1-targeted monoclonal antibody, being alive without disease at 18-month follow-up. Case 3 showed retroperitoneal lymph nodes and lung metastases at initial diagnosis. She was postoperatively treated with a PD-1-targeted monoclonal antibody, with no benefit suggested by computed tomography on follow-up.</div></div><div><h3>Conclusion</h3><div>ALK-RCC represents a distinct entity with clinicopathological, genetic, and immunophenotypic heterogeneity. ALK IHC analysis during primary screening may aid diagnosis in difficult cases. For progressive ALK-RCCs, postoperative adjuvant immunotherapy may be best selected according to IP features. Patients with immune-excluded phenotypes may not benefit from immunotherapy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102266"},"PeriodicalIF":2.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Study of Patient, Nursing, and Oncology Provider Perspectives on Telemedicine Visits for Renal Cell Carcinoma Clinical Trials","authors":"Sahil D. Doshi ,&nbsp;Andrea Knezevic ,&nbsp;Carlene Gonzalez ,&nbsp;Patricia Fischer ,&nbsp;Robert Goodman ,&nbsp;Suzanne Gornell ,&nbsp;Sweta Patel ,&nbsp;Cindy Puzio ,&nbsp;Alisa Ritea ,&nbsp;Chung-Han Lee ,&nbsp;Lauren Evans ,&nbsp;Martin H. Voss ,&nbsp;Robert J. Motzer ,&nbsp;Ritesh R. Kotecha","doi":"10.1016/j.clgc.2024.102268","DOIUrl":"10.1016/j.clgc.2024.102268","url":null,"abstract":"<div><h3>Purpose</h3><div>Clinical trials enable renal cell carcinoma (RCC) patients to receive promising investigational agents, yet access may be limited. Telemedicine (TM) is an increasingly utilized platform that can expand access, but perspectives on its use in clinical trial care are unknown.</div></div><div><h3>Patients and Methods</h3><div>A prospective study was conducted between Jan 2023 – Oct 2023 at Memorial Sloan Kettering Cancer Center. RCC patients enrolled on therapeutic clinical trials who had prior TM visits were eligible. Surveys in English were distributed to patients, treating clinical trial nurses (CTNs), and oncology providers engaged in clinical trials.</div></div><div><h3>Results</h3><div>39 patients, 7 CTNs, and 15 oncology providers were included in our analysis. Regarding clinical trial care, 26 patients (67%) preferred in-person, 4 (11%) preferred TM, and 9 (22%) had no preference. However, 25 patients (64%) reported TM provided an equal quality of care, and 38 (97%) reported a positive or neutral experience. Conversely, 7 CTNs (100%) and 11 providers (73%) preferred in-person care while 4 (27%) indicated no preference. Most, including 6 CTNs (86%) and 13 providers (87%), reported that TM quality of care was inferior. However, most, including 7 CTNs (100%) and 14 providers (93%), reported a positive experience with TM.</div></div><div><h3>Conclusions</h3><div>In this study, one third of RCC participants preferred TM or had no preference, and a majority felt TM delivered equal quality of care. Providers, however, preferred in-person visits and reported inferior quality of care with TM. These findings warrant further evaluation of safety and feasibility to optimize TM integration for clinical trial care delivery.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102268"},"PeriodicalIF":2.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of IMDC Category Shift From Baseline to Nivolumab Initiation in Metastatic Renal Cell Carcinoma: A Sub-Analysis of the MEET-URO 15 Study","authors":"Brigida Anna Maiorano ,&nbsp;Martina Catalano ,&nbsp;Chiara Mercinelli ,&nbsp;Giandomenico Roviello ,&nbsp;Marco Maruzzo ,&nbsp;Ugo De Giorgi ,&nbsp;Silvia Chiellino ,&nbsp;Andrea Sbrana ,&nbsp;Luca Galli ,&nbsp;Paolo Andrea Zucali ,&nbsp;Cristina Masini ,&nbsp;Emanuele Naglieri ,&nbsp;Giuseppe Procopio ,&nbsp;Sara Merler ,&nbsp;Lucia Fratino ,&nbsp;Cinzia Baldessari ,&nbsp;Riccardo Ricotta ,&nbsp;Veronica Mollica ,&nbsp;Mariella Sorarù ,&nbsp;Marianna Tudini ,&nbsp;Sara Elena Rebuzzi","doi":"10.1016/j.clgc.2024.102267","DOIUrl":"10.1016/j.clgc.2024.102267","url":null,"abstract":"<div><h3>Introduction</h3><div>The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score is the most important prognostic score to stratify patients with metastatic renal cell carcinoma (mRCC), helping to guide treatment choice in first line. We hypothesized that IMDC change may also exert a prognostic role in subsequent lines of mRCC therapy.</div></div><div><h3>Methods</h3><div>Meet-URO 15 is a multicenter Italian study of patients with mRCC receiving nivolumab as a second or subsequent line of therapy. This posthoc analysis aimed to evaluate the overall survival (OS) and progression-free survival (PFS) from nivolumab start as primary endpoints, overall response rate (ORR) and disease-control rate (DCR) as secondary endpoints, according to the change in the IMDC category from the first-line setting (baseline) to nivolumab start. Patients with available prognostic IMDC category information at baseline and before nivolumab were included.</div></div><div><h3>Results</h3><div>492 patients were included in the analysis. At baseline, 165 (33.5%), 287 (58.3%), and 40 patients (8.2%) had favorable, intermediate, and poor IMDC categories, respectively. Before nivolumab, 364 patients (73.9%) remained in the same prognostic category as at baseline, 27 (5.5%) improved, and 101 (20.5%) deteriorated. Significantly longer mPFS (<em>P</em> = .01) and mOS (<em>P</em> &lt; .01) were reached by patients with a stable favorable group compared to those worsening to intermediate/poor. A longer mOS was also achieved from intermediate/poor patients who improved their IMDC category before nivolumab compared to those remaining stable/worsening (<em>P</em> &lt; .01 and <em>P</em> = .04, respectively). Maintaining IMDC category stability from baseline to nivolumab determined a more consistent DCR in favorable patients (<em>P</em> = .03). Overall, patients who improved their IMDC risk score reached better survival outcomes than those who remained stable/deteriorated.</div></div><div><h3>Conclusions</h3><div>In our sub-analysis, the shift in the IMDC risk category appears to be a helpful prognostic tool for assessing the outcomes of patients with mRCC treated with ≥2nd line nivolumab.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102267"},"PeriodicalIF":2.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Risk of Metachronous Upper Tract Urothelial Carcinoma After Ureteral Stenting in Patients With Bladder Cancer","authors":"Kamil Malshy,&nbsp;Matthew Steidle,&nbsp;William Tabayoyong,&nbsp;Edward M. Messing","doi":"10.1016/j.clgc.2024.102263","DOIUrl":"10.1016/j.clgc.2024.102263","url":null,"abstract":"","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102263"},"PeriodicalIF":2.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Analysis of Surgical Treatment Modalities in T2N0M0 Bladder Cancer Patients: A Novel Propensity Score-Based Cohort Study","authors":"Yu-Xuan Yang,&nbsp;Gui-Chen Ye,&nbsp;Jia-Cheng Xiang,&nbsp;Kuang-Di Luo,&nbsp;Shao-Gang Wang ,&nbsp;Qi-Dong Xia","doi":"10.1016/j.clgc.2024.102257","DOIUrl":"10.1016/j.clgc.2024.102257","url":null,"abstract":"<div><h3>Objective</h3><div>This study explored prognostic differences between radical cystectomy (RC), tri-modality treatment (TURBt combined with radiotherapy and chemotherapy, TMT), electrocautery (EC) and partial cystectomy (PC) for T2N0M0 MIBC.</div></div><div><h3>Materials and Methods</h3><div>Using SEER data (2004-2015, 2018-2020), we identified T2N0M0 MIBC patients treated with RC, TMT, EC, or PC. Propensity score matching (PSM, 1:1, caliper=0.1) minimized confounding. Kaplan-Meier analysis and Cox regression identified independent prognostic factors, stratified by tumor size and age.</div></div><div><h3>Result</h3><div>This study included 6526 patients with T2N0M0 MIBC. Among them, 348(5.33%) underwent PC, 309(4.73%)underwent EC, 1833(28.09%)received TMT, and 4036(61.84%) RC. After 1:1 propensity score matching, RC showed improved CSS (HR=0.67, 95%CI 0.47-0.95 , and PC also benefited (HR=0.97, 95%CI 0.69-1.36) compared to EC. While TMT showed a worse end (HR=1.41, 95%Cl 1.03-1.92) compared to EC. Cox analysis was used to stratify tumor size and age for subgroup analysis. Results for tumor size subgroups were aligned with PSM findings. In the age-stratified subgroups, patients aged &lt;67 years, both RC (HR=0.54, P=0.107) and TMT(HR=0.91, P=0.785) showed better prognoses compared to EC treatment, while PC treatment showed worse prognoses compared to EC treatment (HR=1.23, P=0.542).; for 68-77 years, RC(0.64, P=0.1436) and PC(HR=0.46, P=0.0283)had advantages, and PC is more recommended. For &gt;78 years, RC had superior CSS over EC and PC, whereas TMT had the poorest prognosis.</div></div><div><h3>Conclusion</h3><div>In clinical T2N0M0 MIBC, overall, RC outperformed focal-tumor therapy and PC, irrespective of tumor size. However, considering age, we recommend PC treatment for patients aged 68-77 and EC for those aged &gt;78 years.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102257"},"PeriodicalIF":2.3,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Renin-Angiotensin System Inhibitors on Response to PD1/L1 Inhibitors in Patients With Metastatic Renal Cell Carcinoma","authors":"Kathryn Fortune ,&nbsp;Soham Ali ,&nbsp;Jack Masur ,&nbsp;Paul Viscuse ,&nbsp;Michael Devitt ,&nbsp;Robert Dreicer ,&nbsp;William Paul Skelton IV","doi":"10.1016/j.clgc.2024.102256","DOIUrl":"10.1016/j.clgc.2024.102256","url":null,"abstract":"<div><h3>Background</h3><div>The renin-angiotensin-aldosterone system (RAAS), traditionally associated with blood pressure and fluid regulation, also plays a role in tumorigenesis. Renin-angiotensin-aldosterone system inhibitors (RAASI), including angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs), have been shown to improve outcomes in various malignant neoplasms. In metastatic urothelial cancer, the use of RAASI have been associated with higher rates of tumor regression in patients receiving immunotherapy (IO) with PD1/L1 inhibitors. This is thought to be due to RAASI-induced downregulation of TGF-beta, for which increased expression is a known mechanism of PD1/L1 inhibitor resistance. We hypothesized that concurrent RAASI in patients with mRCC receiving IO is associated with increased tumor regression.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of patients with mRCC receiving IO as a first- or second-line therapy from 2016-2023 at the University of Virginia. A logistic regression model was used to evaluate the impact of concurrent RAASI on tumor regression. The primary endpoint was any regression of tumor on imaging.</div></div><div><h3>Results</h3><div>Data were available for 128 patients with mRCC who received IO as a first- (n = 91, 71.0%) or second- (n = 37, 28.9%) line treatment. Patients who received RAASI during IO were more likely to have tumor regression compared to patients who were not on concurrent RAASI (OR 3.84 [95% CI 1.81-8.47, <em>P</em> =&lt; .001). This held true regardless if patients received IO as a first-line (OR 2.83 [95% CI 1.2-6.94], <em>P</em> = .0173) or second-line (OR 9.5 [95% CI 1.89-73.1], <em>P</em> = .005) treatment.</div></div><div><h3>Conclusions</h3><div>Our hypothesis generating study suggests that in our mRCC population, concurrent use of RAASI in patients receiving IO was associated with a significantly increased likelihood of tumor regression. These findings highlight the potential therapeutic advantage of RAASI in combination with IO for mRCC patients. Further exploration of this association is warranted in prospective studies to improve treatment outcomes for this patient population.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102256"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Systemic Therapy on Cytoreductive Nephrectomy Outcomes in the National Surgical Quality Improvement Program (NSQIP)","authors":"Shawn Dason ,&nbsp;Rajvi Goradia ,&nbsp;Victor Heh ,&nbsp;Akshay Sood ,&nbsp;Matthew Lee ,&nbsp;Young Son ,&nbsp;Yuanquan Yang ,&nbsp;Shang-Jui Wang ,&nbsp;Elshad Hasanov ,&nbsp;Tasha Posid ,&nbsp;Eric A. Singer","doi":"10.1016/j.clgc.2024.102258","DOIUrl":"10.1016/j.clgc.2024.102258","url":null,"abstract":"<div><h3>Introduction</h3><div>Management of metastatic renal cell carcinoma (mRCC) is highly individualized and often involves cytoreductive nephrectomy (CN) and systemic therapy (ST). The optimal sequencing of CN and ST is uncertain. A difference in perioperative outcomes based on sequence of CN and ST could influence decisionmaking. We analyzed the National Surgical Quality Improvement Program (NSQIP) database to assess whether preoperative systemic therapy adversely impacted perioperative outcomes in patients receiving deferred CN.</div></div><div><h3>Methods</h3><div>This analysis was conducted using the American College of Surgeons NSQIP Participant Use Data File for years 2019 and 2020. Groups were stratified by their receipt of preoperative systemic therapy within 90 days before CN. The primary outcome of our study was overall major complication rate. Secondary outcomes included overall complication rate, length of stay, operative time, discharge to home, adjunctive procedures, conversion from minimally-invasive to open surgery and infectious complications. Multivariate logistic regression was used to assess the role of preoperative systemic therapy and other predictors on the primary and secondary outcome(s).</div></div><div><h3>Results</h3><div>The study cohort comprised of 752 patients (586 upfront vs. 166 deferred) undergoing cytoreductive nephrectomy from 2019-2021. There were no significant differences in major complication rate (8% upfront vs. 5% deferred, <em>P</em> = .188) or overall complication rate (33% upfront vs. 39% deferred, <em>P</em> = .152). On multivariate analysis, bleeding diathesis, adjunctive procedures, and higher ASA class were predictive of major complications. Patients receiving preoperative ST were more likely to be on steroids (23% vs. 7%, p</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102258"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Preferences for Metastatic Prostate Cancer Treatment: A Discrete Choice Experiment","authors":"Yeuk-lam Hong ,&nbsp;Chi-fai Ng ,&nbsp;Kenneth Chun-wai Wong ,&nbsp;Wing-yan Kong ,&nbsp;Peter Ka-Fung Chiu ,&nbsp;Jeremy Yuen-Chun Teoh ,&nbsp;Chi-ho Leung ,&nbsp;Pui-tak Lai","doi":"10.1016/j.clgc.2024.102254","DOIUrl":"10.1016/j.clgc.2024.102254","url":null,"abstract":"<div><h3>Background</h3><div>To examine the preference weightings for risk/benefit attributes of therapy in metastatic prostate cancer (mPC) patients, encompassing hormone-sensitive (mHSPC) and castration-resistant (mCRPC) settings.</div></div><div><h3>Patients and Methods</h3><div>A noninterventional cross-sectional survey employing a discrete choice experiment was conducted, recruiting 200 mHSPC and 100 mCRPC patients within 5 years of diagnosis from the urology and oncology specialty clinics between Feb 2023 and Jul 2023. Patients were randomized into 2 blocks of 9 questions, choosing 1 out of 2 medication profiles consisting 5 attributes, each with 3 levels, determined from a group interview of 5 patients. A mixed logit model estimated attribute-level preference weightings, with tradeoff points calculated.</div></div><div><h3>Results</h3><div>Median age was 75 (IQR:71-81), 170 (56.7%) had no income, 245 (81.7%) cared for themselves, mean maximum out-of-pocket treatment cost was US$20,456 (SD:43,568), and 160 (53.3%) claimed not to consider further treatment when cost exceeding their affordability. Patients favoured self-care ability (4.37, <em>P</em> &lt; .001) and life expectancy extension (2.83, <em>P</em> &lt; .001), disfavoured adverse effects (−6.97, <em>P</em> &lt; .001) and treatment cost (in HK$million or USD$128,205) (−3.14, <em>P</em> &lt; .001). mCPRC patients was more sensitive to treatment cost (−3.61 vs. −2.97), life expectancy extension (3.47 vs. 2.55) and adverse effects (−7.55 vs. −6.80) compared to mHSPC patients. Higher financial affordability patients exhibited higher sensitivity to self-care ability (4.89 vs. 4.02) and adverse effects (−7.57 vs. −6.70).</div></div><div><h3>Conclusion</h3><div>The chance of adverse effects was pivotal in treatment decisions, followed by self-care ability, with cost remaining a major access barrier.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102254"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of 177Lu-PSMA Therapy Following 223Radium Treatment: A Retrospective Multinational Real-World Analysis","authors":"Giulia Giannini ,&nbsp;Mona Kafka ,&nbsp;Hannes Neuwirt ,&nbsp;Nastasiia Artamonova ,&nbsp;Gianpaolo di Santo ,&nbsp;Irene Virgolini ,&nbsp;Robert Dotzauer ,&nbsp;Emil Deiss ,&nbsp;Pia Paffenholz ,&nbsp;Axel Heidenreich ,&nbsp;Sazan Rasul ,&nbsp;Igor Tsaur ,&nbsp;Steffen Rausch ,&nbsp;Holger Einspieler ,&nbsp;Christian la Fougère ,&nbsp;Nils F. Trautwein ,&nbsp;Fabio Zattoni ,&nbsp;Matteo Sepulcri ,&nbsp;Isabel Heidegger","doi":"10.1016/j.clgc.2024.102260","DOIUrl":"10.1016/j.clgc.2024.102260","url":null,"abstract":"<div><h3>Background</h3><div>¹⁷⁷Lu PSMA therapy is increasingly used for metastatic castration-resistant prostate cancer (mCRPC) treatment. However, data on its efficacy and safety in patients previously treated with ²²³Ra remain limited.</div></div><div><h3>Methods</h3><div>This retrospective, multicenter study evaluated 233 mCRPC patients treated with ¹⁷⁷Lu PSMA at 5 European centers. The cohort included 27 patients previously treated with ²²³Ra and 206 Radium-naive patients. Statistical analyses, including Chi-squared, Mann-Whitney U tests, and multivariate logistic regression, were used to assess response and mortality. Predictors of response and mortality were identified using multivariate models.</div></div><div><h3>Results</h3><div>Patients who experienced a longer interval between castration resistance and the initiation of ¹⁷⁷Lu PSMA therapy demonstrated better responses (median 17 months in responders vs. 8.5 months in progressors, <em>P</em> = .001). Platelet counts were significantly lower in the progressive group compared to the responsive group (<em>P</em> = .01). Multivariate regression confirmed lower platelet levels as a predictor of poor response (<em>P</em> = .029). The overall response rate to ¹⁷⁷Lu PSMA was 54%, similar between the ²²³Ra-pretreated and Radium-naive groups. However, mortality was significantly higher in the ²²³Ra-pretreated group (86%) compared to the Radium-naive group (51%, <em>P</em> = .003). ECOG performance status (<em>P</em> = .004) and ALP levels (<em>P</em> = .030) were significant predictors of mortality, while CRP showed a trend towards significance (<em>P</em> = .064). Tolerability of ¹⁷⁷Lu PSMA was comparable to the safety profile reported in the literature, with 44% of ²²³Ra-pretreated patients experiencing AEs and 22% experiencing severe AEs (Grade ≥ 3).</div></div><div><h3>Conclusions</h3><div>¹⁷⁷Lu PSMA therapy is effective and well-tolerated in mCRPC patients pretreated with ²²³Ra. However, higher mortality was observed in the ²²³Ra-pretreated group. ECOG PS, ALP, and platelet counts were significant predictors of response and mortality, and a longer interval between therapies was associated with better outcomes. These findings underscore the importance of treatment sequencing and monitoring prognostic markers.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 1","pages":"Article 102260"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}