Rationale: Despite multiple studies evaluating adjuvant therapy in patients with localized RCC after nephrectomy, largely involving vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs), there remains no standard adjuvant systemic therapy that increases overall survival. While a number of adjuvant trials are underway to determine if there is a role for immune checkpoint inhibitor therapy in treatment of localized RCC, it is hypothesized that neoadjuvant PD-1 priming may be necessary to maximize effi cacy. Thus, the PROSPER RCC trial is a novel trial involving perioperative nivolumab in patients with RCC undergoing nephrectomy.
{"title":"Clinical Trials Corner: A Promising New Drug Class in Treating Metastatic Renal Cell Carcinoma","authors":"M. Parikh","doi":"10.3233/KCA-199001","DOIUrl":"https://doi.org/10.3233/KCA-199001","url":null,"abstract":"Rationale: Despite multiple studies evaluating adjuvant therapy in patients with localized RCC after nephrectomy, largely involving vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs), there remains no standard adjuvant systemic therapy that increases overall survival. While a number of adjuvant trials are underway to determine if there is a role for immune checkpoint inhibitor therapy in treatment of localized RCC, it is hypothesized that neoadjuvant PD-1 priming may be necessary to maximize effi cacy. Thus, the PROSPER RCC trial is a novel trial involving perioperative nivolumab in patients with RCC undergoing nephrectomy.","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-199001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44490919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Maund, A. B. Al-Naeeb, S. Welsh, T. Eisen, K. Fife
Background: The use of conventionally fractionated intensity modulated radiotherapy (IMRT) in the management of oligometastatic renal cell carcinoma (RCC) is currently poorly characterised in the literature. Objective: To evaluate the safety and effectiveness of IMRT for intraabdominal and retroperitoneal RCC oligometastases. Methods: Retrospective analysis of 14 patients with oligometastatic RCC treated with IMRT with the aim of inducing longterm control. Indications for radiotherapy included bleeding abdominal mass (5 patients), solitary renal bed recurrence (5 patients) and isolated, asymptomatic pancreatic mass (4 patients). The prescribed radiotherapy dose was 50 Gray in 20 to 25 fractions. Patients were followed up long-term using regular cross-sectional imaging and clinical review to assess local and distant disease control and treatment related toxicity. Results: At median follow up of 33.5 (6–68) months, 12 patients remain alive (86%), of whom 11 (92%) have no evidence of local recurrence. Six patients (43%) developed further metastatic disease, of whom 4 (67%) received systemic treatment. Median duration of local control was 33.5 months, and 1and 3-year overall survival (OS) was 92.9% and 85.7% respectively. No treatment-related toxicities ≥ grade 3 and no long-term sequelae were observed. Conclusions: IMRT to intra-abdominal and retroperitoneal metastasis in oligo-metastatic RCC can be delivered safely, provide durable responses and excellent longer-term survival if given to a sufficiently high dose over a conventionally fractionated course. Our study is the first to date with long-term follow up to evaluate the role of IMRT in such cases and has important implications for treatment of oligometastatic RCC.
{"title":"Intensity Modulated Radiotherapy is a Well-Tolerated and Effective Treatment for the Long-Term Control of Intra-Abdominal and Retroperitoneal Oligometastatic Renal Cell Cancer","authors":"I. Maund, A. B. Al-Naeeb, S. Welsh, T. Eisen, K. Fife","doi":"10.3233/KCA-170025","DOIUrl":"https://doi.org/10.3233/KCA-170025","url":null,"abstract":"Background: The use of conventionally fractionated intensity modulated radiotherapy (IMRT) in the management of oligometastatic renal cell carcinoma (RCC) is currently poorly characterised in the literature. Objective: To evaluate the safety and effectiveness of IMRT for intraabdominal and retroperitoneal RCC oligometastases. Methods: Retrospective analysis of 14 patients with oligometastatic RCC treated with IMRT with the aim of inducing longterm control. Indications for radiotherapy included bleeding abdominal mass (5 patients), solitary renal bed recurrence (5 patients) and isolated, asymptomatic pancreatic mass (4 patients). The prescribed radiotherapy dose was 50 Gray in 20 to 25 fractions. Patients were followed up long-term using regular cross-sectional imaging and clinical review to assess local and distant disease control and treatment related toxicity. Results: At median follow up of 33.5 (6–68) months, 12 patients remain alive (86%), of whom 11 (92%) have no evidence of local recurrence. Six patients (43%) developed further metastatic disease, of whom 4 (67%) received systemic treatment. Median duration of local control was 33.5 months, and 1and 3-year overall survival (OS) was 92.9% and 85.7% respectively. No treatment-related toxicities ≥ grade 3 and no long-term sequelae were observed. Conclusions: IMRT to intra-abdominal and retroperitoneal metastasis in oligo-metastatic RCC can be delivered safely, provide durable responses and excellent longer-term survival if given to a sufficiently high dose over a conventionally fractionated course. Our study is the first to date with long-term follow up to evaluate the role of IMRT in such cases and has important implications for treatment of oligometastatic RCC.","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-170025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42948199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karan Arora, K. Hanson, E. Habermann, M. Tollefson, S. Psutka
Introduction and Objective: Conflicting data exists regarding the impact of body mass index (BMI) on postoperative outcomes following surgery for renal malignancies (RM). Herein, we investigated associations between obesity, hypoalbuminemia, and/or significant weight loss in the preoperative period, and risk complications and mortality within 30 days of radical (RN) or partial nephrectomy (PN). Materials and Methods: Review of the American College of Surgeons National Surgical Quality Improvement Program database identified 8,618 patients treated with PN or RN for RM between 2005 and 2012. Univariate and multivariable logistic regression models were developed to assess associations between hypoalbuminemia (<3.5 g/dl), >10% weight loss within 6 months of surgery, obesity (BMI >30 kg/m2), and 30-day major complications and mortality. Results: Median BMI was 29.2 kg/m2 with 24.9%, 11.9%, and 8.2% having class I, II, and III obesity, respectively. Weight loss of >10% was observed in 2.6% and 15.4% had preoperative albumin<3.5 g/dl. There were 1,802 complications (20.9%) and 88 deaths within 30 days (1.0%). On multivariable analysis, BMI ≥40 kg/m2 (OR 1.3, p = 0.04), >10% weight loss (OR 1.9, p < 0.001) and hypoalbuminemia (OR 1.5, p < 0.001) were independently associated with 30-day complications, while only >10% weight loss was independently associated with 30-day mortality (OR 2.4, p = 0.03). Conclusions: Extreme obesity, hypoalbuminemia, and significant weight loss were independently associated with risk of significant complications following PN or RN while only significant preoperative weight loss was associated with early mortality, underscoring the need to further understand the utility of moderating these risk factors in the perioperative period.
{"title":"Nutritional Predictors of Perioperative Complications and Mortality Following Nephrectomy for Renal Malignancies: A Population-Based Analysis","authors":"Karan Arora, K. Hanson, E. Habermann, M. Tollefson, S. Psutka","doi":"10.3233/KCA-180036","DOIUrl":"https://doi.org/10.3233/KCA-180036","url":null,"abstract":"Introduction and Objective: Conflicting data exists regarding the impact of body mass index (BMI) on postoperative outcomes following surgery for renal malignancies (RM). Herein, we investigated associations between obesity, hypoalbuminemia, and/or significant weight loss in the preoperative period, and risk complications and mortality within 30 days of radical (RN) or partial nephrectomy (PN). Materials and Methods: Review of the American College of Surgeons National Surgical Quality Improvement Program database identified 8,618 patients treated with PN or RN for RM between 2005 and 2012. Univariate and multivariable logistic regression models were developed to assess associations between hypoalbuminemia (<3.5 g/dl), >10% weight loss within 6 months of surgery, obesity (BMI >30 kg/m2), and 30-day major complications and mortality. Results: Median BMI was 29.2 kg/m2 with 24.9%, 11.9%, and 8.2% having class I, II, and III obesity, respectively. Weight loss of >10% was observed in 2.6% and 15.4% had preoperative albumin<3.5 g/dl. There were 1,802 complications (20.9%) and 88 deaths within 30 days (1.0%). On multivariable analysis, BMI ≥40 kg/m2 (OR 1.3, p = 0.04), >10% weight loss (OR 1.9, p < 0.001) and hypoalbuminemia (OR 1.5, p < 0.001) were independently associated with 30-day complications, while only >10% weight loss was independently associated with 30-day mortality (OR 2.4, p = 0.03). Conclusions: Extreme obesity, hypoalbuminemia, and significant weight loss were independently associated with risk of significant complications following PN or RN while only significant preoperative weight loss was associated with early mortality, underscoring the need to further understand the utility of moderating these risk factors in the perioperative period.","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-180036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42997182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The decision to undergo partial nephrectomy (PN) versus radical nephrectomy (RN) for a localized renal mass should take various factors into consideration, including tumor characteristics, patient’s health status and preference, and risks and benefits of these each approach. PN represents a suitable surgical approach for small renal tumors in favorable locations. It may also better preserve long-term renal function, particularly in patients who may need surgery for a contralateral kidney mass or have preexisting chronic kidney disease. Conversely, RN may be preferred in elderly patients with severe (non-renal related) comorbidities, in patients with an anatomically challenging tumor location, or for larger or locally advanced masses. The presentation and management of renal tumors has changed substantially during the last few decades. The increasing use and quality of crosssectional imaging has been associated with increased incidence, earlier detection and improved staging of renal masses [12]. Most kidney tumors are now diagnosed incidentally in asymptomatic patients [3]. In a recent study by Welch et al. examining a large cohort of Medicare beneficiaries, increase rates of computed tomography (CT) imaging was associated with
{"title":"Partial Nephrectomy is the Surgical Treatment of Choice for (Most) Complex Localized Renal Tumors","authors":"A. Herlemann, A. Herlemann, A. Odisho, S. Porten","doi":"10.3233/KCA-180039","DOIUrl":"https://doi.org/10.3233/KCA-180039","url":null,"abstract":"The decision to undergo partial nephrectomy (PN) versus radical nephrectomy (RN) for a localized renal mass should take various factors into consideration, including tumor characteristics, patient’s health status and preference, and risks and benefits of these each approach. PN represents a suitable surgical approach for small renal tumors in favorable locations. It may also better preserve long-term renal function, particularly in patients who may need surgery for a contralateral kidney mass or have preexisting chronic kidney disease. Conversely, RN may be preferred in elderly patients with severe (non-renal related) comorbidities, in patients with an anatomically challenging tumor location, or for larger or locally advanced masses. The presentation and management of renal tumors has changed substantially during the last few decades. The increasing use and quality of crosssectional imaging has been associated with increased incidence, earlier detection and improved staging of renal masses [12]. Most kidney tumors are now diagnosed incidentally in asymptomatic patients [3]. In a recent study by Welch et al. examining a large cohort of Medicare beneficiaries, increase rates of computed tomography (CT) imaging was associated with","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-180039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48821343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hahn, P. Hale, B. Maughan, B. Haaland, N. Agarwal
Background: First-line treatment of metastatic renal cell carcinoma (mRCC) has incrementally evolved over the past decade. Most recently, promising clinical trials for first-line cabozantinib, nivolumab plus ipilimumab, and bevacizumab plus atezolizumab were reported. However, the comparator arm in all of these trials was sunitinib, so no head-to-head comparison exists for contemporary first-line treatments. Objective: To provide an indirect comparison of first-line treatments for mRCC that are currently approved or likely soon
{"title":"Optimal First-Line Treatment of Metastatic Renal-Cell Carcinoma: A Network Meta-Analysis","authors":"A. Hahn, P. Hale, B. Maughan, B. Haaland, N. Agarwal","doi":"10.3233/KCA-180032","DOIUrl":"https://doi.org/10.3233/KCA-180032","url":null,"abstract":"Background: First-line treatment of metastatic renal cell carcinoma (mRCC) has incrementally evolved over the past decade. Most recently, promising clinical trials for first-line cabozantinib, nivolumab plus ipilimumab, and bevacizumab plus atezolizumab were reported. However, the comparator arm in all of these trials was sunitinib, so no head-to-head comparison exists for contemporary first-line treatments. Objective: To provide an indirect comparison of first-line treatments for mRCC that are currently approved or likely soon","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-180032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44203436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
s from the Sixteenth International Kidney Cancer Symposium, 2nd-3rd November 2017,
来自第十六届癌症国际研讨会,2017年11月2日至3日,
{"title":"Abstracts from the Sixteenth International Kidney Cancer Symposium, 2nd-3rd November 2017, Miami, Florida","authors":"Pedro, Crivelaro, L. Doro","doi":"10.3233/KCA-189001","DOIUrl":"https://doi.org/10.3233/KCA-189001","url":null,"abstract":"s from the Sixteenth International Kidney Cancer Symposium, 2nd-3rd November 2017,","PeriodicalId":17823,"journal":{"name":"Kidney Cancer","volume":"2 1","pages":"I - S50"},"PeriodicalIF":1.2,"publicationDate":"2018-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3233/KCA-189001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45396787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}