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Hoshi S, Numahata K, Kanno H, Sato M, Kuromoto A, Nezu K, Sakai T, Konno C, Ishizuka Y, Izumi H, Taguchi K, Ono K, Hoshi K, Kanto S, Takahashi R, Vladimir B, Akimoto N, Sasagawa I, Ohta S. Updated recommendation on molecular-targeted therapy for metastatic renal cell cancer. Mol Clin Oncol 2017; 7:591-594. [PMID: 29046793 PMCID: PMC5639413 DOI: 10.3892/mco.2017.1371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/31/2017] [Indexed: 01/05/2023] Open
Abstract
Molecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the RCC guidelines, but these guidelines do not address the order of administration of the multiple presently available agents. There are several aspects that remain unknown regarding the optimal administration order and combination of molecular-targeted drugs. Until the optimal treatment sequence is determined by clinical trials, treatment individualization is required for each patient based on patient and disease characteristics. We herein investigate 12 cases of RCC patients who received axitinib. Axitinib was used as the first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months. Based on our cases, axitinib exhibited reasonable therapeutic efficacy as first- as well as second-line treatment. However, more cases are required to draw firm conclusions.
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Affiliation(s)
- Senji Hoshi
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
- Department Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Kenji Numahata
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Hidenori Kanno
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Masahiko Sato
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Akihito Kuromoto
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Kunihisa Nezu
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Takanari Sakai
- Department of Urology, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Chihito Konno
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-8522, Japan
| | - Yuichi Ishizuka
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-8522, Japan
| | - Hideaki Izumi
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-8522, Japan
| | - Katsuyuki Taguchi
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-8522, Japan
| | - Kunio Ono
- Department of Urology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi 986-8522, Japan
| | - Kiyotsugu Hoshi
- Department Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Satoshi Kanto
- Department Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Rika Takahashi
- Department of Rehabilitation, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Bilim Vladimir
- Department of Urology, Niigata Prefectural Cancer Center Hospital, Niigata 951-8566, Japan
| | - Naoe Akimoto
- Clinical Pathology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama 350-0295, Japan
| | - Isoji Sasagawa
- Department Urology, Yamagata Tokushukai Hospital, Yamagata 990-0834, Japan
| | - Shoichiro Ohta
- Clinical Pathology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama 350-0295, Japan
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You D, Lee C, Jeong IG, Song C, Lee JL, Hong B, Hong JH, Ahn H, Kim CS. Impact of metastasectomy on prognosis in patients treated with targeted therapy for metastatic renal cell carcinoma. J Cancer Res Clin Oncol 2016; 142:2331-8. [PMID: 27553579 DOI: 10.1007/s00432-016-2217-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/04/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE We evaluated the value of metastasectomy in patients treated with targeted therapy for metastatic renal cell carcinoma (mRCC). METHODS The medical records of 325 patients who presented with mRCC were reviewed; among these patients, 33 underwent complete metastasectomy followed by targeted therapy (complete metastasectomy group), 29 underwent incomplete metastasectomy followed by targeted therapy (incomplete metastasectomy group), and 263 treated with targeted therapy alone (non-metastasectomy group). We estimated progression-free and overall survivals using Kaplan-Meier curves. A Cox proportional hazards regression model was used to estimate the prognostic significance of metastasectomy. RESULTS Clinicopathological variables did not differ among the three groups except for age, history of nephrectomy, type of metastasis, the International Metastatic Renal Cell Carcinoma Database Consortium risk groups, histology, and bone metastasis. The median progression-free survivals were 29.5, 18.8, and 14.8 months in the complete, incomplete, and non-metastasectomy groups (p < 0.001). Complete metastasectomy (hazard ratio 0.431, p = 0.001) was an independent predictor of disease progression, along with targeted agents, risk groups, sarcomatoid feature, and number of metastatic sites. The median overall survivals were 92.5, 29.6, and 23.5 months in the complete, incomplete, and non-metastasectomy groups (p < 0.001). Complete metastasectomy (hazard ratio 0.378, p = 0.001) was an independent predictor of overall survival, along with targeted agents, type of metastasis, risk groups, sarcomatoid feature, and number of metastatic sites. CONCLUSIONS Complete metastasectomy performed before targeted therapy might improve progression-free and overall survivals in patients with mRCC.
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Affiliation(s)
- Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Chunwoo Lee
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Gyeongsangnam, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
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Hau HM, Thalmann F, Lübbert C, Morgul MH, Schmelzle M, Atanasov G, Benzing C, Lange U, Ascherl R, Ganzer R, Uhlmann D, Tautenhahn HM, Wiltberger G, Bartels M. The value of hepatic resection in metastasic renal cancer in the Era of Tyrosinkinase Inhibitor Therapy. BMC Surg 2016; 16:49. [PMID: 27444582 PMCID: PMC4957271 DOI: 10.1186/s12893-016-0163-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 07/13/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The value of liver-directed therapy (LDT) in patients with metastasic renal cell carcinoma (MRCC) is still an active field of research, particularly in the era of tyrosinkinase inhibitor (TKI) therapy. METHODS The records of 35 patients with MRCC undergoing LDT of metastasic liver lesions between 1992 and 2015 were retrospectively analyzed. Immediate postoperative TKI was given in a subgroup of patients after LDT for metastasic lesions. Uni- and multivariate models were applied to assess overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). RESULTS Following primary tumor (renal cell cancer) resection and LDT, respectively, median OS was better for a total of 16 patients (41 %) receiving immediate postoperative TKI with 151 and 98 months, when compared to patients without TKI therapy with 61 (p = 0.003) and 40 months (p = 0.032). Immediate postoperative TKI was associated with better median PFS (47 months versus 19 months; p = 0.023), whereas in DFS only a trend was observed (51 months versus 19 months; p = 0.110). CONCLUSIONS LDT should be considered as a suitable additive tool in the era of TKI therapy of MRCC to the liver. In this context, postoperative TKI therapy seems to be associated with better OS and PFS, but not DFS.
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Affiliation(s)
- Hans Michael Hau
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Florian Thalmann
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Christoph Lübbert
- />Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany
| | - Mehmet Haluk Morgul
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Moritz Schmelzle
- />Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Georgi Atanasov
- />Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Christian Benzing
- />Department of General, Visceral and Transplant Surgery, Campus Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Undine Lange
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Rudolf Ascherl
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Roman Ganzer
- />Department of Urology, University of Leipzig, Leipzig, Germany
| | - Dirk Uhlmann
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Hans-Michael Tautenhahn
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Georg Wiltberger
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Bartels
- />Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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Husillos Alonso A, Carbonero García M, González Enguita C. Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? World J Nephrol 2015; 4:254-262. [PMID: 25949939 PMCID: PMC4419135 DOI: 10.5527/wjn.v4.i2.254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/18/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Metastatic renal cell carcinoma (mRCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival (ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with mRCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it’s based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with long-term survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.
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