Kidney Cancer - Volume 3, issue 4

Authors: Reijm, E.A. | van Thienen, J.V. | Wilgenhof, S. | Bex, A. | Haanen, J.B.A.G.

Article Type: Review Article

Abstract: Treatment of renal cell carcinoma (RCC) has evolved rapidly since the development of checkpoint inhibitors. Most of the studies have been conducted in patients with metastatic disease and led to a significant change in the treatment landscape. Currently, many studies are investigating immune checkpoint inhibition (ICI) in the neoadjuvant and adjuvant setting and the efficacy of combination therapies. It remains difficult to predict which patients will respond best. Consequently, there is a high need for predictive biomarkers. In this review, we discuss the different studies with ICI in RCC and the molecular correlates with clinical outcome.

Keywords: Renal cell carcinoma, immune checkpoint inhibition, cancer immunotherapy, molecular profiling, review

DOI: 10.3233/KCA-190065

Citation: Kidney Cancer, vol. 3, no. 4, pp. 199-211, 2019

Authors: Parmar, Ambika | Bjarnason, Georg A.

Article Type: Review Article

Abstract:  The introduction of oral vascular endothelial growth factor receptor tyrosine kinase inhibitors therapy has been associated with major improvements in outcome for patients with metastatic kidney cancer. Each drug has been licensed with rigid dosing criteria that are not optimal for all patients. This paper reviews the growing body of evidence suggesting that individualized dosing based on toxicity may be associated with optimal drug exposure for each patient and improved outcome both in the metastatic and adjuvant setting.

Keywords: Kidney neoplasm, medicine individualized, drug dosing biomarker, vascular endothelial growth factor receptor tyrosine kinase inhibitors therapy

DOI: 10.3233/KCA-190077

Citation: Kidney Cancer, vol. 3, no. 4, pp. 213-225, 2019

Authors: van Oostenbrugge, Tim J. | Langenhuijsen, Johan F. | Fütterer, Jurgen J. | Mulders, Peter F.A.

Article Type: Research Article

Abstract: Background: Renal cell carcinoma (RCC) thrombus invasion in the inferior vena cava (IVC) wall needs adequate resection to improve survival. Surgical planning to avoid positive vascular surgical margins and recurrent disease can be facilitated by imaging capable of diagnosing this invasion and the extent of the thrombus. Objective: To evaluate the diagnostic performance of multiparametric MR imaging (mpMRI) for detecting inferior vena cava (IVC) wall invasion and extent of renal cell carcinoma (RCC) thrombus. Methods: In this prospective study, twenty consecutive patients underwent mpMRI before open radical nephrectomy with IVC thrombectomy was performed in a single …high-volume institution by one urologist (PM) blinded for mpMRI findings. Primary endpoint was mpMRI negative- and positive predictive value (NPV/PPV) for IVC wall invasion as encountered during surgery. IVC wall invasion was assessed on mpMRI by a radiologist prior to the surgery based on qualitative imaging parameters. Also, NPV and PPV were calculated with incremental use of quantitative parameters. Therefore, the association between IVC wall invasion and the maximum IVC and renal vein orifice diameter, and the cranial extent of the thrombus was evaluated by logistic regression. After ROC analysis an optimal cut-off point was selected for significantly associated quantitative parameters. NPV and PPV were calculated using this optimal cut-off point. Results: mpMRI NPV and PPV for IVC wall invasion based on qualitative parameters was 82% and 100%, respectively. An increase in IVC diameter was significantly associated with IVC wall invasion (p  < 0.05). With incremental use of an IVC diameter cut-off value of 27 mm NPV and PPV for IVC wall invasion were 100% and 89%, respectively. Conclusion: mpMRI is able to reliably diagnose IVC wall invasion of RCC thrombus and can optimize radical surgical resection. Show more

Keywords: Renal cell carcinoma, MRI, inferior vena cava, thrombus ORCHID TJ van Oostenbrugge: 0000-0002-1614-6296

DOI: 10.3233/KCA-190071

Citation: Kidney Cancer, vol. 3, no. 4, pp. 227-233, 2019

Authors: Staehler, Michael | Spek, Annabel K. | Rodler, Severin | Schott, Melanie | Casuscelli, Jozefina | Mittelmeier, Lena | Schlemmer, Marcus

Article Type: Research Article

Abstract: We report our one-year experience on the use of Tivozanib in metastatic Renal Cell Carcinoma (RCC) in n=23 patients treated within a year after approval. Tumor response according to RECIST criteria was PR in 39.1%, SD in 52.2% and PD in 8.7% of the patients. Median progression free survival (PFS) was 14.9 months (95% CI 5.1-24.8).

Keywords: Renal cell carcinoma, tivozanib, real world data, efficacy, experience, metastatic, systemic therapy, tyrosine kinase inhibitor

DOI: 10.3233/KCA-190073

Citation: Kidney Cancer, vol. 3, no. 4, pp. 235-239, 2019

Authors: Dibble, Elizabeth H. | Kravets, Sasha | Cheng, SuChun | Sakellis, Christopher | Gray, Kathryn P. | Abbott, Amanda | Bossé, Dominick | Pomerantz, Mark M. | McGregor, Bradley A. | Harshman, Lauren C. | Michaelson, M. Dror | McKay, Rana R. | Choueiri, Toni K. | Krajewski, Katherine M. | Jacene, Heather A.

Article Type: Research Article

Abstract: Objective: Compare FDG-PET/CT, CT, and bone scan for detecting and monitoring bone metastases’ response in metastatic renal cell cancer (mRCC). Methods: Patients with mRCC prospectively underwent FDG-PET/CT, CT, and bone scans at baseline and after 8 weeks of therapy. Tumor visibility and metabolic activity were retrospectively recorded. Response was evaluated by PERCIST, RECIST, and MD Anderson bone criteria. Kaplan-Meier methodology estimated event-time distributions for PFS, OS, and time to symptomatic skeletal event (SSE). Log-rank test tested differences in event-time distributions between response at 8 weeks by response criteria. Results: Sixteen patients (n  = 30; 53%) were evaluable. …Baseline FDG-PET/CT detected more osseous metastases (n  = 55) than CT (n  = 45) or bone scan (n  = 34). From baseline to 8 weeks, metabolic activity of lesions decreased >20%, while qualitative and quantitative CT and bone scan parameters were unchanged for most patients. Partial metabolic responders by PERCIST had longer PFS and OS (n  = 5, 20+ months) versus those with stable (n  = 9; PFS = 9.2 mos, OS = 8.7 mos) and progressive (n  = 2; PFS = 5.4 mos, OS = 12.1 mos) metabolic disease, p  = 0.09 and 0.42, respectively. By RECIST, longer PFS and OS was seen for stable (n  = 12, PFS = 8.3 mos, OS = 17.7 mos) versus progressive (n  = 4; PFS = 3.7 mos, OS = 7.5 mos) disease, p  = 0.16, 0.02, respectively. OS was not reached, but estimated ≥20 mos, for 4 patients with RECIST SD and PERCIST PMR, compared to OS of 17.7 mos for other patients with RECIST SD. Conclusions: FDG-PET/CT identified more bone metastases and greater numbers of quantitative and qualitative treatment responses in mRCC compared to CT and bone scan. FDG-PET/CT also may identify a sub-group of patients with better outcomes than predicted by standard imaging modalities. Show more

Keywords: FDG-PET/CT, osseous metastases, renal cell carcinoma, Radium-223, VEGF targeted therapy

DOI: 10.3233/KCA-190075

Citation: Kidney Cancer, vol. 3, no. 4, pp. 241-251, 2019

Authors: Zequi, Stênio de Cássio | Mourão, Thiago Camelo | de Oliveira, Max Moura | Curado, Maria Paula | Gueglio, Guilhermo | da Costa, Walter Henriques | Zuñiga, Alvaro | Bengió, Rubén | Scorticati, Carlos | Rodriguez, Francisco | Autran, Ana Maria | Martínez, Pablo | Ameri, Carlos | Mingote, Pablo | Secin, Fernando Pablo | Decia, Ricardo | da Cunha, Isabela Werneck | Guimarães, Gustavo Cardoso | Glina, Sidney | Palou, Joan | Abreu, Diego

Article Type: Research Article

Abstract: Background: Renal cell carcinoma (RCC) is a lethal neoplasia. Data from Latin America are scarce, and the distinct ethnic origins of this population could affect predictive or prognostic factors. Objective: We aim to describe a large cohort of non-metastatic renal cell carcinoma, identifying the demographic, clinical, and pathological prognostic factors for survival. Methods: We used a multi-institutional retrospective cohort involving 5,670 patients who underwent radical or partial nephrectomy across seven Latin American countries and Spain from 1980 to 2016. The variables were compared, and Kaplan–Meier curves were used to estimate the overall survival (OS) and cancer-specific …survival (CSS). Results: The clear cell subtype represented 66.7% of RCC, followed by chromophobe (13.7%), papillary (5.2%), and others (14.4%). Furthermore, 72.3% of renal masses were <7.0 cm. The 5-year OS and 10-year OS rates were 86.1% and 69.5%, respectively. The 5-year and 10-year CSS rates were 89.9% and 81.8%, respectively. The demographic and clinical predicting factors for OS in the multivariate analysis were age (HR: 2.978), anemia (HR: 1.44), presence of symptoms at presentation (HR: 1.26), Karnofsky score ≤80 (HR: 2.12), and ASA score ≥ 3 (HR: 1.49). The pathological factors were nodal metastasis (HR: 2.14), peri-renal fat invasion (HR: 2.12), inferior vena cava invasion (HR: 1.61), histologic tumoral necrosis (HR: 1.69), and tumor size >7 cm (HR: 1.64). Conclusions: Our findings agreed with those reported for some developed countries. We emphasize that ASA and peri-renal fat invasion as prognostic factors deserve further study. Information regarding microvascular invasion should be regularly incorporated in pathological reports. Show more

Keywords: Renal cell carcinoma, Latin America, survival analysis, nephrectomy

DOI: 10.3233/KCA-190068

Citation: Kidney Cancer, vol. 3, no. 4, pp. 253-261, 2019

Authors: Parikh, Mamta

Article Type: Other

DOI: 10.3233/KCA-199003

Citation: Kidney Cancer, vol. 3, no. 4, pp. 263-264, 2019