Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma

Published on Dec 1, 2018in European Urology17.947
· DOI :10.1016/J.EURURO.2018.08.008
Axel Bex54
Estimated H-index: 54
(NKI-AVL: Netherlands Cancer Institute),
Laurence Albiges58
Estimated H-index: 58
(Université Paris-Saclay)
+ 15 AuthorsThomas Powles84
Estimated H-index: 84
(QMUL: Queen Mary University of London)
Sources
Abstract
Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy al ...
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#1Samra Turajlic (The Royal Marsden NHS Foundation Trust)H-Index: 30
#2Hang Xu (Francis Crick Institute)H-Index: 10
Last. PeaceH-Index: 1
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Clear-cell renal cell carcinoma (ccRCC) exhibits a broad range of metastatic phenotypes that have not been systematically studied to date. Here, we analyzed 575 primary and 335 metastatic biopsies across 100 patients with metastatic ccRCC, including two cases sampledat post-mortem. Metastatic competence was afforded by chromosome complexity, and we identify 9p loss as a highly selected event driving metastasis and ccRCC-related mortality (p = 0.0014). Distinct patterns of metastatic disseminatio...
304 CitationsSource
#1Thomas Powles (QMUL: Queen Mary University of London)H-Index: 84
#2Laurence Albiges (Institut Gustave Roussy)H-Index: 58
Last. Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
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The randomised phase III clinical trial Checkmate-214 showed a survival superiority for the combination of ipilimumab and nivolumab when compared with the previous standard of care in first-line metastatic/advanced clear cell renal cell carcinoma (RCC) (Escudier B, Tannir NM, McDermott DF, et al. CheckMate 214: efficacy and safety of nivolumab plus ipilimumab vs sunitinib for treatment-naive advanced or metastatic renal cell carcinoma, including IMDC risk and PD-L1 expression subgroups. LBA5, ES...
110 CitationsSource
#1Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
#2Peter F.A. Mulders (Radboud University Nijmegen)H-Index: 79
Last. J.B.A.G. Haanen (NKI-AVL: Netherlands Cancer Institute)H-Index: 26
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21 CitationsSource
#1Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
#2Börje Ljungberg (Umeå University)H-Index: 70
Last. Thomas Powles (QMUL: Queen Mary University of London)H-Index: 84
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Patient summary: After the introduction of systemic targeted therapies, the use of nephrectomy in patients with metastatic renal cell carcinoma has declined. Currently, systemic therapy is offered ...
25 CitationsSource
#1Thomas Powles (QMUL: Queen Mary University of London)H-Index: 84
#2Naveed Sarwar (Imperial College London)H-Index: 15
Last. Simon J. Crabb (University of Southampton)H-Index: 30
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Importance The role of cytoreductive nephrectomy in patients with metastatic renal cancer in the era of targeted therapy is uncertain. Objective To establish the safety and efficacy of upfront pazopanib therapy prior to cytoreductive nephrectomy in previously untreated patients with metastatic clear cell renal cancer. Design, Setting, and Participants Single-arm phase 2 study of 104 previously untreated patients with metastatic clear cell renal cancer recruited between June 2008 and October 2012...
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#1Brian I. Rini (Cleveland Clinic)H-Index: 96
#2Tanya B. DorffH-Index: 28
Last. Elizabeth R. Plimack (Fox Chase Cancer Center)H-Index: 61
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Summary Background A subset of patients with metastatic renal-cell carcinoma show indolent growth of metastases. Because of the toxicity and non-curative nature of systemic therapy, some of these patients could benefit from initial active surveillance. We aimed to characterise the time to initiation of systemic therapy in patients with metastatic renal-cell carcinoma under active surveillance. Methods In this prospective phase 2 trial, we enrolled patients with treatment-naive, asymptomatic, met...
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#1Daniel Y.C. Heng (U of C: University of Calgary)H-Index: 16
#2J. Connor WellsH-Index: 11
Last. Toni K. Choueiri (Harvard University)H-Index: 116
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Abstract Background The benefit of cytoreductive nephrectomy (CN) for overall survival (OS) is unclear in patients with synchronous metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. Objective To determine OS benefit of CN compared with no CN in mRCC patients treated with targeted therapies. Design, setting, and participants Retrospective data from patients with synchronous mRCC ( n =1658) from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) were ...
265 CitationsSource
#1Thomas Powles (St Bartholomew's Hospital)H-Index: 84
#2Christian U. Blank (NKI-AVL: Netherlands Cancer Institute)H-Index: 73
Last. Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
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Abstract Background The role of cytoreductive nephrectomy in metastatic clear cell renal cell carcinoma (ccRCC) is controversial. Objective To determine the outcome of patients with metastatic ccRCC who receive sunitinib prior to planned nephrectomy. Design, setting, and participants The study combined the data from two prospective phase 2 studies that assessed upfront sunitinib (12–16 wk) prior to nephrectomy in previously untreated patients with metastatic renal cell carcinoma (RCC). Sunitinib...
85 CitationsSource
#1Börje Ljungberg (Umeå University)H-Index: 70
#2Karim Bensalah (University of Rennes)H-Index: 64
Last. Axel Bex (NKI-AVL: Netherlands Cancer Institute)H-Index: 54
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The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management.
2,421 CitationsSource
#1Stephen H. Culp (University of Texas MD Anderson Cancer Center)H-Index: 19
#2Nizar M. Tannir (University of Texas MD Anderson Cancer Center)H-Index: 69
Last. Christopher G. Wood (University of Texas MD Anderson Cancer Center)H-Index: 81
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BACKGROUND: The benefits of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) should outweigh surgical morbidity. Even when the generally agreed upon selection criteria for CN are met, some patients do poorly after surgery. The objective of this study was to identify preoperative factors that were prognostic of outcome in patients who were being considered for CN. METHODS: The authors conducted a retrospective study to investigate the overall survival (OS) of patients who ...
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#1Eduard Roussel (Katholieke Universiteit Leuven)H-Index: 3
#2Benoit Beuselinck (Katholieke Universiteit Leuven)H-Index: 25
Last. Maarten Albersen (Katholieke Universiteit Leuven)H-Index: 26
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Take Home Message null null Cytoreductive nephrectomy makes way for more effective systemic treatments in the current mRCC treatment paradigm, as disease volume and the number of IMDC risk factors increase. Careful patient selection for upfront or deferred cytoreductive nephrectomy based on these criteria remains key.
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#1Arnaud MejeanH-Index: 61
#2Alain Ravaud (University of Bordeaux)H-Index: 77
Last. Laurent GuyH-Index: 26
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Abstract null null Background null The CARMENA trial in patients with metastatic renal cell carcinoma (mRCC) demonstrated that treatment with sunitinib alone was noninferior to cytoreductive nephrectomy (CN) followed by sunitinib (nephrectomy–sunitinib). null null null Objective null The objective of this study was to provide updated overall survival (OS) outcomes of CARMENA and assess whether some subgroups may still benefit from upfront CN. null null null Design, setting, and participants null...
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#1Zhen Zhang (Anhui Medical University)H-Index: 1
#2Chaozhao Liang (Anhui Medical University)H-Index: 24
Last. L. Zhou (Anhui Medical University)
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Abstract null null Objectives null To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. null null null Methods null 56,617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2906 patients were initially diagnosed with lung metastases, and then were use...
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#1Zhen Zhang (Anhui Medical University)H-Index: 1
#2Chaozhao Liang (Anhui Medical University)H-Index: 24
Last. L. Zhou (Anhui Medical University)
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OBJECTIVES To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. METHODS 56, 617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2, 906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Mul...
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#1Teele KuuskH-Index: 10
#2Yasmin Abu-Ghanem (Royal Free London NHS Foundation Trust)H-Index: 13
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PURPOSE OF REVIEW Immune checkpoint inhibitor (ICI) combination therapy has revolutionized therapy of metastatic renal cancer. The success of immunotherapy has renewed an interest to study these agents in adjuvant and neoadjuvant settings and prior to cytoreductive nephrectomy. This narrative review will give an overview of ongoing trials and early translational research outcomes. RECENT FINDINGS In nonmetastatic renal cell carcinoma (RCC), five phase 3 adjuvant and neoadjuvant trials with ICI m...
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#1Andreas Rosenblad (Uppsala University)
Last. Börje Ljungberg (Umeå University)H-Index: 70
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PURPOSE To psychometrically evaluate the hypothesized four-factor structure of the 19-item Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI-19) health-related quality of life (HRQoL) instrument in a sample of surgically treated renal cell carcinoma (RCC) patients and examine if an alternative factor structure with good psychometric properties may be derived from the available items. METHODS The model fit of the hypothesized four-factor structure was examined using confirmatory ...
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#1Giulia Mazzaschi (University of Parma)H-Index: 8
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Abstract Background The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) in the era of targeted- (TT) and immuno- (IT) therapy remains controversial. Design The primary objective of the present systematic, performed according to PRISMA guidelines review, was to assess the prevalence of CN in mRCC patients enrolled in TT/IT randomized phase II/III clinical trials (RCTs) or expanded access programs (EAPs). Medline database was searched from 2003 to 2019 for studies ...
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#1Renpei Kato (Iwate Medical University)H-Index: 6
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Abstract This study aimed to identify novel prognostic biomarker for advanced renal cell carcinoma (RCC) patients treated with anti-PD-1 therapy, using quantitative multi-immunofluorescence (IF) analysis of tumor immunity. Twenty-five consecutive patients who had metastatic or unresectable RCC treated with anti-PD-1 therapy were studied. The patients were divided into a responder group (n = 12) and a non-responder group (n = 13). Quantitative multi-IF staining was performed on biopsy or surgical...
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#1Eric C. Umbreit (University of Texas MD Anderson Cancer Center)H-Index: 2
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The management of metastatic renal cell carcinoma (mRCC) continues to be a therapeutic challenge; however, the options for systemic therapy in this setting have exploded over the past 20 years. From the advent of toxic cytokine therapy to the subsequent discovery of targeted therapy (TT) and immune checkpoint inhibitors, the landscape of viable treatment options continues to progress. With the arrival of cytokine therapy, two randomized trials demonstrated a survival benefit for upfront cytoredu...
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