scholarly journals Survival Benefit With Resection of Brain Metastases From Renal Cell Carcinoma in the Setting of Molecular Targeted Therapy and Immune Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Mark A Damante ◽  
Kristin Huntoon ◽  
Thomas Olencki ◽  
Bradley Elder
Keyword(s):  
Renal Cell Carcinoma ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Survival Benefit ◽  
Treatment Modalities ◽  
Targeted Agents ◽  
Systemic Treatments ◽  
Molecular Targeted Agents

Abstract INTRODUCTION Patient survival with renal cell carcinoma (RCC) has improved with the use of molecular targeted agents and immunotherapy. Given the potential activity of these agents in treating brain metastases (BM), the role of aggressive local management with surgery and/or radiation may diminish. This study evaluated the benefit of aggressive local therapy of RCC BM in the setting of molecular targeted agents and/or immunotherapy. METHODS A retrospective single-center review between 2011 and 2018 identified 1659 patients treated for RCC. The study group included patients that developed BM and received molecular targeted agents and/or immunotherapy during the course of their disease. Data analyzed included demographic information, systemic treatments, and local BM treatment modalities. Kaplan-Meier curves and log-rank values were used to assess progression free survival (PFS) and overall survival (OS) following RCC and BM diagnosis. RESULTS Of 1659 patients, 108 (6.5%) were diagnosed with BM during their clinical course. Mean OS from diagnosis of RCC for these 108 patients was 44.5 ± 40.1 mo, with 1-, 3-, and 5-yr survival of 76.9%, 43.3%, and 38.1%. All patients were treated with molecular targeted agents and/or immunotherapy. OS was analyzed based on three treatment groups: systemic therapy only (26.1 ± 31.2, n = 21), systemic and radiotherapy (41.4 ± 34.9, n = 54), and systemic and radiotherapy plus BM resection (61.4 ± 46.9, n = 33). Survival benefit was seen with surgery compared to systemic therapy alone (P = .002) and the systemic and radiotherapy cohort (P = .038). PFS did not differ significantly between cohorts. Variables such as pre-treatment performance status (ECOG P = .085; KPS P = .231), number of BM (median 2, P = .685) and status of systemic disease at the time of BM diagnosis did not differ significantly. CONCLUSION In the setting of molecular targeted agents and immunotherapy, BM resection maximizes OS in surgical candidates. Prospective clinical trials are needed to elucidate activity of newer molecular targeted agents and immunotherapy in RCC BM treatment.

scholarly journals Management of metastatic renal cell carcinoma – mini review

2015 ◽  
Vol 2 (2) ◽  
pp. 75-83 ◽  
Author(s):  
Anubha Bharthuar ◽  
Himanshu Pandey ◽  
Swapan Sood
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Clinical Outcomes ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Novel Agents ◽  
Targeted Agents ◽  
Clinical Variability ◽  
Biological Heterogeneity ◽  
Molecular Targeted Agents

The management of metastatic renal cell carcinoma (mRCC) has evolved considerably in the last decade. A number of different systemic molecular targeted agents that have been recently approved have improved the survival of patients with mRCC. This mini-review focuses on the implementation of multi-modality therapy in the management of mRCC and the approved indications of the various available novel agents. These novel agents have expanded our armamentarium and improved clinical outcomes of this challenging disease that has considerable biological heterogeneity and clinical variability.  

Single institution experience on papillary renal cell carcinoma PD-1/PD-L1 expression, pathological analysis, and outcomes after nephrectomy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16048-e16048
Author(s):  
Bradley Curtis Carthon ◽  
Manal Tabba ◽  
Wayne Harris ◽  
Omer Kucuk ◽  
Viraj A. Master ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Clear Cell ◽  
Papillary Renal Cell Carcinoma ◽  
Pathological Examination ◽  
Primary Tumors ◽  
Systemic Treatments ◽  
Papillary Rcc

e16048 Background: The PD-1/PD-L1 pathway plays an important role in tumor growth and tolerance among renal cancer cells. Renal cell carcinoma (RCC) consists of several different histological subtypes, including clear cell and non-clear cell varieties. Papillary RCC is the most common non-clear cell type and accounts for almost 13% of RCC cases. Our center has a large volume of papillary RCC patients treated by nephrectomy or with systemic therapy. This retrospective study examines pathological criteria, outcomes, and PD-1/PD-L1 expression in a defined cohort. Methods: Institutional review board (IRB) approval was obtained to access and retrospectively review clinical and pathological data of patients that presented with papillary RCC and had a partial or radial nephrectomy during a 1 year duration at our institution. We collected data on survival, systemic treatments, and pathological staging. Tumor samples from the patients were also stained and analyzed for PD-1 and PD-L1 expression. Results: 31 patients were identified with papillary histology after nephrectomy. 45% (14/31) of the patients underwent a radial nephrectomy while 55% (17/31) underwent a partial nephrectomy. Of these 31 patients, 23 had tumor slides available for staining and review. 65% (15/23) of the tumor samples were type 1 papillary RCC, and 35% (8/23) were type 2. PD-L1 was expressed in 13% (3/23) of the cases and PD-1 was expressed in 52% (12/23) of the cases. 71% of the patients were pT1 and 84% of the patients were alive at 5 years. Only 1/31 patients required use of systemic therapy. 74% (17/23) of patients were African American. Conclusions: Patients undergoing nephrectomy for papillary RCC at our institution commonly had small primary tumors with excellent survival. 46% of the tumors expressed PD-1, whereas only 12% expressed PD-L1. Trials that study the inhibition of the PD-1/ PD-L1 pathway may be helpful in strategies for treating both localized and metastatic papillary RCC. Further genomic and pathological examination of additional samples is currently underway.

scholarly journals The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

2012 ◽  
Vol 116 (5) ◽  
pp. 978-983 ◽  
Author(s):  
D. Clay Cochran ◽  
Michael D. Chan ◽  
Mebea Aklilu ◽  
James F. Lovato ◽  
Natalie K. Alphonse ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Gamma Knife ◽  
Local Control ◽  
Renal Cell ◽  
Local Failure ◽  
Targeted Agents ◽  
Distant Failure

Object Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS. Methods Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13–24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival. Results Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume. Conclusions Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.

Efficacy of systemic therapy for metastatic renal cell carcinoma in patients over 75 years of age.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16080-e16080
Author(s):  
Ryuichi Mizuno ◽  
Kimiharu Takamatsu ◽  
Nozomi Hayakawa ◽  
Takeo Kosaka ◽  
Nobuyuki Tanaka ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Systemic Therapy ◽  
Renal Cell ◽  
Systemic Treatment ◽  
The Elderly ◽  
Line Treatment ◽  
Targeted Agents ◽  
First Line ◽  
First Line Treatment

e16080 Background: In the last decade, approval of targeted agents and immune checkpoint inhibitors (ICI) have dramatically changed the scenario of systemic treatment of metastatic renal cell carcinoma (mRCC) with improved survival. Although elderly individuals represent a consistent proportion, clinical trials have not directly compared the efficacy and safety of targeted agents in the elderly population. Methods: A total of 195 patients were retrospectively reviewed. All patients received systemic therapy for mRCC at Keio University hospital in Japan (Institutional review board approval No 2013-0425). Patients were divided into two groups (≥75 or < 75 years) according to their age at the time of systemic therapy initiation. The disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were compared between the two cohorts. Results: The elderly cohort (≥75 years old) comprised of 42 patients (21.5%). The DCR for first line treatment in patients ≥75 years old and < 75 years old was 75.0 and 76.2 %, respectively (p = 0.8728). The median PFS for first line treatment in patients ≥75 years old and < 75 years old was 10.7 (95% CI 7.5–20.7) and 11.6 (95% CI 9.7–16.3) months, respectively (p = 0.6074). The median OS for systemic treatment in patients ≥75 years old and < 75 years old was 37.3 (95% CI 18.0–65.2) and 45.5 (95% CI 35.1–56.8) months, respectively (p = 0.0424). Conclusions: Systemic treatment for mRCC was feasible and effective in Japanese patients over 75 years of age.

Changes in Renal Function of Patients with Metastatic Renal Cell Carcinoma During Treatment with Molecular-Targeted Agents

2015 ◽  
Vol 11 (3) ◽  
pp. 329-335 ◽  
Author(s):  
Hideaki Miyake ◽  
Mototsugu Muramaki ◽  
Satoshi Imai ◽  
Ken-ichi Harada ◽  
Masato Fujisawa
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Targeted Agents ◽  
Molecular Targeted Agents
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