Hyponatraemia as a risk factor in renal cell carcinoma treatment with nivolumab.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14528-e14528
Author(s):  
Christian Grohe ◽  
Simon Gwynn ◽  
Richard Evans
Keyword(s):  
Renal Cell Carcinoma ◽  
Risk Factor ◽  
Cell Carcinoma ◽  
Cancer Patients ◽  
Renal Cell ◽  
Negative Impact ◽  
Correct Diagnosis ◽  
Phase Iii ◽  
Cancer Data ◽  
Diagnosis And Management

e14528 Background: In the general hospital population, the incidence of hyponatraemia is reported at varying levels up to 40%. In a retrospective analysis of 3,357 cancer patients (4,702 admissions) hyponatraemia was noted in 47%. A strong and independent association between hyponatraemia and longer length of stay with higher mortality was highlighted. The investigation, diagnosis and management of hyponatraemia is often inadequate in cancer patients. This poster offers recommendations for the improved diagnosis and management of hyponatraemia patients with renal cell carcinoma treated with nivolumab. Hyponatraemia occurs in 20% of patients with renal cell carcinoma and is associated with reduced survival. Patients with hyponatraemia before treatment had a median overall survival of 5.5 months compared with 18.6 months for those with normal sodium values. Methods: Key publications concerning the incidence, evaluation and management of hyponatraemia in patients with RCC as well as unpublished data from Phase III registration studies were reviewed and the data examined to consider impacts on current oncology practice Results: Hyponatraemia is a negative prognostic indicator in cancer. Data show that effective treatment of hyponatraemia in cancer patients reduces mortality. It has been shown in vitro that a hypotonic environment is pro-tumorigenic, whereas a slightly hypertonic environment may have a negative impact on clonogenicity. This may suggest a more complex impact on outcomes in cancer patients than simply the mortality associated with hyponatraemia. The presentation of hyponatraemia in cancer patients is complex and may be caused by the direct impacts of disease, iatrogenic factors or different treatment approaches Conclusions: Hyponatraemia is the most commonly occurring electrolyte disturbance in cancer patients, potentially representing a modifiable risk factor, with resultant impact on patient survival. The clinician should be aware of the potential for Immuno-oncology agents to precipitate hyponatraemia and consider that the correct diagnosis and management of hyponatraemia may further enhance efficacy and survival.

Risk of hyperglycemia attributable to everolimus in renal cell and non–renal cell carcinoma patients: A meta-analysis.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 515-515
Author(s):  
Kevin Y Xu ◽  
Raji Shameem ◽  
Shenhong Wu
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Cancer Patients ◽  
Renal Cell ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Phase Iii ◽  
Close Monitoring ◽  
High Grade ◽  
Tumor Types

515 Background: Everolimus has been used widely in cancer patients and is associated with the development of hyperglycemia. Due to confounding factors, everolimus’ specific impact on hyperglycemia has not been well understood. We performed a meta-analysis to determine the risk of hyperglycemia attributable to everolimus in cancer patients of varying tumor types. Methods: PubMed and ASCO conference abstracts up to June 2015 were systematically searched. Eligible studies included randomized controlled trials (RCTs) in which everolimus was compared to placebo in cancer patients with or without additional cancer therapies. Heterogeneity tests were performed to examine between-study differences in hyperglycemia. The incidence and relative risk of all-grade and high-grade hyperglycemia attributable to everolimus were determined using random- or fixed-effects models. Results: A total of 7 phase III and 2 phase II RCTs with various tumors were included in our analysis. Everolimus significantly increased the risk of all-grade (RR = 2.60, 95% CI: 2.03-3.31, P < 0.001) and high-grade (RR = 3.00, 95% CI: 1.72-5.23; P < 0.001) hyperglycemia. The incidences of all-grade and high-grade hyperglycemia attributable to everolimus were 6.8% (95% CI: 3.4-13.2%) and 2.5% (95%: 1.2-4.9%) respectively. The everolimus-specific risk of all-grade hyperglycemia varied significantly with tumor types (P < 0.001), with the highest incidence seen in renal cell carcinoma (27.2%, 95% CI: 22.2-32.8%) and the lowest in breast cancer (3.3%, 95% CI: 1.3-8.2%). No significant variation was found between everolimus alone or everolimus in combination with other agents. Similar results were also found for the risk of high-grade hyperglycemia attributable to everolimus. Conclusions: The specific contribution of everolimus to both all-grade and high-grade hyperglycemia may be modified significantly by tumor types. Close monitoring should be given to patients with renal cell carcinoma.

Hyponatraemia as an unrecognised risk factor in non-small cell lung cancer (NSCLC) treatment with nivolumab.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14526-e14526 ◽  
Author(s):  
Christian Grohe ◽  
Simon Gwynn ◽  
Richard Evans
Keyword(s):  
Lung Cancer ◽  
Risk Factor ◽  
Cancer Patients ◽  
Negative Impact ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Prognostic Indicator ◽  
Common Side Effect ◽  
Diagnosis And Management

e14526 Background: The investigation, diagnosis and management of hyponatraemia is often inadequate in cancer patients. In a retrospective analysis of 3,357 cancer patients hyponatraemia was noted in up to 47%. A strong and independent association between hyponatremia and longer length of stay with higher mortality was highlighted and associated with standard chemotherapy. No pooled data, however are available on the effect of immuno-oncology (IO) treatment options such as nivolumab on HN in lung cancer patients. Methods: Key publications and data registries concerning the incidence, evaluation and management of hyponatraemia in patients with NSCLC and treated with nivolumab were analysed. Our data show that hyponatraemia is a common side effect and around 5.2% of patients treated with nivolumab progressed from baseline to a Grade 3 / 4 adverse event. Results: The aetiology of hyponatraemia in cancer patients is complex, appearing to be a negative prognostic indicator. Existing data show that effective treatment of hyponatraemia in cancer patients may be associated with reduced mortality. In addition, the role of sodium on the cancer cell cycle requires further investigation. It has been shown in vitro that a hypotonic environment is pro-tumorigenic, whereas a slightly hypertonic environment may have a negative impact on clonogenicity in prostate cancer cells. This may suggest a more complex interaction impacting on cancer patients other than a simplistic mortality association with hyponatraemia. Nivolumab treatment is associated with HN and particular attention should be paid to the correction of symptomatic HN in these patients. Conclusions: Hyponatraemia is the most commonly occurring electrolyte disturbance in cancer patients and may represent a modifiable risk factor impacting patient survival. The clinician should be aware of the potential for IO therapies to precipitate hyponatraemia. Consideration of the correct diagnosis and management of hyponatraemia may further enhance the prognosis of NSCLC patients treated with IO agents.

Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial

The Lancet ◽  
2008 ◽  
Vol 372 (9637) ◽  
pp. 449-456 ◽  
Author(s):  
Robert J Motzer ◽  
Bernard Escudier ◽  
Stéphane Oudard ◽  
Thomas E Hutson ◽  
Camillo Porta ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Phase Iii ◽  
Advanced Renal Cell Carcinoma ◽  
Double Blind ◽  
Phase Iii Trial

scholarly journals Cabozantinib for the Management of Metastatic Clear Cell Renal Cell Carcinoma

2018 ◽  
Vol 5 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Sharon Del Vecchio ◽  
Robert J Ellis
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Progression Free Survival ◽  
Current Treatment ◽  
Phase Iii ◽  
Solid Organ ◽  
Cell Renal Cell Carcinoma ◽  
Randomised Controlled

Cabozantinib is a multi-tyrosine kinase inhibitor used for the treatment of various solid-organ tumours. It was recently approved as a first- and second-line therapeutic for the management of advanced/metastatic renal cell carcinoma based on the results of two randomised controlled trials. The phase III METEOR trial compared cabozantinib against everolimus as a second- or greater line therapy and found benefits in progression-free and overall survival, and the phase II CABOSUN trial compared cabozantinib against sunitinib as a first-line therapeutic and found benefits in terms of progression-free survival. This review briefly summarises how cabozantinib fits into current treatment paradigms for the management of advanced renal cell carcinoma.

scholarly journals Axitinib versus placebo as an adjuvant treatment of renal cell carcinoma: results from the phase III, randomized ATLAS trial

2018 ◽  
Vol 29 (12) ◽  
pp. 2371-2378 ◽  
Author(s):  
M. Gross-Goupil ◽  
T.G. Kwon ◽  
M. Eto ◽  
D. Ye ◽  
H. Miyake ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Adjuvant Treatment ◽  
Renal Cell ◽  
Phase Iii
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