A systematic review: Role of systemic therapy on treatment and prevention of brain metastasis in renal cell carcinoma

Abstract

Aim To define the inclusion/exclusion status of patients with brain metastasis in phase-III clinical trials and the effect of systemic therapies in metastatic renal cell cancer patients with brain metastasis. Methods “kidney neoplasms”[MeSH Terms] OR (“kidney”[All Fields] AND “neoplasms”[All Fields]) OR “kidney neoplasms”[All Fields] OR (“kidney”[All Fields] AND “cancer”[All Fields]) OR “kidney cancer”[All Fields] AND “brain metastasis” were used for searching “PubMed” electronic database and “clinicaltrials.gov” website. Results Five of 19 landmark phase-III clinical trials included patients with stable or asymptomatic brain metastasis and there was no data about outcomes of brain metastasis. The effect of systemic therapy on prevention of brain metastasis in renal cell cancer was evaluated in four studies. Two studies showed that the incidence of brain metastasis decreased, while the other two studies showed no effect of antiangiogenic agents on the prevention of brain metastasis in patients with renal cell cancer. There were 10 trials regarding systemic therapy of renal cell cancer brain metastasis. The overall response rate improved through a combination of targeted therapies and local treatment. The results of the trials studying the effect of tyrosine kinase inhibitors without local treatment were controversial. None of the ongoing clinical trials included patients with active brain metastasis. Conclusion In metastatic renal cell cancer patients with brain metastasis, the overall response rate improved with the combination of targeted agents and local treatment. Further trials are needed to evaluate the effect of systemic treatment on the prevention or treatment of brain metastasis in patients with renal cell cancer.

A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19

“… 46 , 47 , 48 In our previous case-report, we observed that nivolumab within the last seven days before diagnosis provided a good clinical course of COVID-19 in a seventy-five-year-old female malign melanoma patient. 49 Furthermore, there are still ongoing clinical trials investigating the effect of nivolumab on COVID-19 (NCT04413838, NCT04343144, NCT04356508). One of the main concerns regarding the use of ICIs during pandemic is that the clinical findings of pneumonitis due to ICIs or pneumonia of COVID-19 may confuse the patient management.…”

Clinical Outcomes in COVID-19 Patients Treated with Immunotherapy

“…A systemic review and meta-analysis of COVID-19 patients with cancer who were treated with chemotherapy found that there was an increased risk of death (OR: 1.9; 95% confidence interval: 1.3–2.7), after adjusting for confounding variables, compared to patients that received targeted therapies, IMT, surgery or radiotherapy [ 49 ]. Another meta-analysis of 6042 patients with COVID-19 showed that ICIs received within 30 days before diagnosis did not increase mortality or the severity of disease in affected patients [ 50 ].…”

Metastatic Renal Cell Carcinoma to the Cerebrum in a Patient With Lynch Syndrome: A Case Report

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