Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation

Bamias, Aristotle; Escudier, Bernard; Sternberg, Cora N.; Zagouri, Flora; Dellis, Athanasios; Djavan, Bob; Tzannis, Kimon; Kontovinis, Loukas; Stravodimos, Konstantinos; Papatsoris, Athanasios; Mitropoulos, Dionysios; Deliveliotis, Ch.; Dimopoulos, Meletios Α.; Constantinides, C.

doi:10.1634/theoncologist.2016-0435

Cited by 75 publications

(67 citation statements)

References 100 publications

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“…The subject investigated should not be restricted to mRCC – all solid tumors can be included to verify our results. As recommended by the European Association of Urology, European Multidisciplinary Congress on Urological Cancers and National Comprehensive Cancer Network, sorafenib is indeed no longer the usual treatment of choice for the second‐line setting of mRCC in 2018 . However, patients in the current study were treated between April 2006 and April 2011, when sorafenib was still the standard of care second‐line treatment for mRCC.…”

Section: Discussionmentioning

confidence: 98%

“…As recommended by the European Association of Urology, European Multidisciplinary Congress on Urological Cancers and National Comprehensive Cancer Network, sorafenib is indeed no longer the usual treatment of choice for the second-line setting of mRCC in 2018. 29 However, patients in the current study were treated between April 2006 and April 2011, when sorafenib was still the standard of care second-line treatment for mRCC. Furthermore, as the first approved TKI agent for mRCC, sorafenib has a common mechanism with other TKI drugs, thus we consider the present results are common sense in the era of targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

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Tumor growth velocity: A modified tumor growth rate defining tumor progression during sorafenib treatment in patients with metastatic renal cell carcinoma

Wang

Guang

et al. 2018

Int J of Urology

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Objectives To investigate the role of tumor growth velocity in defining tumor progression in metastatic renal cell carcinoma patients treated with the vascular endothelial growth factor tyrosine kinase inhibitor, sorafenib. Methods A modified calculation for tumor growth velocity was introduced to evaluate the tumor growth velocity, before and after sorafenib withdrawal. Known prognostic factors together with tumor growth velocity before drug withdrawal and tumor growth velocity after drug withdrawal were compared using a χ2‐test from a contingency table, and partial likelihood test from a Cox regression model for overall survival. Results A total of 114 patients who reached progressive disease and withdrew from sorafenib were enrolled after a median follow‐up period of 107.8 months. Tumor growth velocity before drug withdrawal was 7.347 ± 4.040, and tumor growth velocity after drug withdrawal was 11.647 ± 5.937 (P < 0.001). Higher tumor growth velocity before drug withdrawal was correlated with a higher risk Memorial Sloan Kettering Cancer Center score (P = 0.022), Karnofsky Performance Status <80 (P = 0.028), non‐clear cell carcinoma (P = 0.037), higher tumor nucleus grade (P < 0.001) and best treatment response (P < 0.001). Patients with tumor growth velocity before drug withdrawal >5.0 had shorter overall survival (P < 0.001). On multivariate analysis, factors associated with overall survival were high/intermediate Memorial Sloan Kettering Cancer Center risk score (hazard ratio 2.119, P = 0.006), non‐clear histological subtype (hazard ratio 1.900, P = 0.031), tumor growth velocity before drug withdrawal ≥5.0 (hazard ratio 2.758, P < 0.001) and progressive disease as best response (hazard ratio 2.069, P = 0.001). Conclusions Significantly faster tumor growth can be observed if sorafenib is discontinued in the case of disease progression. Thus, we suggest not to withdraw targeted agents until tumor growth velocity is >5.0.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Tumor growth velocity: A modified tumor growth rate defining tumor progression during sorafenib treatment in patients with metastatic renal cell carcinoma

Wang

Guang

et al. 2018

Int J of Urology

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“…1L, first line; 2L, second line; CTLA-4, cytotoxic T lymphocyte-associated protein 4; ICI, immune checkpoint inhibitors; mOS, median overall survival; mPFS, median progression-free survival; PD-1, programmed death-1; PD-L1, programmed death ligand-1; VEGF, vascular endothelial growth factor TKI, tyrosine kinase inhibitor. Pazopanib is a VEGFR-TKI which has been approved for first-line treatment of patients with IMDC low-risk disease in Japan [5], and pazopanib-related TLS in mRCC has previously been reported [11]. Pazopanib is almost completely (>99.9%) bound to serum albumin, and a low serum albumin level may lead to a higher free fraction of pazopanib, and this may result in a higher toxicity of pazopanib.…”

Section: Discussionmentioning

confidence: 99%

Pazopanib after Nivolumab-Induced Tumor Lysis Syndrome in a Patient with Metastatic Clear-Cell Renal Cell Carcinoma

Narukawa¹,

Hongo²,

Fujihara³

et al. 2020

Case Rep Oncol

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Nivolumab, a programmed death-1 checkpoint inhibitor, is worldwide available for metastatic renal cell carcinoma (mRCC). Limited data exist on the response to vascular endothelial growth factor receptor-tyrosine kinase inhibitor (TKI) therapy after administration of nivolumab. In this case study, we report on a patient with tumor lysis syndrome (TLS), which was induced by pazopanib after the administration of nivolumab. A 69-year-old woman with a primary diagnosis of mRCC received pazopanib as a fourth-line therapy, after sunitinib, axitinib, and nivolumab as first-, second-, and third-line therapies, respectively. Two weeks after the administration of pazopanib, she presented to the emergency room of our institution, complaining of fatigue associated with nausea and diarrhea. Her laboratory results showed hyperphosphatemia, hyperuricemia, hypocalcemia, and possible acute kidney injury; the results were consistent with TLS. Our case report highlights TLS as a potential reaction to pazopanib following nivolumab; and we consider careful observation is necessary when administering TKI after immune checkpoint inhibitors.

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“…We also searched for articles with level of evidence (LoE) I not included in the publications retrieved by our search. Detailed description of our methodology has been published elsewhere (13). Our algorithm was based on the data regarding temporary management of RCC.…”

Section: Forum Of Clinical Oncologymentioning

confidence: 99%

“…In an effort to develop intergroup guidelines, the Hellenic Genito-Urinary Cancer Group has adapted a novel methodology of systematic review and critical evaluation of existing guidelines, instead of developing its own guidelines (12,13). In order to develop a therapeutic algorithm for RCC, we conducted a systematic review of the existing guidelines in MEDLINE according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement.…”

Section: Introductionmentioning

confidence: 99%

Developing an algorithm for the management of Renal Cell Carcinoma: focus on metastatic disease

Kyriazoglou

Dimitriadis

Bamias

2017

Forum of Clinical Oncology

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© De Gruyter Open Keywords: Renal cell carcinoma • Metastatic Disease • Therapeutic algorithmGeneral Hospital Alexandra, Athens, Greece Anastasios Kyriazoglou*, Ioannis Dimitriadis, Aristotelis BamiasThe treatment paradigm in renal cell carcinoma (RCC) is rapidly changing. The incidental finding of small renal tumours combined with the development of novel therapeutic agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin (mTOR) pathways or inhibiting the interaction of the programmed death 1 (PD 1) receptor with its ligand have dramatically improved the prognosis of patients suffering from this malignancy. At the same time, the availability of multiple effective options with similar indications complicates the development and applicability of guidelines in this disease. We conducted a systematic review of the existing guidelines. Our study revealed areas of agreement as well as of discrepancies amongst the published scientific papers included. By critically evaluating these areas, we developed a therapeutic algorithm for RCC. We suggest that this methodology can define the practices of wide applicability and areas of future research.

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Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation

Abstract: Currently, there is uncertainity on the role of surgery in MRCC and on the choice of available guidelines in relapsed RCC. The best practice is individualization of targeted therapies. Systematic review of guidelines can help to identify unmet medical needs and areas of future research.

Cited by 75 publications

References 100 publications

Tumor growth velocity: A modified tumor growth rate defining tumor progression during sorafenib treatment in patients with metastatic renal cell carcinoma

Tumor growth velocity: A modified tumor growth rate defining tumor progression during sorafenib treatment in patients with metastatic renal cell carcinoma

Pazopanib after Nivolumab-Induced Tumor Lysis Syndrome in a Patient with Metastatic Clear-Cell Renal Cell Carcinoma

Developing an algorithm for the management of Renal Cell Carcinoma: focus on metastatic disease

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