Immunotherapy for advanced renal cell cancer

Coppin, Chris; Porzsolt, Franz; Kumpf, Julia; Coldman, Andrew J.; Wilt, Timothy J

doi:10.1002/14651858.cd001425

Cited by 187 publications

(210 citation statements)

References 78 publications

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“…Table 1 shows the 19.0 months; P < .001). The potential effect of those differences was adjusted for in multivariate Cox regression models.…”

Section: Resultsmentioning

confidence: 98%

“…During the study period, most patients received interferon, which was demonstrated to have a modest impact on survival. 19 Therefore, therapies other than cytoreductive nephrectomy and lymphadenectomy were unlikely to affect cancer-specific mortality rates. 20 Finally, it should be emphasized that the group of patients staged with a lymphadenectomy likely represents a heterogeneous group, because the decision to perform a lymphadenectomy might be based on idiosyncratic beliefs and situational factors.…”

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confidence: 99%

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Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Lughezzani

Capitanio

Jeldres

et al. 2009

Cancer

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BACKGROUND: Virtually all staging schemes aimed at predicting the prognosis of surgically treated patients diagnosed with metastatic renal cell carcinoma (MRCC) omit the use of lymph node stage. In the current study, the authors tested the prognostic significance of lymph node stage in patients with MRCC within a population‐based cohort of patients treated with cytoreductive nephrectomy to assess whether the inclusion of lymph node stage could improve the accuracy of cancer‐specific mortality predictions. METHODS: Within the Surveillance, Epidemiology, and End Results database, the authors identified 1153 patients who were treated with cytoreductive nephrectomy for MRCC, with (negative lymph nodes [N0] vs positive lymph nodes [N1‐2]) or without (unknown lymph node stage [Nx]) lymphadenectomy. Of 797 patients treated with lymphadenectomy, 42.9% were found to have lymph node metastases. Kaplan‐Meier plots and univariate and multivariate Cox regression analyses tested the statistical significance and the independent predictor status of lymph node stage, Fuhrman grade, tumor size, year of surgery, race, sex, and age in patients who underwent lymphadenectomy at the time of cytoreductive nephrectomy. RESULTS: At 3 years after cytoreductive nephrectomy, the cancer‐specific mortality‐free rates of N1‐2 versus N0 versus Nx patients were 14.4% versus 34.7% versus 34.0%, respectively. Lymph node stage represented the most informative variable and achieved independent predictor status in all multivariate models (P < .001). Consideration of lymph node stage added 3.2% accuracy to other predictors of cancer‐specific mortality. CONCLUSIONS: The findings of the current study indicate that lymph node stage should be considered in prognostic models. The TNM staging of MRCC patients also should rely on the stage of locoregional lymph nodes, because the 3‐year cancer‐specific mortality rates of lymph node‐negative and lymph node‐positive MRCC patients differ by as much as 20%. Cancer 2009. © 2009 American Cancer Society.

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“…Table 1 shows the 19.0 months; P < .001). The potential effect of those differences was adjusted for in multivariate Cox regression models.…”

Section: Resultsmentioning

confidence: 98%

mentioning

confidence: 99%

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Lughezzani

Capitanio

Jeldres

et al. 2009

Cancer

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“…[9,10] Until recently, standard treatment for mRCC has consisted of immunotherapy with either interleukin-2 (IL-2) or interferon-a (IFNa), both of which are associated with overall response rates (ORRs) of 5-20%, and significant clinical toxicities. [11][12][13][14][15] In randomized controlled trials, IFNa has been associated with a median overall survival (OS) of 12-19 months, [16][17][18] and highdose IL-2 can result in disease cure in 5-10% of patients. [19] Additionally, treatment options were scarce for those patients who progressed on cytokine therapy.…”

Section: Introductionmentioning

confidence: 99%

Axitinib for the Management of Metastatic Renal Cell Carcinoma

Escudier

Gore

2011

Drugs R D

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“…Many other drugs which could come under the umbrella of targeted therapy were approved in subsequent years (sorafenib, mTOR inhibitors, bevacizumab, pazopanib, axitinib and many others). These drugs showed improvement in the overall survival (OS), progression-free survival (PFS) and response rates as compared to immunotherapy [15][16][17][18]. With such a response, even concern has been raised about the delay in the treatment of TT caused by CRN.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

Khochikar

2016

Indian J Surg Oncol

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Renal cell carcinoma accounts for 3% of adult solid malignant tumours. Approximately 25% of the patients present with metastatic disease at presentation. In the era of immunotherapy (interferon alpha-2b and interleukin-2), studies showed significant survival benefit with cytoreductive nephrectomy (CRN) followed by interferon alpha-2b than interferon alpha 2-b alone. Introduction of targeted therapies (vascular endothelial growth factor receptor-tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors) in 2005 generated a great interest in the management of metastatic renal cell carcinoma (mRCC) as these drugs exhibited tumour shrinkage in the primary tumour as well as in the metastatic site/s. Though there is no level 1 evidence, many studies have shown the usefulness of cytoreductive nephrectomy along with targeted therapy as against to targeted therapy alone. This review is aimed at the rationale behind the cytoreductive nephrectomy in mRCC, the current evidence and what is in store for the future. A detailed search on the management of mRCC was carried out on MEDLINE, Embase, CANCERLIT and Cochrane Library databases using the key words Bcytoreductive nephrectomy^, Bimmunotherapy^and Btargeted therapy^since 1980 till 2015. Original articles, review articles, monograms, book chapters on metastatic renal cancer and textbooks on urologic oncology, oncology and urology were reviewed. Various international guidelines on this issue were also studied. An identical search was performed using the American Society of Clinical Oncology Abstract database. Trials in the progress or recently completed that were relevant to this paper were identified through clinicaltrials.gov. The latest information for new articles ahead of publication was last accessed in November 2015. CRN has remained an integral part to the management of metastatic renal cell carcinoma mainly for the patients with good performance status, life expectancy of more than 12 months and in the absence of adverse prognostic factors. It had shown measurable survival benefit in the era of immunotherapy (CRN + immunotherapy vs. immunotherapy alone). In the era of targeted therapy, many studies have shown significant survival benefit with CRN + targeted therapy. However, there is no clear level 1 evidence to support this. The ongoing trials (CARMENA and European Organisation for Research and Treatment of Cancer SURTIME) would perhaps guide us in the way in which we should manage mRCC disease in the future. Maybe we may find some answers on the issues of the effectiveness of targeted therapy, the timing of CRN and sequencing these treatment arms once the results of these ongoing and future trials are through.

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Immunotherapy for advanced renal cell cancer

Cited by 187 publications

References 78 publications

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Axitinib for the Management of Metastatic Renal Cell Carcinoma

Cytoreductive Surgery in the Management of Renal Tumours: Rationale, Current Evidence and Future Perspectives

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