Prognostic Factors for Overall Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor–Targeted Agents: Results From a Large, Multicenter Study

Heng, Daniel Yick Chin; Xie, Wanling; Regan, Meredith M.; Warren, Mark; Golshayan, Ali Reza; Sahi, Chakshu; Eigl, Bernhard J.; Ruether, J. Dean; Cheng, Tina; North, Scott; Venner, Peter; Knox, Jennifer J.; N., Kim; Kollmannsberger, Christian; McDermott, David F.; Oh, William K.; Atkins, Michael B.; Bukowski, Ronald M.; Rini, Brian I.; Choueiri, Toni K.

doi:10.1200/jco.2008.21.4809

Cited by 1,861 publications

(1,549 citation statements)

References 24 publications

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“…Heng et al [76] recently expanded upon the Motzer criteria by analyzing a cohort of 645 patients with mRCC (all subtypes) treated with VEGF-targeted agents. They found that additional prognostic value for overall survival was gained from the use of higher absolute neutrophil and platelet counts (greater than the upper limit of normal), allowing for creation of three risk categories.…”

Section: Predicting Response To Systemic Therapymentioning

confidence: 99%

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Tumor Biology and Prognostic Factors in Renal Cell Carcinoma

2011

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In the past 15 years, there has been an increased understanding of the tumor biology of renal cell carcinoma (RCC). The identification of vascular endothelial growth factor (VEGF), its related receptor (VEGFR), and the mammalian target of rapamycin as dysregulated signaling pathways in the development and progression of RCC has resulted in the rational development of pharmaceutical agents capable of specifically targeting key steps in these pathways. Clinical trials have demonstrated survival benefit with these agents, particularly in clear cell RCC patients. However, metastatic RCC will progress in all patients, resulting in a critical need to determine patient risk and optimize treatment. The goal of this article is to highlight the significant breakthroughs made in understanding the critical genetic alterations and signaling pathways underlying the pathogenesis of RCC. The discovery of prognostic factors and development of comprehensive nomograms to stratify patient risk and predictive biomarkers to facilitate individualized treatment selection and predict patient response to therapy also are reviewed. The Oncologist 2011;16(suppl 2):4 -13

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Section: Predicting Response To Systemic Therapymentioning

confidence: 99%

“…Several nomograms have been developed for localized and metastatic disease using factors such as histology, stage, symptoms, performance status (PS), and tumor size (Table 3) [36,[65][66][67][68][69][70][71][72][73][74][75][76]. In 2001, Yaycioglu et al [65] developed a prognostic model independent of pathological stage.…”

Section: Prognostic Schemamentioning

confidence: 99%

Tumor Biology and Prognostic Factors in Renal Cell Carcinoma

2011

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“…A study conducted by the MD Anderson group has also examined who will benefit from CRN and concluded that survival differences between CRN and non-CRN patients did not begin to diverge until 8.5 months [31]. There are statistical models available in predicting the OS in patients with mRCC treated with TT, and maybe, one can make use of these models while selecting patients for CRN [32]. There is no surprise that the ongoing CARMENA and EORTC SURTIME prospective trials have recruited patients with good performance status.…”

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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“…Ce système d'établissement du pronostic a été élaboré à l'époque des cytokines. À l'époque des traitements ciblés, Heng et ses collaborateurs ont publié un score similaire, mais pas tout à fait identique, pour la stratification en fonction du risque, score qui peut s'appliquer à tous les patients recevant un traitement de nos jours 10 .…”

Section: Traitement De Première Ligneunclassified

Prognostic Factors for Overall Survival in Patients With Metastatic Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor–Targeted Agents: Results From a Large, Multicenter Study

Abstract: This model validates components of the MSKCC model with the addition of platelet and neutrophil counts and can be incorporated into patient care and into clinical trials that use VEGF-targeted agents.

Cited by 1,861 publications

References 24 publications

Tumor Biology and Prognostic Factors in Renal Cell Carcinoma

Tumor Biology and Prognostic Factors in Renal Cell Carcinoma

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

Prise en charge du cancer du rein de stade avancé : Mise à jour 2013 des lignes directrices consensuelles du Forum canadien sur le cancer du rein

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