Radiographical efficacy of systemic treatment for bone metastasis from renal cell carcinoma

Abstract

Enlarged bone metastasis from renal cell carcinoma (RCC) can cause skeletal-related events, and thus treatment to inhibit the growth of bone metastases is often required. Although radiotherapy for RCC bone metastases can achieve a certain degree of local control, evidence is lacking regarding the effects of systemic therapy to improve bone metastasis. The present study aimed to assess the treatment efficacy of targeted therapy and immune checkpoint inhibitors, and to determine whether systemic therapy without radiotherapy can shrink bone metastases of RCC. The present study retrospectively reviewed 44 patients with RCC with bone metastases treated via systemic therapy, including targeted therapy or immune checkpoint inhibitors. Patients were divided into two groups: Those who underwent systemic therapy with radiotherapy for bone lesions (n=29); and those who underwent systemic therapy without radiotherapy for bone lesions (n=15). The radiographical efficacy of systemic therapy and the time to progression of bone metastases were compared between groups. The overall response rate of systemic therapy with radiotherapy was 44%, and in total, 13 patients demonstrated a partial response. Only one patient (6%) had a partial response among those who were treated via systemic therapy without radiotherapy. The time to progression of bone metastasis was 9.5 and 2.1 months in patients treated with and without radiotherapy, respectively (P<0.0001). Collectively, the present results suggested that targeted therapy or immune checkpoint inhibitors without radiotherapy had only a slight effect on bone metastasis control.

Clinical outcomes and prognostic factors following the surgical resection of renal cell carcinoma spinal metastases

“…12,13 Even recently approved systemic therapies, including mTT and/or treatment with ICIs, have a limited effect on the control of bone metastasis. 27 Metastasectomy of bone lesions, especially in the spine, has a positive impact on prolonged survival, as well as improved PS because it decreases SREs, including intractable pain and paralysis. Our study is unique in terms of reporting postoperative survival after spinal metastasectomy and identifying risk factors for poor prognosis in multivariate analysis, with the largest case series of 65 patients.…”

“…Bone metastases were reported as risk factors associated with short‐term survival in patients with metastatic RCC in the cytokine 26 and postcytokine era 12,13 . Even recently approved systemic therapies, including mTT and/or treatment with ICIs, have a limited effect on the control of bone metastasis 27 . Metastasectomy of bone lesions, especially in the spine, has a positive impact on prolonged survival, as well as improved PS because it decreases SREs, including intractable pain and paralysis.…”

Immune Checkpoint Inhibitor Therapy for Bone Metastases: Specific Microenvironment and Current Situation

“…There is a case report that nivolumab monotherapy relieved bone metastases in a metastatic RCC patient who underwent radical nephrectomy [ 142 ]. Negishi et al found that ICI monotherapy had limited effects on bone metastases, which may be related to the decrease of PD-L1 expression in bone metastases, while controlled bone metastases and reduced incidence of skeletal-related events emerged when using radiotherapy combined with ICI [ 143 , 144 ]. A case report described the therapy of CT-guided percutaneous cryoablation combined with local administration of nivolumab to the primary tumor, which augmented the systemic immune response to elicit against bone metastases and made the uptake of metastatic bone lesions decrease in PET scan [ 145 ].…”

Case report: Complete remission of bone metastasis from renal cell carcinoma in histopathological examination after treatment with immune checkpoint inhibitors

“…The quality of life (QoL) and prognosis of patients with mRCC are worsened by SRE ( 4 , 5 ), and bone metastasis is a poor prognostic factor ( 6 – 8 ). However, in recent years, the development of immune checkpoint inhibitors (ICIs) has improved the prognosis of mRCC in some clinical trials ( 9 , 10 ), and ICIs have become the standard treatment ( 11 ). In mRCC patients with intermediate-risk/poor-risk by the International Metastatic RCC Database Consortium (IMDC) risk classification ( 12 ), the 5-year OS rate was dramatically improved to 43% with ICI treatment ( 13 ).…”