Alberto C Pieretti1, Daniel D Shapiro1, Mary E Westerman1, Hyunsoo Hwang2, Xuemei Wang2, Luis A Segarra1, Matthew T Campbell3, Nizar M Tannir3, Eric Jonasch3, Surena F Matin1, Christopher G Wood1, Jose A Karam4. 1. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. 2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. 3. Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 4. Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: jakaram@mdanderson.org.
Abstract
OBJECTIVE: Tumor shrinkage of at least 10% after presurgical targeted molecular therapy (TMT) in renal cell carcinoma (RCC) patients has been associated with better overall survival (OS) outcomes. We characterized primary and metastatic tumor diameter response and OS in patients with metastatic clear cell RCC (ccRCC) who received preoperative TMT, immunotherapy, or both followed by deferred cytoreductive nephrectomy (dCN). MATERIALS AND METHODS: Patients with metastatic ccRCC (n = 198) who underwent preoperative therapy and dCN from 2005 to 2019 were identified retrospectively. Longest primary and metastatic tumor diameters were calculated using cross-sectional images obtained before systemic therapy and dCN using the Response Evaluation Criteria in Solid Tumors. Patients were stratified by tumor shrinkage of at least 10% in the primary and/or metastatic tumors after systemic therapy. The Kaplan-Meier method was used to estimate OS, and Cox proportional hazards models were used to assess the association of patient characteristics with OS. RESULTS: In total, 31.31% of patients had only metastatic tumor shrinkage (MTS) ≥ 10%, 8.08% had only primary tumor shrinkage (PTS) ≥ 10%, 32.32% had PTS and MTS ≥ 10%, and 28.28% had PTS/MTS < 10%. The median OS, number of patients with tumor shrinkage ≥ 10%, and International Metastatic Database Consortium (IMDC) scores were similar among the 3 systemic therapy groups (all P ≥ 0.80). Patients with MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% had significantly longer median OS compared to patients with PTS/MTS < 10% (P < 0.01). Patients with intermediate-risk IMDC scores had significantly longer median OS compared to patients in the poor-risk group. After adjusting for preoperative therapy and IMDC risk group, MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% were associated with better OS outcomes (HR 0.48 95% CI 0.32-0.73, P < 0.001; HR 0.48, 95% CI 0.23-0.98, P = 0.04; HR 0.44, 95% CI 0.29-0.67, P < 0.001, respectively). CONCLUSIONS: Intermediate risk score and shrinkage of at least 10% in the primary tumor, metastases, or both were associated with better OS outcomes in patients with metastatic ccRCC who underwent dCN independent of the type of preoperative systemic therapy.
OBJECTIVE: Tumor shrinkage of at least 10% after presurgical targeted molecular therapy (TMT) in renal cell carcinoma (RCC) patients has been associated with better overall survival (OS) outcomes. We characterized primary and metastatic tumor diameter response and OS in patients with metastatic clear cell RCC (ccRCC) who received preoperative TMT, immunotherapy, or both followed by deferred cytoreductive nephrectomy (dCN). MATERIALS AND METHODS: Patients with metastatic ccRCC (n = 198) who underwent preoperative therapy and dCN from 2005 to 2019 were identified retrospectively. Longest primary and metastatic tumor diameters were calculated using cross-sectional images obtained before systemic therapy and dCN using the Response Evaluation Criteria in Solid Tumors. Patients were stratified by tumor shrinkage of at least 10% in the primary and/or metastatic tumors after systemic therapy. The Kaplan-Meier method was used to estimate OS, and Cox proportional hazards models were used to assess the association of patient characteristics with OS. RESULTS: In total, 31.31% of patients had only metastatic tumor shrinkage (MTS) ≥ 10%, 8.08% had only primary tumor shrinkage (PTS) ≥ 10%, 32.32% had PTS and MTS ≥ 10%, and 28.28% had PTS/MTS < 10%. The median OS, number of patients with tumor shrinkage ≥ 10%, and International Metastatic Database Consortium (IMDC) scores were similar among the 3 systemic therapy groups (all P ≥ 0.80). Patients with MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% had significantly longer median OS compared to patients with PTS/MTS < 10% (P < 0.01). Patients with intermediate-risk IMDC scores had significantly longer median OS compared to patients in the poor-risk group. After adjusting for preoperative therapy and IMDC risk group, MTS ≥ 10%, PTS ≥ 10%, and PTS/MTS ≥ 10% were associated with better OS outcomes (HR 0.48 95% CI 0.32-0.73, P < 0.001; HR 0.48, 95% CI 0.23-0.98, P = 0.04; HR 0.44, 95% CI 0.29-0.67, P < 0.001, respectively). CONCLUSIONS: Intermediate risk score and shrinkage of at least 10% in the primary tumor, metastases, or both were associated with better OS outcomes in patients with metastatic ccRCC who underwent dCN independent of the type of preoperative systemic therapy.
Authors: Katherine M Krajewski; Yoko Franchetti; Mizuki Nishino; André P Fay; Nikhil Ramaiya; Annick D Van den Abbeele; Toni K Choueiri Journal: Oncologist Date: 2014-04-22
Authors: James J Hsieh; Mark P Purdue; Sabina Signoretti; Charles Swanton; Laurence Albiges; Manuela Schmidinger; Daniel Y Heng; James Larkin; Vincenzo Ficarra Journal: Nat Rev Dis Primers Date: 2017-03-09 Impact factor: 52.329
Authors: Brian I Rini; Elizabeth R Plimack; Viktor Stus; Rustem Gafanov; Robert Hawkins; Dmitry Nosov; Frédéric Pouliot; Boris Alekseev; Denis Soulières; Bohuslav Melichar; Ihor Vynnychenko; Anna Kryzhanivska; Igor Bondarenko; Sergio J Azevedo; Delphine Borchiellini; Cezary Szczylik; Maurice Markus; Raymond S McDermott; Jens Bedke; Sophie Tartas; Yen-Hwa Chang; Satoshi Tamada; Qiong Shou; Rodolfo F Perini; Mei Chen; Michael B Atkins; Thomas Powles Journal: N Engl J Med Date: 2019-02-16 Impact factor: 91.245
Authors: Robert J Motzer; Nizar M Tannir; David F McDermott; Osvaldo Arén Frontera; Bohuslav Melichar; Toni K Choueiri; Elizabeth R Plimack; Philippe Barthélémy; Camillo Porta; Saby George; Thomas Powles; Frede Donskov; Victoria Neiman; Christian K Kollmannsberger; Pamela Salman; Howard Gurney; Robert Hawkins; Alain Ravaud; Marc-Oliver Grimm; Sergio Bracarda; Carlos H Barrios; Yoshihiko Tomita; Daniel Castellano; Brian I Rini; Allen C Chen; Sabeen Mekan; M Brent McHenry; Megan Wind-Rotolo; Justin Doan; Padmanee Sharma; Hans J Hammers; Bernard Escudier Journal: N Engl J Med Date: 2018-03-21 Impact factor: 91.245
Authors: E Jason Abel; Stephen H Culp; Nizar M Tannir; Pheroze Tamboli; Surena F Matin; Christopher G Wood Journal: Eur Urol Date: 2011-07-14 Impact factor: 20.096
Authors: E Jason Abel; Stephen H Culp; Nizar M Tannir; Surena F Matin; Pheroze Tamboli; Eric Jonasch; Christopher G Wood Journal: Eur Urol Date: 2010-10-16 Impact factor: 20.096
Authors: Carlotta Palumbo; Francesco A Mistretta; Sophie Knipper; Angela Pecoraro; Zhe Tian; Cristina Dzyuba-Negrean; Shahrokh F Shariat; Fred Saad; Claudio Simeone; Alfredo Berruti; Alberto Briganti; Anil Kapoor; Alessandro Antonelli; Pierre I Karakiewicz Journal: Clin Genitourin Cancer Date: 2020-05-20 Impact factor: 2.872
Authors: Andrew G McIntosh; Eric C Umbreit; Levi C Holland; Cindy Gu; Nizar M Tannir; Surena F Matin; Jose A Karam; Stephen H Culp; Christopher G Wood Journal: Cancer Date: 2020-06-09 Impact factor: 6.860
Authors: Axel Bex; Peter Mulders; Michael Jewett; John Wagstaff; Johannes V van Thienen; Christian U Blank; Roland van Velthoven; Maria Del Pilar Laguna; Lori Wood; Harm H E van Melick; Maureen J Aarts; J B Lattouf; Thomas Powles; Igle Jan de Jong Md PhD; Sylvie Rottey; Bertrand Tombal; Sandrine Marreaud; Sandra Collette; Laurence Collette; John Haanen Journal: JAMA Oncol Date: 2019-02-01 Impact factor: 31.777