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.

Purpose: Immune dysfunction reported in renal cell carcinoma (RCC) patients may contribute to tumor progression. Myeloid-derived suppressor cells (MDSC) represent one mechanism by which tumors induce T-cell suppression. Several factors pivotal to the accumulation of MDSC are targeted by the tyrosine kinase inhibitor, sunitinib. The effect of sunitinib on MDSC-mediated immunosuppression in RCC patients has been investigated. Experimental Design: Patient peripheral blood levels of MDSC and regulatoryT-cell (Treg) and T-cell production of IFN-g were evaluated before and after sunitinib treatment. Correlations between MDSC and Treg normalization as well asT-cell production of IFN-g were examined. The in vitro effect of sunitinib on patient MDSC was evaluated. Results: Metastatic RCC patients had elevated levels of CD33 + HLA-DR -and CD15 + CD14-MDSC, and these were partially overlapping populations. Treatment with sunitinib resulted in significant reduction in MDSC measured by several criteria. Sunitinib-mediated reduction in MDSC was correlated with reversal of type 1 T-cell suppression, an effect that could be reproduced by the depletion of MDSC in vitro. MDSC reduction in response to sunitinib correlated with a reversal of CD3 + CD4 + CD25 hi Foxp3 + Treg cell elevation. No correlation existed between a change in tumor burden and a change in MDSC, Treg, or T-cell production of IFN-g. In vitro addition of sunitinib reduced MDSC viability and suppressive effect when used at z1.0 Ag/mL. Sunitinib did not induce MDSC maturation in vitro. Conclusions: Sunitinib-based therapy has the potential to modulate antitumor immunity by reversing MDSC-mediated tumor-induced immunosuppression.

Purpose: Immune dysfunction is well documented in renal cell carcinoma (RCC) patients and likely contributes to tumor evasion. This dysfunction includes a shift from a type-1 to a type-2 T-cell cytokine response and enhanced T-regulatory (Treg) cell expression. Given the antitumor activity of select tyrosine kinase inhibitors such as sunitinib in metastatic RCC (mRCC) patients, it is relevant to assess their effect on the immune system. Experimental Design: Type-1 (IFNg) and type-2 (interleukin-4) responses were assessed in T cells at baseline and day 28 of treatment with sunitinib (50 mg/d) by measuring intracellular cytokines after in vitro stimulation with anti-CD3/anti-CD28 antibodies. Results: After one cycle of treatment, there was a significant increase in the percentage of IFNgproducingTcells (CD3 + , P < 0.001; CD3 + CD4 + , P = 0.001), a reduction in interleukin-4 production (CD3 + cells, P = 0.05), and a diminished type-2 bias (P = 0.005).The increase in type-1response may be partly related to modulation of Treg cells. The increased percentage of Treg cells noted in mRCC patients over healthy donors (P = 0.001) was reduced after treatment, although not reaching statistical significance. There was, however, an inverse correlation between the increase in type-1response after two cycles of treatment and a decrease in the percentage of Treg cells (r = -0.64, P = 0.01). In vitro studies suggest that the effects of sunitinib onTreg cells are indirect. Conclusions: The demonstration that sunitinib improved type-1 T-cell cytokine response in mRCC patients while reducingTreg function provides a basis for the rational combination of sunitinib and immunotherapy in mRCC.

Patients who have mRCC and sarcomatoid differentiation can demonstrate objective responses and tumor shrinkage to VEGF-targeted therapy. Patients who have clear-cell histology and a lower percentage of sarcomatoid differentiation may have better outcomes with VEGF-targeted therapy.

Well‐defined adaptative and amphiphilic polymer conetworks based on hydrophilic poly(N,N‐dimethylamino‐2‐ethyl methacrylate) (PDMAEMA) and hydrophobic poly(ε‐caprolactone) (PCL) have been prepared by combination of ATRP, ROP, and “Click chemistry.” Telechelic α,ω‐alkyne terminated PCL crosslinker was obtained by ring‐opening polymerization (ROP) of CL in THF at 80 °C initiated by 1,4‐butanediol and catalyzed by tin(II) bis 2‐ethyl hexanoate (Sn(Oct)2), followed by the quantitative esterification of hydroxyl end‐groups by activated 4‐pentynoic acid. In parallel, an azido‐containing PDMAEMA‐based copolymer was obtained in a three‐step strategy involving primarily the copolymerization of DMAEMA with newly synthesized 2‐(2‐azidoethoxy)ethyl methacrylate (AEEMA) monomer. The latter was obtained by nucleophilic substitution of chloride atom from 2‐(2‐chloroethoxy)ethanol by an azide group followed by the esterification reaction of the hydroxyl group with methacrylic anhydride. The copolymerization was carried out in an equivolumic mixture of H2O and isopropanol at r.t. and initiated by a ω‐bromoisobutyryl oligo PEO macroinitiator in the presence of various ligated copper(I)‐based catalysts. In a last step, both polymer precursors were chemically linked by the Huisgen‐1,3‐dipolar cycloaddition in anhydrous THF at r.t. using CuBr complexed by 2,2′‐bipyridine ligand as catalyst. Final material was characterized by the means of DSC and SEM, both attesting of a homogeneous distribution of the PCL crosslinkers and a highly porous structure in this new amphiphilic model conetworks. © 2008 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 46: 4997–5013, 2008

To our knowledge this is the largest analysis investigating the impact of VHL inactivation on the outcome of vascular endothelial growth factor targeted agents in metastatic renal cell carcinoma. We did not find a statistically significant increase in response to vascular endothelial growth factor targeted agents in patients with VHL inactivation. Loss of function mutations identified a population of patients with a greater response. Investigation of downstream markers is under way.

Background The available prognostic models for overall survival (OS) in patients with metastatic urothelial carcinoma (UC) have been derived from clinical trial populations of cisplatin-treated patients. Objective To develop a new model based on ‘real world’ patients. Design, Setting, Participants Individual patient-level data from 29 centres was collected, including metastatic UC and first-line cisplatin- or carboplatin-based chemotherapy administered between 01/2006 and 01/2011. Intervention First-line, platinum-based, combination chemotherapy. Outcome measures and statistical analysis The population was randomly split into a development and a validation cohort. Generalized boosted regression modelling was used to screen out irrelevant variables and address multivariable analyses. Two nomograms were built to estimate OS probability, the first based on baseline factors and platinum agent, the second incorporating objective response (OR). The performance of the above nomograms and that of other available models was assessed. We plotted decision curves to evaluate the clinical usefulness of the two nomograms. Results and limitations A total of 1,020 patients were analysed (development: 687; validation: 333). In a platinum-stratified Cox model, significant variables for OS were performance status (p<0.001); white blood cell count (p=0.013); body mass index (p=0.003); ethnicity (p=0.012); lung, liver, or bone metastases (p<.001); and prior perioperative chemotherapy (p=0.012). The c-index was 0.660. The distribution of the nomogram scores was associated with OR (p<0.001), and incorporating OR into the model further improved the c-index in the validation cohort (0.670). Conclusions We developed and validated two nomograms for OS to be used before and after completion of first-line chemotherapy for metastatic UC. Patient summary We proposed two models for estimating OS of patients with metastatic UC receiving firstline, platinum-based chemotherapy. These nomograms have been developed on real world patients who were treated outside of clinical trials and may be used irrespective of the chemotherapeutic platinum agent.

Sunitinib and sorafenib can be safely given to patients with renal insufficiency, provided adequate monitoring of renal function. For those patients developing an increase in Cr, dose modifications may be required to allow continuation of therapy. The clinical outcome of patients with baseline renal dysfunction and patients who develop renal dysfunction does not appear to be compromised.