NCCN Guidelines Insights: Kidney Cancer, Version 2.2020

Motzer, Robert J.; Jonasch, Eric; Michaelson, M. Dror; Nandagopal, Lakshminarayanan; Gore, John L.; George, Saby; Alva, Ajjai; Haas, Naomi B.; Harrison, Michael R.; Plimack, Elizabeth R.; Sosman, Jeffrey A.; Agarwal, Neeraj; Bhayani, Sam B.; Choueiri, Toni K.; Costello, Brian A.; Derweesh, Ithaar; Gallagher, Thomas H.; Hancock, Steven; Kyriakopoulos, Christos E.; LaGrange, Chad A.; Lam, Elaine T.; Lau, Clayton; Lewis, Bryan; Manley, Brandon; McCreery, Brittany; McDonald, Andrew; Mortazavi, Amir; Pierorazio, Phillip M.; Ponsky, Lee; Redman, Bruce G.; Somer, Bradley G.; Wile, Geoffrey; Dwyer, Mary A.; Hammond, Lydia J.; Zuccarino-Catania, Griselda

doi:10.6004/jnccn.2019.0054

Cited by 199 publications

(176 citation statements)

References 350 publications

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“…Unlike ccRCC, the management of nccRCC remains unclear and clinical trials are preferred [47]. Indeed, few prospective data for nccRCC treatment are available and trials have shown a lower efficacy of anti-angiogenic therapy compared to ccRCC with an impact on the prognosis of both PFS and OS [48].…”

Section: Non-clear Cell Renal Cell Carcinomamentioning

confidence: 99%

Immunotherapy in Renal Cell Carcinoma: The Future Is Now

Deleuze

Saout

Dugay

et al. 2020

IJMS

148

130

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Renal cell carcinoma is the third type of urologic cancer and has a poor prognosis with 30% of metastatic patients at diagnosis. The antiangiogenics and targeted immunotherapies led to treatment remodeling emphasizing the role of the tumour microenvironment. However, long-term responses are rare with a high rate of resistance. New strategies are emerging to improve the efficacy and the emerging drugs are under evaluation in ongoing trials. With the different treatment options, there is an urgent need to identify biomarkers in order to predict the efficacy of drugs and to better stratify patients. Owing to the limitations of programmed death-ligand 1 (PD-L1), the most studied immunohistochemistry biomarkers, and of the tumor mutational burden, the identification of more reliable markers is an unmet need. New technologies could help in this purpose.

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Section: Non-clear Cell Renal Cell Carcinomamentioning

confidence: 99%

Immunotherapy in Renal Cell Carcinoma: The Future Is Now

Deleuze

Saout

Dugay

et al. 2020

IJMS

148

130

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“…NCCN guidelines suggest that for subsequent therapy in metastatic RCC, the simplest approach is to change the mechanism of action related to the second-line therapy, e.g., if a subject was treated with a TKI as rstline treatment, a PD-1 agent should be the second option. Nevertheless, observational data support the use of sequential TKIs following the treatment with an initially different TKI (2,27). Treatment of metastatic RCC with two TKIs in sequence, both sharing a similar molecular target yet with different clinical effects, could be comparable to newer, more-expensive agents, which are mostly unavailable in developing countries.…”

Section: Discussionmentioning

confidence: 99%

“…Renal cell carcinoma (RCC) is one of the most common types of cancer and its incidence has been rising by approximately 0.6% each year; however, death rates have been falling by 0.7% each year (1,2). Patients with advanced RCC develop new metastatic lesions up to 10-30% despite being treated with new drugs, including vascular endothelial growth factor-tyrosine kinase inhibitor (VEGF-TKI) or targeted therapies (3,4).…”

Section: Introductionmentioning

confidence: 99%

Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

Martin-Aguilar

Núñez-López

Ramirez‐Sandoval

2020

Preprint

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Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI).Methods: A prospective observational cohort in Mexico (2012–2019). We included 148 subjects with metastatic RCC and who had progression despite treatment with sunitinib (n = 144) or pazopanib (n = 4). The primary end-point was time to disease progression as evaluated every 12–16 weeks.Results: The mean age of the cohort was 58 years (interquartile range [IQR] 48-68), 104 (70%) were men, and 51 (35%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.5 months (95% confidence interval [CI]: 6.8–10.2) and 40.1 months (95% CI: 35.2–45.0) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 63.9–79.4). On multivariate analyses, age >65 years was associated with a longer PFS (HR 0.57; 95% CI: 0.35-0.93; p = 0.025). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–17.9] vs. 7.2 months [95% CI: 5.5–8.9]; p = 0.018). Adverse events grade ≥3 associated with sorafenib occurred in 42 (28%) patients.Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.

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“…Many of these syndromes have extrarenal manifestations that can cause significant morbidity and mortality if not properly managed; hence, identifying patients with these conditions can have major implications for management of the patient and their family members. As far as who should be referred for genetic counseling, the NCCN and American Urological Association (AUA) recommend patients who are 46 years of age or younger with renal malignancy undergo genetic counseling [96,97]. The AUA also states genetic counseling should be considered for patients with multifocal or bilateral renal masses, or a personal or family history suggestive of hereditary renal neoplastic syndromes.…”

Section: Genetic Testing and Renal Cancermentioning

confidence: 99%

Cancer Genetics and Therapeutic Opportunities in Urologic Practice

Adashek

Leonard

Roszik

et al. 2020

Cancers

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This article aims to summarize the current literature on genetic alterations related to tumors of the genitourinary tract. Novel associations have recently been reported between specific DNA alterations and genitourinary malignancies. The most common cause of chromosome 3p loss in clear cell renal cell carcinoma is a chromothripsis event, which concurrently generates a chromosome 5q gain. Specific patterns of clear cell renal cell carcinoma metastatic evolution have been uncovered. The first therapy targeting a specific molecular alteration has now been approved for urothelial carcinoma. Germline mutations in DNA damage repair genes and the transcription factor HOXB13 are associated with prostate cancer and may be targeted therapeutically. The genetic associations noted across different genitourinary cancers can inform potential screening approaches and guide novel targeted treatment strategies.

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NCCN Guidelines Insights: Kidney Cancer, Version 2.2020

Cited by 199 publications

References 350 publications

Immunotherapy in Renal Cell Carcinoma: The Future Is Now

Immunotherapy in Renal Cell Carcinoma: The Future Is Now

Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

Cancer Genetics and Therapeutic Opportunities in Urologic Practice

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