Stereotactic Radiotherapy for Oligoprogression in Metastatic Renal Cell Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Phase 2 Prospective Multicenter Study

Cheung, Patrick; Patel, Samir; North, Scott; Sahgal, Arjun; Chu, William; Soliman, Hany; Ahmad, Belal; Winquist, Eric; Niazi, Tamim; Patenaude, François; Lim, Gerald; Heng, Daniel Yick Chin; Dubey, Arbind; Czaykowski, Piotr; Wong, Rebecca; Swaminath, Anand; Morgan, Scott C.; Mangat, Rupi; Keshavarzi, Sareh; Bjarnason, Georg A.

doi:10.1016/j.eururo.2021.07.026

Cited by 82 publications

(52 citation statements)

References 33 publications

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“…Renal clear cell carcinoma is not radiotherapy sensitive (1). However, preoperative radiotherapy may increase the chance of surgical benefit in metastatic renal clear cell carcinoma, which may be related to the reduction of tumor burden caused by distant metastasis by radiotherapy (22,23). However, our data showed that treatment, in addition to targeted therapy and immunotherapy, could be an effective treatment option in this case.…”

Section: Discussionmentioning

confidence: 73%

Selection of Optimal Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Clear Cell Renal Cell Carcinoma: A Predictive Model Based on SEER Database

Zhang

Yang

et al. 2022

Front. Oncol.

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BackgroundCurrently, the progress of targeted drugs in the treatment of metastatic clear cell renal cell carcinoma (mccRCC) is limited. Cytoreductive nephrectomy (CN), as an alternative treatment, can improve the prognosis of patients with metastatic renal cell carcinoma to some extent. However, it is unclear which patients would benefit from this tumor reduction operation. As a consequence, we developed a predictive model to identify patients who may well benefit from CN in terms of survival.MethodsWe identified patients with metastatic clear cell renal cell carcinoma retrospectively from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015) and classified them into surgery and non-surgery groups. Propensity score matching (PSM) was performed to balance the baseline characteristics. Patients who survived longer than the median overall survival (OS) of no-surgery group were defined as surgical-benefit patients. Then, we developed a predictive model based on preoperative characteristics using multivariable Logistic regression. Calibration curves and the area under the receiver operating characteristic (AUC) were used to evaluate the efficiency of the predictive model. The clinical value of the nomogram was assessed utilizing decision curve analysis (DCA).ResultsOur study collected 5544 patients from the SEER database, with 2352(42.4%) receiving cytoreductive surgery. Overall survival (OS) was longer in the CN group than in the non-surgery group after 1:1 propensity scoring matching (median OS: 19 months vs 7 months; hazard ratio (HR) =0.4106, P< 0.001). In the matched surgery group, 65.7% (367) patients survived more than 7 months after the operation and they were considered to benefit from CN. The predictive model performed well on both the training group (AUC=73.4%) and the validation group (AUC=71.9%) and the calibration curves indicated a high degree of consistency. The decision curve analysis curve demonstrated the clinical utility. We classified surgical patients into the beneficial group and non-beneficial group by using the predictive model, then discovered a substantial difference in OS between the two groups.ConclusionsWe developed a nomogram to select ideal mccRCC patients who might benefit from cytoreductive nephrectomy. Clinicians could make a more precise treatment strategy for mccRCC patients.

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Section: Discussionmentioning

confidence: 73%

Selection of Optimal Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Clear Cell Renal Cell Carcinoma: A Predictive Model Based on SEER Database

Zhang

Yang

et al. 2022

Front. Oncol.

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“…conducted a single‐arm phase 2 trial of SBRT for oligoprogression in mRCC patients receiving TT. The local control rate at 1‐year, the cumulative incidence of changing systemic therapy at 1‐year, the median PFS, and OS at 1‐year were 93%, 47%, 9.3 months, and 92%, respectively 62 . De et al .…”

Section: Metastasectomy and Focal Treatment For Metastatic Lesionsmentioning

confidence: 99%

“…The local control rate at 1-year, the cumulative incidence of changing systemic therapy at 1year, the median PFS, and OS at 1-year were 93%, 47%, 9.3 months, and 92%, respectively. 62 De et al investigated 72 mRCC patients with radiotherapy for oligoprogressive lesions in lung/mediastinum (n = 35), spine (n = 30), and nonspine bone (n = 5) during no treatment (n = 33) and treatment with TT (n = 23) and ICI (n = 13). The local control rate, PFS, and OS at 1-year were 96%, 52%, and 91%, respectively.…”

Section: Metastasectomy and Focal Treatment For Metastatic Lesionsmentioning

confidence: 99%

Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

2022

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Abbreviations & Acronyms AS = active surveillance cCa = corrected calcium CI = confidence interval CN = cytoreductive nephrectomy CNS = central nervous system CR = complete response HR = hazard ratio ICI = immune checkpoint inhibitor IFN-a = interferon alpha IMDC = International Metastatic RCC Database Consortium IPTW = propensity scorebased inverse probability of treatment weight KPS = Karnofsky performance status mRCC = metastatic renal cell carcinoma NLR = neutrophil-tolymphocyte ratio ORR = objective response rate OS = overall survival PFS = progression-free survival RCC = renal cell carcinoma RCT = randomized controlled trial REMARCC = registry for metastatic renal cell carcinoma SBRT = stereotactic radiation therapy SRS = stereotactic radiosurgery TT = targeted therapy WBRT = whole-brain radiotherapy

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“…In this setting, RRS is not used at the initiation of a systemic treatment line as described, but at the end in order to prolong the time on this therapy line and extend PFS, to reduce toxicity of further therapy lines and ultimately to prolong OS. A prospective study assessing SBRT in oligoprogressive disease under TKI therapy revealed a median PFS of 9.3 months and a change to a subsequent therapy at a median time of 12.6 months [ 32 ]. The survival data of our study with a median PFS after RRS of 13 months and median OS of 35 months is comparable and further supports the rationale to explore prospectively the use of RRS in oligometastatic and oligoprogressive patients with metastatic RCC.…”

Section: Discussionmentioning

confidence: 99%

Image-Guided Robotic Radiosurgery for the Treatment of Lung Metastases of Renal Cell Carcinoma—A Retrospective, Single Center Analysis

Rodler

Götz

Mumm

et al. 2022

Cancers

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Pulmonary metastases are the most frequent site of metastases in renal cell carcinoma (RCC). Metastases directed treatment remains an important treatment option despite advances in systemic therapies. However, the safety and efficacy of robotic radiosurgery (RRS) for the treatment of lung metastases of RCC remains unclear. Patients with metastatic RCC and lung metastases treated by RRS were retrospectively analyzed for overall survival (OS), progression-free survival (PFS), local recurrence free survival (LRFS) and adverse events. The Kaplan–Meier method was used for survival analysis and the common terminology criteria for adverse events (CTCAE; Version 5.0) classification for assessment of adverse events. A total of 50 patients were included in this study. Median age was 64 (range 45–92) years at the time of RRS. Prior to RRS, 20 patients (40.0%) had received either tyrosine kinase inhibitors or immunotherapy and 27 patients (54.0%) were treatment naïve. In our patient cohort, the median PFS was 13 months (range: 2–93). LRFS was 96.7% after two years with only one patient revealing progressive disease of the treated metastases 13 months after RRS. Median OS was 35 months (range 2–94). Adverse events were documented in six patients (12%) and were limited to grade 2. Fatigue (n = 4) and pneumonitis (n = 2) were observed within 3 months after RRS. In conclusion, RRS is safe and effective for patients with metastatic RCC and pulmonary metastases. Radiation induced pneumonitis is specific in the treatment of pulmonary lesions, but not clinically relevant and survival rates seem favorable in this highly selected patient cohort. Future directions are the implementation of RRS in multimodal treatment approaches for oligometastatic or oligoprogressive disease.

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Stereotactic Radiotherapy for Oligoprogression in Metastatic Renal Cell Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Phase 2 Prospective Multicenter Study

Cited by 82 publications

References 33 publications

Selection of Optimal Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Clear Cell Renal Cell Carcinoma: A Predictive Model Based on SEER Database

Selection of Optimal Candidates for Cytoreductive Nephrectomy in Patients with Metastatic Clear Cell Renal Cell Carcinoma: A Predictive Model Based on SEER Database

Surgical and focal treatment for metastatic renal cell carcinoma: A literature review

Image-Guided Robotic Radiosurgery for the Treatment of Lung Metastases of Renal Cell Carcinoma—A Retrospective, Single Center Analysis

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