Article

Primary Tumor Response to Targeted Agents in Patients with Metastatic Renal Cell Carcinoma

Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
European Urology (Impact Factor: 12.48). 10/2010; 59(1):10-5. DOI: 10.1016/j.eururo.2010.09.034
Source: PubMed

ABSTRACT The recent development of multiple targeted agents for metastatic renal cell carcinoma (mRCC) has changed the treatment paradigm; hence the benefit and optimal timing of cytoreductive nephrectomy is being reevaluated.
To determine primary tumor response to treatment with targeted agents in patients with mRCC.
We reviewed the clinical and radiographic data of all mRCC patients seen at our institution between November 2004 and December 2009 without prior systemic treatment who received targeted therapy with their primary tumor in situ.
Two independent reviewers measured the diameter of primary and metastatic tumors at baseline and subsequent scans, using Response Evaluation Criteria Solid Tumors (RECIST) v.1.1 to assess disease response.
We identified 168 consecutive patients with a median 15 mo of follow-up and a median maximum tumor diameter of 9.6 cm. Median maximum primary tumor response was -7.1% (interquartile range: -14.0 to -0.1). A total of 61 patients had multiple studies available for evaluation. In 43 patients with <10% decrease in primary tumor within in the first 60 d, median maximum response was -7.2% at 154 d versus -24.5% maximum response at 174.5 d for 18 patients with ≥10% decrease in primary tumor during the initial 60 d.
Decrease in primary tumor diameter >30% while on targeted therapy for mRCC is rare, with most patients demonstrating minimal or no decrease in primary tumor diameter. Early response predicts a better overall primary tumor response.

Download full-text

Full-text

Available from: Stephen Culp, Dec 12, 2013
0 Followers
 · 
104 Views
  • Source
    European Urology 07/2012; 62(1):182-3. DOI:10.1016/j.eururo.2012.04.013 · 12.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: With an increasing number of small renal masses being diagnosed organ-preserving treatment strategies such as nephron-sparing surgery (NSS) or radiofrequency and cryoablation are gaining importance. There is evidence that preserving renal function reduces the risk of death of any cause, cardiovascular events, and hospitalization. Some patients have unfavourable tumor locations or large tumors unsuitable for NSS or ablation which is a clinical problem especially in those with imperative indications to preserve renal function. These patients may benefit from downsizing primary tumors by targeted therapy. This paper provides an overview of the current evidence, safety, controversies, and ongoing trials.
    06/2012; 2012:250479. DOI:10.1155/2012/250479
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In patients with metastatic renal cell carcinoma (mRCC), the timing of systemic targeted therapy in relation to cytoreductive nephrectomy (CN) is under investigation. To evaluate postoperative complications after the use of presurgical targeted therapy prior to CN. A retrospective review of all patients who underwent a CN at The University of Texas M.D. Anderson Cancer Center from 2004 to 2010 was performed. Inclusion in this study required documented evidence of mRCC, with treatment incorporating CN. Patients receiving presurgical systemic targeted therapy prior to CN were compared to those undergoing immediate CN. Complications were assessed using the modified Clavien system for a period of 12 mo postoperatively. Presurgical therapy was administered to 70 patients prior to CN (presurgical), while 103 patients had an immediate CN (immediate). A total of 232 complications occurred in 57% of patients (99 of 173). Use of presurgical systemic targeted therapy was predictive of having a complication>90 d postoperatively (p=0.002) and having multiple complications (p=0.013), and it was predictive of having a wound complication (p<0.001). Despite these specific complications, presurgical systemic targeted therapy was not associated with an increased overall complication risk on univariable or multivariate analysis (p=0.064 and p=0.237) and was not predictive for severe (Clavien ≥3) complications (p=0.625). This study is limited by its retrospective nature. As is inherent to any retrospective study reporting on complications, we are limited by reporting bias and the potential for misclassification of specific complications. Despite an increased risk for specific wound-related complications, overall surgical complications and the risk of severe complications (Clavien ≥3) are not greater after presurgical targeted therapy in comparison to upfront cytoreductive surgery.
    European Urology 05/2011; 60(5):964-71. DOI:10.1016/j.eururo.2011.05.032 · 12.48 Impact Factor