Clinical genitourinary cancer最新文献

{"title":"Appearance of New Lesions Associate With Poor Prognosis in Pembrolizumab-Treated Urothelial Carcinoma","authors":"Takuto Hara,&nbsp;Jun Teishima,&nbsp;Yasuyoshi Okamura,&nbsp;Kotaro Suzuki,&nbsp;Yukari Bando,&nbsp;Tomoaki Terakawa,&nbsp;Koji Chiba,&nbsp;Yoji Hyodo,&nbsp;Yuzo Nakano,&nbsp;Hideaki Miyake","doi":"10.1016/j.clgc.2024.102236","DOIUrl":"10.1016/j.clgc.2024.102236","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigated the variations in response patterns, including target lesion enlargement and the emergence of new lesions, in patients with urothelial carcinoma receiving pembrolizumab therapy and assessed the impact of new lesions on patient outcomes.</div></div><div><h3>Methods</h3><div>This retrospective analysis included patients with urothelial carcinoma treated with pembrolizumab following platinum failure. Response Evaluation Criteria in Solid Tumors criteria were used to assess the target lesion size and appearance of new lesions. Patients were categorized into 2 groups: the primary progressive disease (PD) group, consisting of patients who progressed within 28 to 84 days of treatment initiation, and the secondary PD group, consisting of patients who progressed more than 84 days after treatment initiation. Survival analyses were performed to evaluate the impact of new lesions on patient outcomes.</div></div><div><h3>Results</h3><div>In this study, 42 patients experienced primary PD, and 37 experienced secondary PD. Among patients with primary PD, 64.3%, 73.8%, 45.2% had an increase of 20% or more in target lesion size, newly emerged lesions, and both an increase in target lesion size and new lesions, respectively. Kaplan–Meier analysis revealed that patients with primary PD and new lesions had significantly shorter overall survival after PD than those with only target lesion growth and those with secondary PD (both <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>This study revealed the heterogeneity of response patterns during pembrolizumab therapy in patients with urothelial carcinoma and primary pembrolizumab resistance and the presence of new lesions early in treatment. Earlier imaging evaluation should be performed to assess for the appearance of new lesions, leading to sequential treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102236"},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concordance Between the Expert Reading of Biparametric-MRI and the Nonexpert Multiparametric-MRI for the Detection of Clinically Significant Prostate Cancer: Clinical Implications","authors":"Nahuel Paesano ,&nbsp;María José Gutiérrez Vallecillo ,&nbsp;Violeta Catalá ,&nbsp;Larisa Tcholakian ,&nbsp;Xavier Alomar ,&nbsp;Miguel Barranco ,&nbsp;Abel González-Huete ,&nbsp;Jonathan Hernández Mancera ,&nbsp;Enric Trilla ,&nbsp;Juan Morote","doi":"10.1016/j.clgc.2024.102233","DOIUrl":"10.1016/j.clgc.2024.102233","url":null,"abstract":"<div><h3>Purpose</h3><div>Prostate-magnetic resonance imaging (MRI) interpretation is challenging, with expertise playing a crucial role. Biparametric MRI (bpMRI) is gaining popularity in experienced centers due to its time and cost advantages over multiparametric MRI (mpMRI). We aim to analyze concordance between nonexpert radiologist PI-RADS from mpMRI and expert radiologist PI-RADS from bpMRI, and its clinical implications.</div></div><div><h3>Material and Methods</h3><div>222 men suspected of having prostate cancer (PCa) and mpMRI reported by nonexpert radiologists were referred to a reference center for transperineal MRI-TRUS fusion biopsy where an expert radiologist reported bpMRI PI-RADS 2.1 and segmentation, blinded to external mpMRI. Mapping targeted suspected lesions and 12-core systematic biopsies were performed. Clinically significant PCa (csPCa) was diagnosed when ISUP-grade group was ≥2.</div></div><div><h3>Results</h3><div>Concordance between both PI-RADS existed in 49.1% of cases (Kappa index 0.288). In 102 cases (45.9%), expert reclassification to lower PI-RADS existed, while an increase existed in 11 cases (5.0%), <em>P</em> &lt; .001. Agreement existed in 30.8% of nonexpert PI-RADS 3, 43.6% of PI-RADS 4, and 83.7% of PI-RADS 5, <em>P</em> &lt; .001. Potential clinical implications included 27% reduction in prostate biopsies when using expert bpMRI readings compared to nonexpert mpMRI readings (<em>P</em> &lt; 0.001), while undetected csPCa were 4.2% and 3.4%, respectively, <em>P</em> = .669. Over-detection reduction of insignificant PCa was 29.4% and 0%, respectively, <em>P</em> = .034.</div></div><div><h3>Conclusions</h3><div>Concordance between nonexpert PI-RADS mpMRI and expert PI-RADS bpMRI was low, increasing with nonexpert PI-RADS. Expert reclassification would reduce prostate biopsies by more than one quarter and over-detection of iPCa, while csPCa detection remained similar.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102233"},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Docetaxel Versus Androgen-Receptor Signaling Inhibitors (ARSI) as Second-Line Therapy After Failure of First-Line Alternative ARSI for the Elderly ≥ 75 Years Old With Metastatic Castration-Resistant Prostate Cancer (mCRPC): A SPARTACUSS—Meet-URO 26 Real-World Study","authors":"Anna Patrikidou ,&nbsp;Calogero Saieva ,&nbsp;Richard Lee-Ying ,&nbsp;Pier Vitale Nuzzo ,&nbsp;Talal El Zarif ,&nbsp;Heather McClure ,&nbsp;Matthew Davidsohn ,&nbsp;Marc Eid ,&nbsp;Gian Paolo Spinelli ,&nbsp;Fabio Catalano ,&nbsp;Malvina Cremante ,&nbsp;Giuseppe Fotia ,&nbsp;Sabrina Rossetti ,&nbsp;Loana Valenca ,&nbsp;Charles Vauchier ,&nbsp;Carlotta Ottanelli ,&nbsp;Livia Andrade ,&nbsp;Vincenzo Gennusa ,&nbsp;Ricardo Pereira Mestre ,&nbsp;Giuseppe Fornarini ,&nbsp;Edoardo Francini","doi":"10.1016/j.clgc.2024.102230","DOIUrl":"10.1016/j.clgc.2024.102230","url":null,"abstract":"<div><h3>Background</h3><div>Androgen receptor signalling inhibitors (ARSIs) abiraterone acetate (AA) enzalutamide (Enza), are currently the standard first-line (L1) treatments for metastatic castration-resistant prostate cancer (mCRPC), and docetaxel (D) is reserved as second-line (L2) after ARSI failure. Nonetheless, D use in men ≥ 75 years old is restricted owing to treatment toxicities and patient comorbidities, and a L2 alternative ARSI is frequently used. We aimed to evaluate real-life survival and toxicity outcomes of these elderly patients after failure of L1 ARSI treatment.</div></div><div><h3>Material and Methods</h3><div>We retrospectively evaluated efficacy and safety in a real-world international cohort of consecutive patients ≥ 75 years old when starting L1 ARSI for mCRPC according to the choice of L2 treatment (D versus alternative ARSI).</div></div><div><h3>Results</h3><div>Of the 122 identified patients, 57 (46.7%) had received L2 ARSI and 65 (53.3%) L2 D. No difference was found in the L1 overall survival (OS) for the ARSI and D groups (32.8 vs. 30.0 months, respectively; Hazard ratio [HR] = 1.22; 95% CI, 0.77-1.95; <em>P</em> = .40) or in the L2 OS (18.5 vs. 17.8 months, respectively; HR = 1.09; 95% CI, 0.69-1.74; <em>P</em> = .71). No difference was observed for rPFS from L2 (<em>P</em> = .12), although a trend was observed for a numerically improved rPFS on D.</div></div><div><h3>Conclusion</h3><div>Within the limitations of a retrospective design and small population, our study suggests that D or ARSI after failure of L1 alternative ARSI are clinically comparable L2 options for elderly patients with mCRPC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102230"},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Blockade Therapies Efficacy and Toxicity in Patients With Impaired Renal Function in Metastatic Bladder Cancer","authors":"Deniz Tural ,&nbsp;Cagatay Arslan ,&nbsp;Fatih Selcukbiricik ,&nbsp;Omer Fatih Olmez ,&nbsp;Emre Akar ,&nbsp;Mustafa Erman ,&nbsp;Yüksel Ürün ,&nbsp;Dilek Erdem ,&nbsp;Saadettin Kilickap","doi":"10.1016/j.clgc.2024.102228","DOIUrl":"10.1016/j.clgc.2024.102228","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we reported the real-life results of data from impaired renal patients with urothelial carcinoma who were treated with ICTs.</div></div><div><h3>Methods</h3><div>The patients were categorized into 3 different groups GFR ≥60mL/min (normal), 60mL/min-30mL/min (low), and less than 30 mL/min (very low) based on GFR. The primary endpoints were the overall response rate (ORR), overall survival (OS), duration of response with ICT, and safety. Median follow-up and OS were estimated by using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>One hundred-five (60.3%) of patients were GFR normal, 26.4% were GFR low with 30mL/min-60mL/min, and 13.2% were very low group. ORR for GFR normal, low and very low groups were 36% (<em>n</em> = 38), 26% (<em>n</em> = 12) and %31 (7); <em>P</em> = .2, respectively. The median duration of response for GFR normal, low and very low groups were 47.2 months (95% CI, 24.5-51.4), 33.1 months (95% CI, 26.9-47), and 23.5 months (95% CI, 12.2-43.7); <em>P</em> = .01, respectively. The Median OS rate for GFR normal, low and very low groups were 11.9 (7.2-16.5) months, 4.7 (1.8-7.7) and 6.8 (1.1-13.6) months, <em>P</em> = .015, respectively. In addition, GFR &lt;60 ml/min HR = 1.6; 95% CI 1.12-1.80; <em>P</em> = .02, maintained a significant association with OS in multivariate analysis.</div></div><div><h3>Conclusions</h3><div>Long-term follow-up of real-world data confirms that the overall survival rate and durable response rate with ICT were higher in patients with GFR &gt;60mL/min. On the other hand, we demonstrated that ICT was effective and a durable response seen in a group of patients with renal inpairement who did not have an effective systemic treatment option.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102228"},"PeriodicalIF":2.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemomobilisation Using Gemcitabine-Oxaliplatin for Salvage High Dose Chemotherapy and Autologous Stem Cell Transplant in Advanced Testicular Germ Cell Cancer","authors":"Jane McKenzie ,&nbsp;Ciara Conduit ,&nbsp;Melissa Ng Liet Hing ,&nbsp;Kristina Zlatic ,&nbsp;Kerrie Stokes ,&nbsp;Sharlea Disney ,&nbsp;Amit Khot ,&nbsp;Simon J. Harrison ,&nbsp;Jeremy Lewin ,&nbsp;Ben Tran","doi":"10.1016/j.clgc.2024.102234","DOIUrl":"10.1016/j.clgc.2024.102234","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>At relapse, testicular germ cell tumors may be treated with high-dose chemotherapy and autologous stem cell transplant.</div></span></li><li><span>•</span><span><div>Traditional chemomobilisation protocols for autologous stem cell transplant may be unsuitable for pretreated patients.</div></span></li><li><span>•</span><span><div>Gemcitabine and Oxaliplatin provides satisfactory stem cell mobilization and treatment outcomes for this high-risk group.</div></span></li></ul></div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102234"},"PeriodicalIF":2.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Does Not Impact Cancer Specific Mortality: From Sub-Distributional and Cause-Specific Hazard Analysis in RCC Patients Undergoing Radical Nephrectomy and Thrombectomy","authors":"Younjuong Kim ,&nbsp;Jun Gyo Gwon ,&nbsp;Hyun Young Lee ,&nbsp;Bumjin Lim ,&nbsp;Jung Kwon Kim ,&nbsp;Cheryn Song ,&nbsp;Dalsan You ,&nbsp;In Gab Jeong ,&nbsp;Jun Hyuk Hong ,&nbsp;Bumsik Hong ,&nbsp;Hanjong Ahn ,&nbsp;Jungyo Suh","doi":"10.1016/j.clgc.2024.102231","DOIUrl":"10.1016/j.clgc.2024.102231","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of age on cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients undergoing radical nephrectomy with thrombectomy (RNTx) for renal cell carcinoma (RCC) with venous thrombus.</div></div><div><h3>Patients and Methods</h3><div>We retrospectively analyzed 196 patients who underwent RNTx for RCC with venous thrombus between 1990 and 2018 at a single tertiary referral center. Patients were categorized into three age groups: &lt;60, 60-69, and ≥70 years. The cumulative incidence function (CIF) for CSM and OCM was calculated using the Aalen-Johansen estimator, and hazard ratios (HR) from sub-distributional hazard (SDH) and cause-specific hazard (CSH) models were employed to assess the impact of age on mortality.</div></div><div><h3>Results</h3><div>The median follow-up was 40.5 months. Of the 196 patients, 105 experienced disease progression, 125 had cancerrelated deaths, and 155 died from any cause. Perioperative outcomes, including ICU admission, 90-day readmission, and 90-day mortality, were similar across age groups. The CIF for 5-year CSM differed significantly among age groups (<em>p</em> = 0.032), though this difference was not observed at 10 years. OCM increased significantly with age, particularly in the ≥70 group at 10 years (<em>p</em> = 0.045). Multivariable SDH and CSH models showed no significant differences in CSM between age groups.</div></div><div><h3>Conclusion</h3><div>While age was associated with increased OCM, it did not significantly impact the hazard of CSM. Older age alone should not be considered a contraindication for surgical intervention in RCC with venous thrombus.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102231"},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Statin Use With Survival Outcomes in Patients With Metastatic Castration-Resistant Prostate Cancer (mCRPC) Treated With Androgen Receptor Targeted Therapies (ART)","authors":"Zakaria Chakrani ,&nbsp;Mann Patel ,&nbsp;George Mellgard ,&nbsp;Stephen McCroskery ,&nbsp;Nathaniel Saffran ,&nbsp;Nicole Taylor ,&nbsp;Bobby C. Liaw ,&nbsp;Matthew Galsky ,&nbsp;William Oh ,&nbsp;Che-Kai Tsao ,&nbsp;Teja Ganta ,&nbsp;Vaibhav Patel","doi":"10.1016/j.clgc.2024.102227","DOIUrl":"10.1016/j.clgc.2024.102227","url":null,"abstract":"<div><h3>Background</h3><div>Statins may provide a compounded effect on ART by decreasing cholesterol levels thus decreasing de novo androgen synthesis and tumor cell viability. We investigated the clinical efficacy of concurrent statin use on outcomes of patients with mCRPC taking ART.</div></div><div><h3>Methods</h3><div>A single-institution retrospective analysis of patients with mCRPC receiving ART from 2010 to 2021 was performed. Our primary outcome was PSA progression free survival (PFS), and our secondary outcomes were overall survival (OS). Patient characteristics were collected in addition to ART treatment course, statin treatment, and survival outcomes. Cox proportional hazards regression model was used to estimate hazard ratios (HR) for OS and PSA PFS and multivariable logistic regression to determine risk factors.</div></div><div><h3>Results</h3><div>153 patients with mCRPC treated with ART were included. A total of 67 patients (43.8%) received concurrent statins. Median PSA PFS was 20.4 months for patients that received statins versus 15.3 months for patients who did not receive statins. Median OS was 45.1 months for patients who received concurrent statins versus 29.7 months for patients who did not. On univariate and multivariate survival analyses, there was no statistically significant difference between groups for PSA PFS (HR 0.7; CI 0.44-1.1; <em>P</em> = .123) and OS (HR 0.67; CI 0.42-1.06; <em>P</em> = .089).</div></div><div><h3>Conclusions</h3><div>Our analysis suggests that statins do not significantly improve clinical outcomes in patients with mCRPC. Ultimately, current understanding remains limited, and prospective studies are needed, but here we provide a cost-effective, timely, and selective preliminary analysis.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102227"},"PeriodicalIF":2.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Gene Expression Patterns Identify Patients who Relapse After Neoadjuvant Pembrolizumab and Radical Cystectomy in the PURE-01 Study","authors":"Moritz J. Reike ,&nbsp;Daniele Raggi ,&nbsp;Chiara Mercinelli ,&nbsp;Antonio Cigliola ,&nbsp;Valentina Tateo ,&nbsp;Damiano Alfio Patanè ,&nbsp;Emanuele Crupi ,&nbsp;Tiago Costa de Padua ,&nbsp;Peter C. Black ,&nbsp;Ewan A. Gibb ,&nbsp;Andrea Necchi","doi":"10.1016/j.clgc.2024.102214","DOIUrl":"10.1016/j.clgc.2024.102214","url":null,"abstract":"<div><h3>Purpose</h3><div>The PURE-01 clinical trial reported the use of neoadjuvant treatment with pembrolizumab prior to radical cystectomy (RC) in patients with muscle-invasive bladder. Specific molecular subtypes and immune signatures were reported to be associated with a favorable survival. However, reports on the detailed tumor biology of patients relapsing after neoadjuvant pembrolizumab are lacking.</div></div><div><h3>Materials and Methods</h3><div>Microarray data from transurethral resection of the bladder tumor (TURBT; n = 102) and matched RC (N = 25) tissue from patients in PURE-01 who experience a disease relapse were analyzed, with gene expression signatures and molecular subtypes. The Kaplan–Meier method was used to estimate differences in patient outcomes. Immune-signatures were split by median for survival analysis. All significance testing used a two-sided t-test at a threshold of <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The study cohort consisted of 102 patients, of whom N = 19 (19%) experienced relapse. Molecular subtyping revealed that neuroendocrine-like tumors had the worst outcomes, while tumors classified as Claudin-low did show only one recurrence event. Differential gene expression analysis identified genes associated with relapse, including KRT20, H19, and immune-associated genes such as CXCL9 and CXCL11.</div></div><div><h3>Conclusion</h3><div>This study provides a detailed characterization of patients who relapsed after neoadjuvant pembrolizumab and RC and identifies distinct gene expression patterns associated with relapse. These findings may have implications for predicting patient response and guiding treatment decisions in the neoadjuvant setting.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102214"},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma","authors":"Vincent E. Xu ,&nbsp;Oluwafolajimi Adesanya ,&nbsp;Sarah Azari ,&nbsp;Samita Islam ,&nbsp;Matthew Klein ,&nbsp;Arthur Drouaud ,&nbsp;Ryan M. Antar ,&nbsp;Phat Chang ,&nbsp;Armine Smith ,&nbsp;Michael J Whalen","doi":"10.1016/j.clgc.2024.102224","DOIUrl":"10.1016/j.clgc.2024.102224","url":null,"abstract":"<div><h3>Introduction</h3><div>Upper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use.</div></div><div><h3>Methods</h3><div>The National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively.</div></div><div><h3>Results</h3><div>Of 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, <em>P</em> = .028), cN+ status (OR 7.40, <em>P</em> &lt; .001) and treatment at an academic facility (OR 2.02, <em>P</em> &lt; .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, <em>P</em> &lt; .014).</div></div><div><h3>Conclusion</h3><div>We report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102224"},"PeriodicalIF":2.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Pembrolizumab plus Axitinib combination for Metastatic Renal Cell Carcinoma in a Real-World Scenario: Data From the Prospective ProPAXI Study","authors":"Annalisa Guida ,&nbsp;Alessio Gili ,&nbsp;Claudia Mosillo ,&nbsp;Marco Maruzzo ,&nbsp;Eleonora Lai ,&nbsp;Francesco Pierantoni ,&nbsp;Davide Bimbatti ,&nbsp;Umberto Basso ,&nbsp;Giuseppe Fornarini ,&nbsp;Sara Elena Rebuzzi ,&nbsp;Fabio Calabrò ,&nbsp;Linda Cerbone ,&nbsp;Claudia Caserta ,&nbsp;Grazia Sirgiovanni ,&nbsp;Debora Serafin ,&nbsp;Orazio Caffo ,&nbsp;Sarah Scagliarini ,&nbsp;Sergio Bracarda","doi":"10.1016/j.clgc.2024.102225","DOIUrl":"10.1016/j.clgc.2024.102225","url":null,"abstract":"<div><h3>Background</h3><div>Pembrolizumab/Axitinib combination is approved as first-line therapy in mRCC. The aim of this study is to evaluate outcomes of PAXI combo in the real-world in Italy.</div></div><div><h3>Methods</h3><div>This is a prospective study including patients diagnosed with mRCC who received combination as first-line therapy in recruiting Italian Centers. Data about patient characteristics, safety and outcome were collected.</div></div><div><h3>Results</h3><div>170 pts have been treated from December 2020 to September 2023. The majority had clear-cell histology (83%). Sarcomatoid feature was present in 33%of available cases. About one half of patients (55%) had synchronous metastasis. In 58% of cases nephrectomy was performed, of which 27% were cytoreductive and 4% were deferred nephrectomies. Lung metastases were identified in 106 patients (62%), bone and liver involvement in 66 and 29 patients (38.8% and 17.1%) respectively. Stratifying by IMDC criteria, 32 patients (18.8%) were at favorable-risk, 106 (62.4%) at intermediate-risk, and 32 (18.8%) at poor-risk. At time of analysis, treatment was ongoing in 49% of patients. Progression occurred in 45% of patients. Median PFS was 19.2 months (95% CI: 15-NR). With a median follow-up of 19.3 months (range 1.3-34.5), at 24-months and 36-months landmark analysis 62% (95% CI, 53-70) and 58% (95% CI, 47-69) of treated patients are still alive respectively. Disease control rate was achieved in 84.6% of patients: 4.3% reached a complete response, 52% had a partial response and 28.8% a stable disease. Primary progression was observed in 15.3% of patients. In the multivariate analysis, the prognostic significance of age ≥ 65 years, non-clear cell histology, IMDC score, and adverse events and gender interaction as predictors of worse OS were confirmed.</div></div><div><h3>Conclusion</h3><div>This is the first available prospective study on first-line Pembrolizumab/Axitinib combination in real world scenario. Our findings support the effectiveness and safety of first-line this combination in mRCC and reveal that gender emerged as a prognostic factor in relation to the occurrence of adverse events.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"22 6","pages":"Article 102225"},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}