Sunitinib vs Nephrectomy Followed By Sunitinib In Metastatic Renal Cell Carcinoma
In an interim analysis of the French phase III noninferiority Carmena trial reported in The New England Journal of Medicine, M éjean et al found that sunitinib alone was not inferior in overall survival vs nephrectomy followed by sunitinib in patients with intermediate- or poor-risk metastatic clear cell renal cell carcinoma.08/08/2018
ConclusionThe findings from the study suggested that there were pathological differences in multifocal renal tumors, and that papillary carcinoma may be more common than clear cell carcinoma. The recurrence rate and survival rate of multifocal RCC were similar to monofocal tumors. Tumor recurrence may be related to satellite tumor nodules, which can only be detected once surgery is performed.
Adjuvant sunitinib has significantly improved disease-free survival versus placebo in patients with renal cell carcinoma at high risk of recurrence post-nephrectomy.11/14/2018
Dr. Jose Karam explains the role of cytoreductive nephrectomies when patients have metastatic kidney cancer.11/12/2018
CONCLUSIONS: nephron sparing surgery in renal tumors>3 cm is an effective and safe treatment for VHL patients. PMID: 30403378 [PubMed - in process]
Despite the evolution of systemic therapy from the immunotherapy to targeted therapy eras, surgical management remains a mainstay of treatment of patients with locally advanced, lymph node-positive, and distant metastatic renal cell carcinoma.11/07/2018
CONCLUSIONS: Correlations between VEGFR1 and VEGFR2 SNPs and longer DFS with sunitinib suggest germline SNPs are predictive of improved outcomes with adjuvant sunitinib in patients with renal cell carcinoma. Independent validation studies are needed to confirm these findings. PMID: 30401688 [PubMed - as supplied by publisher]
Rationale: T-cell large granular lymphocytic leukemia (T-LGLL) is a rare lymphoproliferative neoplasm of cytotoxic T cells and renal cell carcinoma (RCC) is the most common form of kidney cancer, but T-LGLL associated with RCC has never been reported. Patient concerns: A 58-year-old Chinese male presented with general fatigue and intermittent-remittent fever, accompanied by palpitations and dizziness. Diagnosis: Radical nephrectomy was performed, and a diagnosis of clear cell carcinoma (T1N0M0, I phase) was made based on the postoperative pathology findings. With typical cellular morphology, immunophenotype and T-c...
Rationale: Collecting duct carcinoma (CDC) is a rare type of nonclear renal cell carcinoma, often presenting at an advanced stage of the disease, and standard treatment guidelines have not been established. Patient concerns: A 73-year-old man was admitted to our hospital with complaints of fever and lower right back pain. Diagnoses: Computed tomography revealed a poorly defined tumor of the right kidney without metastasis. The patient underwent right radical nephrectomy and was diagnosed with clinical stage T1bN0M0 renal cancer; the pathological findings showed collecting duct carcinoma. Interventions: After nep...
In an interim analysis of the French phase III noninferiority Carmena trial reported in The New England Journal of Medicine, Arnaud M Ã©jean, MD, PhD, of the HÃ´pital EuropÃ©en Georges Pompidou, and colleagues found that sunitinib alone was not inferior in overall survival vs nephrectomy followed by sunitinib in patients with intermediate- or poor-risk metastatic clear cell renal cell carcinoma.10/30/2018
ConclusionsCurrently, ST should be prioritized in the management of patients with de novo mRCC who require medical therapy. CN maintains a role in patients with limited metastatic burden amenable to surveillance or metastasectomy, and may potentially be considered in patients with favorable response after initial ST or for symptom's palliation.Patient summaryIn the contemporary era, receiving systemic therapy is the priority in metastatic kidney cancer. Nephrectomy still has a role in patients with limited burden of metastases, well-selected patients based on established prognostic and predictive factors, and patients with...