Dataset Information

Surgery for thoracic oligoprogression in metastatic renal cell cancer in the era of new systemic therapies.

ABSTRACT:

Background

Novel systemic therapies have improved response rates and survival in metastatic renal cell cancer (mRCC) and are considered standard of care for this entity. However, complete remission (CR) is rare and often oligoprogression is observed. Here, we analyse the role of surgery for oligoprogressive lesions in mRCC.

Methods

We retrospectively analyzed all patients who underwent surgery for thoracic oligoprogressive lesions of mRCC after receiving systemic therapy including immunotherapy, tyrosine kinase inhibitors (TKI), and/or multikinase inhibitors at our institution between 2007 and 2021 regarding treatment modalities, progression-free survival (PFS) and overall survival (OS).

Results

Ten patients with oligoprogressive mRCC were included. The median interval between nephrectomy and oligoprogression was 65 months (range, 16-167). Median PFS after surgery for oligoprogression was 10 months (range, 2-29) and median OS after resection 24 months (range, 2-73). In 4 patients, CR was achieved of whom three showed no progression at last follow-up (PFS median 15 months, range, 10-29). In 6 patients, removal of the progressive site resulted in stable disease (SD) for a median of 4 months (range, 2-29), before 4 of them progressed.

Conclusions

In selected cases, surgery can lead to sustained disease control in patients with oligoprogressive mRCC after systemic treatment including immunotherapy and novel treatment agents.

SUBMITTER: Le UT

PROVIDER: S-EPMC10089849 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Surgery for thoracic oligoprogression in metastatic renal cell cancer in the era of new systemic therapies.

Le Uyen-Thao UT Passlick Bernward B Schmid Severin S

Journal of thoracic disease 20230320 3

<h4>Background</h4>Novel systemic therapies have improved response rates and survival in metastatic renal cell cancer (mRCC) and are considered standard of care for this entity. However, complete remission (CR) is rare and often oligoprogression is observed. Here, we analyse the role of surgery for oligoprogressive lesions in mRCC.<h4>Methods</h4>We retrospectively analyzed all patients who underwent surgery for thoracic oligoprogressive lesions of mRCC after receiving systemic therapy including ...[more]

PMID: 37065601

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Project description:BackgroundAntibiotic use alters commensal gut microbiota, which is a key regulator of immune homeostasis.ObjectiveTo investigate the impact of antibiotic use on clinical outcomes in metastatic renal cell carcinoma (mRCC) patients treated with systemic agents.Design, setting, and participantsWe analyzed two cohorts: an institutional cohort (n=146) receiving programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1)-based immune checkpoint inhibitors (ICIs) and a trial-database cohort (n=4144) receiving interferon-α (n=510), mammalian target of rapamycin (mTOR) inhibitors (n=660), and vascular endothelial growth factor targeted therapies (VEGF-TT; n=2974) on phase II/III clinical trials.Outcomes measurements and statistical analysisThe association of antibiotic use (defined as use from 8 wk before to 4 wk after the initiation of anticancer therapy) with progression-free survival (PFS) and overall survival (OS) was evaluated using Cox regression, adjusted for known prognostic factors including International Metastatic RCC Database Consortium risk factors.Results and limitationsMost patients were male, had clear cell histology, and were at an intermediate risk. Overall, in the institutional cohort, objective response rate (ORR) was 30%, PFS was 7.2 mo, and 1-yr OS was 77%. Antibiotic users (n=31, 21%) had a lower ORR (12.9% vs 34.8%, p=0.026) and shorter PFS (adjusted hazard ratio [HR]=1.96, 95% confidence interval [CI] 1.20-3.20, p=0.007) than antibiotic nonusers. In the trial-database cohort, antibiotic use (n=709, 17%) adversely impacted OS in patients treated with interferon (HR=1.62, 95% CI 1.13-2.31, p=0.008) or with VEGF-TT and prior cytokines (HR=1.65, 95% CI 1.04-2.62, p=0.033), but not patients treated with mTOR inhibitors or VEGF-TT without prior cytokines. Limitations include retrospective design, and limited details regarding concomitant medications and antibiotic indication/duration.ConclusionsAntibiotic use appears to reduce the efficacy of immunotherapy-based regimens in mRCC. The modulation of gut microbiota may play an important role in optimizing outcomes of patients treated with ICIs.Patient summaryWe evaluated metastatic renal cell carcinoma patients and found that those who were treated with immunotherapy had worse outcomes if they also received antibiotics at the start of treatment. This study highlights the importance of judicious antibiotic use.

Dataset Information

Surgery for thoracic oligoprogression in metastatic renal cell cancer in the era of new systemic therapies.

Background

Methods

Results

Conclusions

Publications

Surgery for thoracic oligoprogression in metastatic renal cell cancer in the era of new systemic therapies.

Similar Datasets

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