Unmarried status is a barrier for access to treatment in patients with metastatic renal cell carcinoma

International Urology and Nephrology - We tested the effect of marital status on cytoreductive nephrectomy, metastasectomy, and systemic therapy rates, as well as on cancer-specific mortality (CSM)...     

Immunotherapy in metastatic renal cell carcinoma

Metastatic renal cell carcinoma has a poor prognosis. Conventional therapies such as chemotherapy, radiation or hormonal treatment have hardly any effect on the progression of this disease. As renal cell carcinoma seems to be an immunogenic tumor, several immunotherapeutic approaches with different response rates have been developed since the early 1990s. We present an overview of various immunotherapeutic approaches such as cytokine-based regimes, with and without different cytotoxic chemotherapy, of metastatic renal cell carcinoma. In addition, local therapies (e.g. inhalation of interleukin-2) are reviewed.K. Rohrmann and M. Staehler contributed equally to the project and are to be considered as co-first authors     

Nephrectomy in metastatic renal cell carcinoma

Progress in the treatment of metastatic renal cell carcinoma in recent decades might be characterized as promising by the optimist, nonexistent by the pessimist, and somewhere between by the realist. Regardless of one's point of view, the dilemma of what to do with the primary tumor persists. With notable exceptions, the duration and quality of survival are not influenced favorably by nephrectomy.     

Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly

Objective

Prevalence of end-stage renal disease, modality of treatment, and type of hemodialysis vascular access used varies widely by race/ethnicity in the United States, but outcomes of hemodialysis vascular access by race/ethnicity are poorly described. The objective of this study is to evaluate variations in outcomes of hemodialysis vascular access in the elderly by race/ethnicity.

Surgery in advanced and metastatic renal cell carcinoma

Curative surgery in more advanced renal cell carcinoma is limited to solitary metastases or regional disease. Response to systemic immunotherapy continues to be reported; however, most responses are limited and not durable. Only randomized, prospective clinical trials will prove the efficacy of systemic therapy.     

High-dose tamoxifen in metastatic renal cell carcinoma

The effectiveness of high-dose Tamoxifen in the treatment of metastatic renal cell carcinoma was evaluated. Fifteen patients were treated for eight weeks with 80 mg. of Tamoxifen daily. Side effects were minimal. Results showed progression of disease in 47 per cent of the patients, no change in disease was seen in 40 per cent, and 13 per cent showed a partial objective response. Twenty per cent of patients showed deterioration of performance status. High-dose Tamoxifen does not appear to be useful in the treatment of advanced renal cell carcinoma.     

Hypertrophic osteoarthropathy in metastatic renal cell carcinoma

Clinical signs of hypertrophic osteoarthropathy developed in a thirty-eight-year-old man with metastatic hypernephroma. Roentgenograms of the extremities detected the characteristic periosteal reaction along the radius, ulna, metacarpals, femur, tibia, and fibula, bilaterally. The pathogenesis of this syndrome is unknown; it appears to be mediated by a pathologic reflex with the vagus nerve as the afferent limb. When seen in patients with renal cell carcinoma, hypertrophic osteoarthropathy may herald the development of intrathoracic metastases.     

Metastatectomy prior to immunochemotherapy for metastatic renal cell carcinoma

INTRODUCTION: We reviewed our experiences in performing cytoreductive metastatectomy before initiating systemic immunochemotherapy and tried to investigate potential prognostic factors for such an approach. PATIENTS AND METHODS: A retrospective analysis of 57 patients who received interleukin-2, interferon-alpha, and 5-fluorouracil immunochemotherapy for metastatic renal cell carcinoma was conducted. Before undergoing immunochemotherapy, 20 of the 57 patients had received metastatectomy along with nephrectomy (metastatectomy group) and the other 37 nephrectomy alone (non-metastatectomy group). RESULTS: The metastatectomy group demonstrated median disease-specific and progression-free survival of 23 and 13 months, respectively. The patients in the metastatectomy group were identified as having a better performance status and primarily demonstrating pulmonary metastasis compared with those in the non-metastatectomy group. As assessed in the metastatectomy group, factors such as the number of metastatic lesions, completeness of metastatectomy, and location of metastatic lesions (lung only vs. others) were observed to be significantly associated with overall survivals on univariate analysis. CONCLUSIONS: Metastatectomy may still play a significant therapeutic role for metastatic renal cell carcinoma even in the era of immunochemotherapy as part of a multidisciplinary treatment approach in a selected group of patients in adequate general condition who have pulmonary-limited metastasis that can be completely resected.     

Severe paraneoplastic hypereosinophilia in metastatic renal cell carcinoma

Background

Onabotulinumtoxin A (OnabotA) injection has been investigated as a novel treatment for benign prostatic enlargement caused by benign prostatic hyperplasia. An OnabotA - induced volume reduction caused by sympathetic fibers impairment has been proposed as a potential mechanism of action. Our aim was to investigate the expression of apoptosis-regulating proteins in the rat prostate following OnabotA intraprostatic injection.

Methods

Adult Wistar rats were injected in the ventral lobes of the prostate with 10 U of OnabotA or saline. A set of OnabotA-injected animals was further treated with 0.5 mg/kg of phenylephrine (PHE) subcutaneously daily. All animals were sacrificed after 1 week and had their prostates harvested. Immunohistochemical staining was performed for Bax, Bcl-xL and caspase-3 proteins and visualized by the avidin-biotin method. The optical density of the glandular cells was also determined, with measurement of differences between average optical densities for each group.

Results

Saline-treated animals showed intense epithelial staining for Bcl-xL and a faint labelling for both Bax and Caspase-3. OnabotA-treated rats showed a reduced epithelial staining of Bcl-xL and a consistently increased Bax and Caspase-3 staining when compared with saline-treated animals. PHE-treated animals showed a stronger Bcl-xL staining and reduced staining of both Bax and Caspase-3 when compared to the OnabotA group. Mean signal intensity measurements for each immunoreaction confirmed a significant decrease of the signal intensity for Bcl-xL and a significant increase of the signal intensity for Bax and Caspase 3 in OnabotA-injected animals when compared with the control group. In OnabotA+PHE treated animals mean signal intensity for Bcl-xL, Bax and Caspase 3 immunoreactions was identical to that of the control animals.

Conclusions

These results support the hypothesis that OnabotA activates apoptotic pathways in the rat prostate through a mechanism that involves sympathetic outflow impairment.     

Treatment of metastatic renal cell carcinoma and renal pelvic cancer

A better understanding of the molecular biology of renal cell carcinoma (RCC) and the emergence of molecular targeted drugs have revolutionized the treatment for patients with metastatic RCC (mRCC). Multi-targeted tyrosine kinase inhibitors (sorafenib and sunitinib) and mammalian target of rapamycin inhibitors (temsirolimus and everolimus) have recently shown superiority over interferon-α or placebo. However, while the molecular targeted drugs have demonstrated encouraging results, these drugs have also sometimes induced unexpected adverse events. Control of adverse events is important to obtain the maximum effectiveness and sustain quality of life for patients. Because renal pelvic cancer has many similarities in pathogenesis with urinary bladder cancer, the same chemotherapeutic regimen is often proposed for patients with metastatic renal pelvic cancer. Combined chemotherapy with gemcitabine and cisplatin is now widely considered to be first-line chemotherapy against these metastatic diseases; however, there are still unresolved problems with this treatment, including the limited survival benefit. To select new therapeutic modalities, a more profound understanding of the molecular biology of renal pelvic cancer is crucial. The purpose of this review is to summarize the current evidence supporting the role and activities of new chemotherapeutic agents and to reveal potential future directions in the management of mRCC and renal pelvic cancer.     

Embolization and subsequent nephrectomy in metastatic renal cell carcinoma

Summary Twenty-five patients with primary metastatic adenocarcinoma renis were treated by embolization and delayed nephrectomy. The objective of the study was to examine whether the natural history of the disease is influenced by this combined treatment. Most patients (19/25) had measurable metastatic lesions. No patient received additional therapy unless progression occurred. Embolization was mainly performed with Gelfoam and Gianturco coils. Complete remission of metastases was observed in 1 patient (still in remission after 36 months); stable disease in 6 patients (lasting between 14 and 31 months). Eighteen patients died after a median survival of 5.7 months (range 14 days to 11 months). No major complication related to the embolization procedure occurred. Angio-infarction followed by nephrectomy cannot be recommended for widespread use in patients with primary metastatic kidney carcinoma. The procedure may be tested in controlled clinical trials together with other treatment protocols, such as immunotherapy, infarction with radioactive particles, or chemoembolization. These approaches are experimental and therefore limited to institutions with sufficient experience.     

Role of nephrectomy in metastatic renal cell carcinoma

Metastatic kidney cancer is still a devastating disease but it represents a very heterogeneous situation. Some patients will have a median survival limited to some months, while others will live several years. If the initial diagnosis of kidney cancer at metastatic stage is quite uncommon, it raises the question of whether or not performing initial nephrectomy. The point was long debated as it was suggested that initial nephrectomy could result in a spontaneous metastase regression and protect against local complications (hematuria, local pain,...). Today, nephrectomy must not be systematic, as effective alternative treatments are often available. Furthermore spontaneous postoperative metastasis regression is unusual. Two recent prospective randomized trials clarified the impact of initial nephrectomy. It is now accepted that initial surgery prior to systemic immunotherapy results in 30% survival benefit. However this procedure should only be considered for highly selected cases: patients in otherwise good condition (ECOG 0-1), macroscopically complete local resection, no supra-hepatic caval thrombus, and patients suitable for systemic immunotherapy treatment. Several questions remain unanswered, such as lymph node dissection to be performed, and its real survival impact. Furthermore the definition of "suitable" patients for immunotherapy has to be clarified, based on the recent results from the Percy Quatro study. It would probably be more effective to consider only patients with an expected good survival benefit using immunotherapy, such as those classified as "good prognosis" based on the CRECY criteria. Finally the development of new drugs, targeting mainly the angiogenic pathway may lead to different future indications in this setting.     

Systemic therapy for metastatic renal cell carcinoma

Renal cell cancer (RCC) is the most common form of cancer of the kidney and accounts for approximately 44,000 cases per year in the United States. Historically, only immunotherapy showed activity in metastatic RCC. The improved survival and quality of life for patients with metastatic RCC over the last several years are direct results of advances made in understanding the development of RCC. Three targeted therapies-sunitinib, sorafenib, and temsirolimus-have been approved for use in the United States recently. Current research is aimed at developing new drugs and combining available drugs to improve upon the responses and survival seen with approved single agents.