Chromophobe renal cell carcinoma (RCC) is a rare subtype of RCC and accounts for about 5% of all RCC cases. A recent retrospective study, published in the journal Clinical Genitourinary Cancer, looked at the clinical outcomes and genomic features of 109 patients with metastatic chromophobe RCC, of which 29 had sarcomatoid features. Sarcomatoid carcinoma is a relatively uncommon form of cancer where the malignant cells in the tumour resemble both epithelial cells (carcinoma) and mesenchymal cells (sarcoma).
The study showed that the patients with sarcomatoid features had poorer clinical outcomes than those without sarcomatoid features. Median time to recurrence (2.7 vs 48.8 months) and time to treatment failure (1.8 vs 8.0 months) were both shorter in patients with sarcomatoid features compared to those without. Median overall survival was also shorter in patients with sarcomatoid features (7.5 vs 38 months). Of 6 patients who did not respond to nivolumab therapy, 4 had sarcomatoid features.
The researchers conclude that because of poor clinical outcomes in patients with metastatic chromophobe RCC with sarcomatoid features, these patients need close surveillance following nephrectomy. Additional research into the biology of chromophobe RCC with sarcomatoid features is warranted to identify new treatments for this group of patients.
This review presents the findings of a meta-analysis of 13 cancer clinical trials representing nearly 9,000 patients to identify the barriers to clinical trial participation in the United States. Since this is a US study, some of the patient-related barriers regarding medical insurance do not apply for patients in the UK.
A phase 2 study published in the British Journal of Urology last year evaluated the effectiveness of neoadjuvant axitinib given before surgery to reduce the size of renal tumours (stage cT2a) to enable partial nephrectomy in 18 patients.
The tumours decreased in size in 16 of the 18 patients, and these 16 patients had a partial nephrectomy. However, 6 patients developed metastases and 2 patients had recurrent renal cancer in the two years following the partial nephrectomy.
Neoadjuvant axitinib is successful at reducing the size of renal tumours; however, the the use of partial versus radical nephrectomy for a cT2 tumour remains controversial. Other studies to investigate neoadjuvant treatments, including checkpoint inhibitors, are forthcoming to find the best way to manage these tumours.
A retrospective study using data from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) dataset looked at the efficacy of nivolumab (225 patients) and cabozantinib (53 patients) when used to treat metastatic renal cell carcinoma (RCC) in the real world.
The study found similar outcomes for patients treated with nivolumab and cabozantinib in the second-line, suggesting that both are acceptable options for patients whose cancer progresses following first-line treatment with vascular endothelial growth factor receptor (VEGFR)-targeted therapy, such as sunitinib or pazopanib.
A recent study reported in European Urology by investigators at the Mayo Clinic in Rochester, Minnesota, USA compared partial nephrectomy with percutaneous ablation (radiofrequency ablation or cryoablation) in the treatment of 1422 patients with localised renal tumours, stage cT1. Patients were followed for at least 6 years.
There were no significant differences in local recurrence, metastases and cancer-related death between partial nephrectomy and ablation. 5-year local recurrence-free survival rates were 97.7%, 95.9%, and 95.9% for partial nephrectomy, radiofrequency ablation and cryoablation , respectively. The 5-year metastasis-free survival rates were 98%, 93.9%, and 100%, and 5-year cancer-specific survival rates were 99%, 96%, and 100%, respectively.
They concluded that percutaneous ablation for localised renal tumours is an appropriate treatment option for patients who are not able to have surgery; however, additional follow-up and further study are still needed.
The world’s first ‘Darwinian’ cancer drug programme was launched by the Institute of Cancer Research (ICR), and aims to deliver a step change in cancer treatment. The programme will be run from the ICR’s £75 million state-of-the-art Centre for Cancer Drug Discovery in London.
The new cancer drug programme will harness evolutionary science to tackle cancer’s ability to develop resistance to treatment using anti-evolution drugs and combinations of treatments. The programme will use artificial intelligence and advanced maths to ‘herd’ cancer for treatment.
More cancer patients are living longer and with fewer side effects, but “unfortunately, we’re also seeing that cancer can become resistant very quickly to new drugs – and this is the greatest challenge we face”, says Dr Olivia Rossanese, the newly appointed head of biology in the Centre for Cancer Drug Discovery.
She continued, “Within the Centre for Cancer Drug Discovery, we plan to deliver a drug discovery programme that is wholly focused on meeting the challenge of cancer evolution and drug resistance through completely new ways of attacking the disease.
“This ‘Darwinian’ approach to drug discovery gives us the best chance yet of defeating cancer, because we will be able to predict what cancer is going to do next and get one step ahead.”
The Food and Drug Administration (FDA) in the United States has approved the avelumab (Bavencio) plus axitinib (Inlyta) combination for first-line treatment of advanced renal cell carcinoma (RCC).
The approval is the first by the FDA for an anti-PD-L1 therapy as part of a combination treatment for patients with advanced RCC. Around 20-30% of people are diagnosed with advanced RCC, and 30% of people treated for early stage RCC go on to develop advanced disease. This highlights the significant unmet need for effective first-line treatments that delay disease progression and are tolerable for patients.
The approval is based on the results from the open-label phase 3 JAVELIN Renal 101 study involving 886 patients. In this study, median progression-free survival was extended by more than 5 months compared with sunitinib.
The avelumab plus axitinib combination is currently being reviewed by the European Medicines Agency (EMA) for use within Europe.
A recent study published in Cardiovascular and Interventional Radiology this month looked at the use of percutaneous cryoablation for stage T1b (4.1-7.0 cm) renal cell carcinoma (RCC). This non-invasive technique, which involves ‘freezing’ the tumour using fine needles inserted through the skin (percutaneous), has not yet been widely adopted. The current study investigated the safety, technical results and clinical outcomes of using percutaneous cryoablation for T1b tumours in 37 patients.
Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively, and cancer-specific survival was 100% at 1, 2, and 3 years. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Grade 2 or higher complications occurred in 16.2% of patients.
The researchers concluded that percutaneous cryoablation for stage T1b RCC tumours is technically very successful, has excellent cancer-specific survival, and an acceptable safety profile.
In a recent study, published in BMC Cancer last month, it was reported that the levels of the programmed cell death proteins PD-1, PD-L1 and PD-L2 varied between primary tumour, metastases and site of metastases. For example, PD-L1 was higher in metastatic tumours compared with primary tumours, and PD-1 expression was 65.3% in lung/lymph metastases compared with 10.5% in brain metastases and 12.5% in visceral metastases. Both PD-1 expression and PD-L1 expression in the primary or metastatic lesion was associated with shorter overall survival.
The researchers suggest that metastases should be analysed for these proteins to facilitate effective individualised treatment.
A recent study published in Science Direct followed patients with metastatic renal cell carcinoma (RCC), who were ineligible for active surveillance, to determine whether a delay in receiving first-line treatment affected outcomes.
In the study, the overall median treatment delay was 6.3 weeks. Patients with bone metastases and advanced disease at diagnosis were more likely to experience a treatment delay. The researchers reported that there were no differences in progression-free survival and overall survival between patients who waited less than 6.3 weeks for first-line treatment compared with those who waited longer than 6.3 weeks.
In conclusion, the researchers reported that patients with metastatic RCC with bone metastases or advanced disease are most likely to experience a delay in receiving first-line treatment, but this delay does not appear to have an effect on survival outcomes.