Essential Peer-Reviewed Reading in Kidney Cancer
The peer-reviewed articles summarized in this section were selected by the
Editor-in-Chief, Robert A. Figlin, MD, for their timeliness, importance, relevance,
and potential impact on clinical practice or translational research.
Outcomes of Patients with Metastatic Renal Cell
Carcinoma Treated with Targeted Therapy After
Immuno-oncology Checkpoint Inhibitors. Graham ,
Shah AY, Wells JC, et al. Eur Urol Oncol. 2019 Nov 27.
pii: S2588-9311(19)30160-9. doi:
10.1016/j.euo.2019.11.001. Epub ahead of print
Summary: Among 314 patients, 276 (87.9%) and 38
(12.1%) were treated with VEGFR-TKI and mTORI therapy,
respectively. The most common tyrosine kinase
inhibitor treatments were axitinib, cabozantinib, and
sunitinib following IO therapy. In adjusted models, patients
treated with VEGFR-TKI versus mTORI therapy
had lower hazard of TTD after IO treatment (aHR=0.46;
95% CI: 0.30-0.71; p < 0.01). One-year OS probability
(65% vs 47%, P < 0.01) and proportion of ORR (29.8%
vs 3.6%, P < 0.01) were significantly greater for patients
treated with VEGFR-TKIs versus those treated with
mTORIs.
Conclusion: Targeted therapy has clinical activity following
IO treatment. Patients who received VEGFRTKIs
versus mTORIs following IO therapy had
improved clinical outcomes. These findings may help
inform treatment guidelines and clinical practice for
patients post-IO therapy. Patients may continue to experience
clinical benefits from targeted therapies after
progression on immuno-oncology treatment.
The association of anxiety and depression with
perioperative and oncologic outcomes among
patients with clear cell renal cell carcinoma
undergoing nephrectomy. Packiam VT, Tyson I,
Tsivian M, et al. Urol Oncol. 2019 Nov 21. pii: S1078-
1439(19)30441-7. doi: 10.1016/j.urolonc.2019.10.017.
Epub ahead of print
Summary: The authors reviewed the institutional
nephrectomy registry of 1,990 adults who underwent
radical or partial nephrectomy for unilateral, sporadic,
nonmetastatic ccRCC between 1995 and 2011. Baseline
anxiety and depression were identified using ICD-9
codes. Associations of anxiety or depression with 30-
day complications and oncologic outcomes were evaluated.
A total of 197 (10%) patients were identified
with a diagnosis of anxiety or depression. Median follow
up among survivors was 10.0 (IQR 7.3-13.6) years,
during which time 864 patients died, including 363
from RCC. After PS adjustment, clinical and pathologic
features were well balanced between groups. Patients
with anxiety or depression had increased overall 30-
day complications compared to those without (17% vs.
11%, P = 0.011). No significant differences were noted
in time to local ipsilateral recurrence (P = 0.54), distant
92 Kidney Cancer Journal
metastases (P = 0.96), or death from RCC (P = 0.42) between
patients with vs. without anxiety or depression,
while patients with anxiety or depression trended toward
worse overall survival (hazard ratio 1.29, 95%CI
0.98-1.69, P = 0.065).
Conclusion: Neither anxiety nor depression were significantly
associated with oncologic outcomes among
patients who underwent surgery for localized ccRCC.
The trend toward worse overall survival among patients
with anxiety or depression warrants further investigation.
Understanding racial disparities in renal cell
carcinoma incidence: estimates of population
attributable risk in two US populations. Callahan
CL, Schwartz K, Corley DA, et al. Cancer Causes Control.
2019 Nov 28. doi: 10.1007/s10552-019-01248-1.
Epub ahead of print
Summary: This study calculated race- and sex-specific
population attributable risk percentages (PAR%) and
their 95% confidence intervals (CI) for hypertension
and chronic kidney disease (CKD) among black and
white subjects 50 years of age from the US Kidney
Cancer Study (USKC; 965 cases, 953 controls), a casecontrol
study in Chicago and Detroit, and a nested
case-control study in the Kaiser Permanente Northern
California health care network (KPNC; 2,162 cases,
21,484 controls). The authors also estimated PAR% for
other modifiable RCC risk factors (cigarette smoking,
obesity) in USKC. In USKC, the PAR% for hypertension
was 50% (95% CI 24-77%) and 44% (95% CI 25-64%)
among black women and men, respectively, and 29%
(95% CI 13-44%) and 27% (95% CI 14-39%) for white
women and men, respectively. In KPNC, the hypertension
PAR% was 40% (95% CI 18-62%) and 23% (95%
CI 2-44%) among black women and men, and 27%
(95% CI 20-35%) and 19% (95% CI 14-24%) among
white women and men, respectively. The PAR% for
CKD in both studies ranged from 7 to 10% for black
women and men but was negligible (<1%) for white
subjects. In USKC, the PAR% for current smoking was
20% and 8% among black and white men, respectively,
and negligible and 8.6% for black and white women,
respectively. The obesity PAR% ranged from 12 to 24%
across all race/sex strata.
Conclusion: If the associations found are causal, interventions
that prevent hypertension and CKD among
black Americans could potentially eliminate the racial
disparity in RCC incidence (hypothetical black:white
RCC incidence ratio of 0.5). KCJ
J O U R N A L C L U B