Promising Biomarkers in Renal Cell Carcinoma

4siRenal cell carcinoma (RCC) incidence has been increasing in recent years, and it now represents the sixth most common cancer diagnosis in men and the tenth in women. Although this is partly due to increased detection of incidental small renal masses on unrelated imaging, advanced RCC continues to be diagnosed in a significant portion of patients, with more than 15% presenting with distant metastases. Biomarkers can be a cost-effective tool to identify high-risk patients and institute appropriate individualised therapies. While the literature in this field is nascent, this paper focuses on several biomarkers that have been extensively investigated in the diagnosis and prognosis of RCC, as well as in predicting its response to treatments, particularly the newer immuno-oncology drugs.openopenKapoor, Jada; Claps, Francesco; Mir, M. Carmen; Ischia, JosephKapoor, Jada; Claps, Francesco; Mir, M. Carmen; Ischia, Josep

Promising Biomarkers in Renal Cell Carcinoma

Renal cell carcinoma (RCC) incidence has been increasing in recent years, and it now represents the sixth most common cancer diagnosis in men and the tenth in women. Although this is partly due to increased detection of incidental small renal masses on unrelated imaging, advanced RCC continues to be diagnosed in a significant portion of patients, with more than 15% presenting with distant metastases. Biomarkers can be a cost-effective tool to identify high-risk patients and institute appropriate individualised therapies. While the literature in this field is nascent, this paper focuses on several biomarkers that have been extensively investigated in the diagnosis and prognosis of RCC, as well as in predicting its response to treatments, particularly the newer immuno-oncology drugs

Prediction of pathological stage at radical prostatectomy: do commonly used prostate cancer nomograms apply to men from Far North Queensland?

Background: Clinical nomograms are routinely used by urologists to predict pathological and clinical outcomes. Commonly used prostate cancer nomograms include Partin's tables and Memorial Sloan Kettering Cancer Centre (MSKCC) nomograms which were developed in high-volume centres in the United States. We aimed to assess whether these tools are valid for prostate cancer patients in Far North Queensland. Methods: All patients undergoing radical prostatectomy in Cairns between August 2014 and September 2017 were identified. Preoperative data were entered into the online nomogram tools. The predicted probability of organ-confined (OC) disease, extra-prostatic extension (EPE) and seminal vesical invasion was compared to the observed outcomes. Results: Preoperative clinical information was available for 290 patients. Partin's tables accurately estimated OC disease, EPE and seminal vesical invasion with the observed outcome plot overlying the ideal correlation curve. More patients in our cohort had OC disease than was predicted by the MSKCC nomogram; fewer patients had EPE that was predicted by the MSKCC nomogram. On logistic regression modelling, the area under the curve for MSKCC and Partin's were 0.751 and 0.706, respectively, suggesting both tests have good performance in predicting final pathological outcome for our population of patients with no statistical difference between the two nomograms (P = 0.29). Conclusion: The MSKCC preoperative nomogram and Partin's tables were both able to accurately predict pathological outcomes from preoperative clinical information in men from Far North Queensland, despite likely differences in population genetics and environmental exposures

Indirect comparisons of efficacy between combination approaches in metastatic hormone-sensitive prostate cancer: a systematic review and network meta-analysis

Context: There have been substantial changes in the management of men with metastatic hormone-sensitive prostate cancer (mHSPC) over the past 5 yr, with upfront combination therapies replacing androgen-deprivation therapy (ADT) alone. A range of therapies have entered the space with no clear answer regarding their comparative efficacy. Objective: To perform a systematic review and network meta-analysis to characterise the comparative efficacy of combination approaches in men with mHSPC. Evidence acquisition: We searched multiple databases and abstracts of major meetings up to June 2019 for randomised trials of patients receiving first-line therapy for metastatic disease, a combination of ADT and one (or more) of taxane-based chemotherapy, and androgen receptor-targeted therapies. The primary endpoint was overall survival (OS) and we evaluated progression-free survival as a secondary outcome. We performed subgroup analysis based on the volume of disease. Evidence synthesis: We found seven trials that met our eligibility criteria using either docetaxel, abiraterone acetate, enzalutamide, or apalutamide in combination with ADT. All agents in combination with ADT were shown to be superior to ADT alone; enzalutamide + ADT had the lowest absolute hazard ratio compared with ADT only (hazards ratio 0.53, 95% confidence interval 0.37–0.75), and an estimated 76.9% probability that it is the preferred treatment to prolong OS compared with other combination treatments, or with ADT alone. Enzalutamide appeared to have better OS compared with docetaxel in men with low-volume disease, but there was no difference in other comparisons. Conclusions: Combination therapy with any of docetaxel, abiraterone acetate, enzalutamide, or apalutamide provides a significant OS benefit when compared with ADT alone. We did not identify significant differences in OS between different combination therapies. Subtle differences between these options provide clinicians considerable flexibility when selecting options for individual patients. Patient summary: Many men with metastatic, hormone-sensitive prostate cancer should be managed with upfront combination therapy instead of androgen-deprivation therapy alone. Clinicians may consider many factors during the decision-making process, and thus management should be tailored for patients individually. Combination therapy with any of docetaxel, abiraterone acetate, enzalutamide, or apalutamide provides a significant overall survival (OS) benefit when compared with androgen-deprivation therapy alone. We did not identify significant differences in OS between different combination therapies. Subtle differences between these options allow clinicians considerable flexibility when selecting options for individual patients