real world experience with sunitinib treatment in patients with metastatic renal cell carcinoma clinical outcome according to risk score

Abstract Background ADONIS is an ongoing observational study in 9 European countries, designed to evaluate treatment patterns/outcomes in patients with metastatic renal cell carcinoma (mRCC) treated with first-line sunitinib and/or second-line axitinib post sunitinib. We present an evaluation of sunitinib efficacy by risk group, in the real-world setting examined in ADONIS. Methods Patients were enrolled at the start of first-line sunitinib treatment or second-line axitinib post sunitinib treatment. Evaluation of sunitinib efficacy was assessed by International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center risk criteria. Results For all patients in this analysis (N = 467), median progression-free survival was 23.8 (95% CI 16.5-28.5), 11.8 (8.1-17.4), and 4.6 (2.5-7.7) months for IMDC favorable-, intermediate-, and poor-risk groups, respectively. Median overall survival was 97.1 (46.3-not evaluable [NE]), 33.5 (20.5-46.6), and 10.0 (4.5-19.8) months for the respective risk groups. Data on individual risk factors were available for a subgroup of patients, allowing analysis by intermediate risk by 1 versus 2 risk factors. When including this subgroup (n = 120), median overall survival for IMDC favorable-, intermediate-1, and intermediate-2 risk factors was 21.6 (16.3-NE), 20.5 (15.5-NE), and 15.1 (4.1-NE) months, respectively. Conclusions For patients overall and by risk-group stratification, survival estimates were aligned with improvements in clinical practice over the past decade. In patients with intermediate-1 risk, overall survival was very similar to patients with favorable risk. However, further exploration is needed to confirm these observations. ClinicalTrials.gov identifier: NCT0218441

A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer

A systematic review was performed to evaluate the clinical effectiveness of docetaxel in combination with prednisolone (docetaxel is licensed in the UK for use in combination with prednisone or prednisolone for the treatment of patients with metastatic hormone-refractory prostate cancer. Prednisone is not used in the UK, but it is reasonable to use docetaxel plus prednisone data in this review of docetaxel plus prednisolone) for the treatment of metastatic hormone-refractory prostate cancer. A scoping search identified a trial of docetaxel plus prednisone vs mitoxantrone plus prednisone, but did not identify any trials comparing docetaxel plus prednisolone/prednisone with any other treatments. Therefore, we considered additional indirect evidence that would enable a comparison of docetaxel plus prednisolone/prednisone with other chemotherapy regimens and active supportive care. Systematic searching (upto April 2005) identified seven randomised controlled trials. One large well-conducted trial assessed docetaxel plus prednisone vs mitoxantrone plus prednisone; this showed statistically significant improvements with 3-weekly docetaxel in terms of overall survival, quality of life, pain response and PSA decline. Two other chemotherapy regimens that included docetaxel with estramustine also showed improved outcomes in comparison with mitoxantrone plus prednisone. Three trials that compared mitoxantrone plus corticosteroids with corticosteroids alone were identified and their results for overall survival combined, which showed very little difference between the two groups. The addition of clodronate to mitoxantrone plus prednisone showed no significant differences in comparison with mitoxantrone plus prednisone alone. The evidence suggests that chemotherapy regimens containing 3-weekly docetaxel are superior to mitoxantrone or corticosteroids alone

Cloud thermodynamic phase inferred from merged POLDER and MODIS data

International audienceThe global spatial and diurnal distribution of cloud properties is a key issue for understanding the hydrological cycle, and critical for advancing efforts to improve numerical weather models and general circulation models. Satellite data provides the best way of gaining insight into global cloud properties. In particular, the determination of cloud thermodynamic phase is a critical first step in the process of inferring cloud optical and microphysical properties from satellite measurements. It is important that cloud phase be derived together with an estimate of the confidence of this determination, so that this information can be included with subsequent retrievals (optical thickness, effective particle radius, and ice/liquid water content). In this study, we combine three different and well documented approaches for inferring cloud phase into a single algorithm. The algorithm is applied to data obtained by the MODIS (MODerate resolution Imaging Spectroradiometer) and POLDER3 (Polarization and Directionality of the Earth Reflectance) instruments. It is shown that this synergistic algorithm can be used routinely to derive cloud phase along with an index that helps to discriminate ambiguous phase from confident phase cases. The resulting product provides a semi-continuous confidence index ranging from confident liquid to confident ice instead of the usual discrete classification of liquid phase, ice phase, mixed phase (potential combination of ice and liquid particles), or simply unknown phase clouds. This approach is expected to be useful for cloud assimilation and modeling efforts while providing more insight into the global cloud properties derived from satellite data

Metastatic Renal Cell Carcinoma Rapidly Progressive to Sunitinib: What to Do Next?

Background: From 10% to 26% of patients with metastatic renal cell carcinoma (mRCC) experience rapidly progressive disease (PD) on treatment with sunitinib. Objective: To investigate the benefit of subsequent treatment with another tyrosine kinase inhibitor (TKI) or a mammalian target of rapamycin (mTOR) inhibitor in such primary refractory patients. Design, setting, and participants: A total of 150 mRCC patients with rapidly PD on first- line sunitinib (within two cycles, n = 93, or four cycles, n = 57) were identified: median age 59 yr; nephrectomy 86%; histological subtypes: clear cell (77.8%), papillary (14%), and sarco- matoid features (18%); according to the Memorial Sloan-Kettering Cancer Center and French classifications: good risk (11% and 7%, respectively), intermediate (68% and 63%, respectively), and poor (21% and 29%, respectively). Outcome measurements and statistical analysis: Data were retrospectively collected by a questionnaire from 19 European oncology centers between March 2005 and March 2011. Pro- gression-free survival (PFS) and overall survival (OS) were calculated (Kaplan-Meier method). Results and limitations: Median OS from the start of first-line treatment was 7.4 mo. Second-line treatment was administered to 86 (57%) patients (44 mTOR inhibitors: 23 ever- olimus and 21 temsirolimus; 39 TKIs alone or in combination; three chemotherapy). Second- line PFS was not significantly different between TKIs and mTOR inhibitors (2.0 vs 0.9 mo; p = 0.536). Median OS from the start of second-line treatment was 5.0 mo for mTOR inhibitors and 6.6 mo for TKIs (p = 0.15). Conclusions: Treatment with further TKIs or mTOR inhibitors for mRCC patients primarily refractory to first-line sunitinib in the observed time period achieved very minimal benefit, suggesting avoiding TKI rechallenge and possibly preferring alternative strategies, such as immune checkpoint inhibitors, after PD to a treatment line including a TKI in this setting. Patient summary: The present work collected data about 150 patients affected by meta- static renal cell carcinoma, who received one of the current standard of care as first-line treatment, namely, the antiangiogenic drug sunitinib, and experienced rapid worsening of the disease. We investigated and described the subsequent outcome of such patients treated with two different types of drug, administered as second-line therapy, to better understand the best strategy to adopt for patients who got no benefit from sunitinib and to describe the current therapeutic approach in such cases

Metastatic collecting duct carcinoma of the kidney treated with sunitinib

Collecting duct carcinoma (CDC) of the kidney is a rare and aggressive malignant tumor arising from the distal collecting tubules which has been shown to have a poor response to several kinds of systemic therapy. We present a case of metastatic CDC that responded favorably to a multiple tyrosine kinase inhibitor, sunitinib, achieving a partial response in both lung and skeletal metastases. To our knowledge, this is the first report showing therapeutic activity of sunitinib against CDC. Considering these findings, it would be worthwhile prospectively investigating the role of multiple tyrosine kinase inhibitors, particularly sunitinib, in the management of metastatic CDC