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Andersson-Evelönn, E., Landfors, M., Haider, Z., Köhn, L., Ljungberg, B., Roos, G. & Degerman, S. (2019). DNA methylation associates with survival in non-metastatic clear cell renal cell carcinoma. BMC Cancer, 19, Article ID 65.
Open this publication in new window or tab >>DNA methylation associates with survival in non-metastatic clear cell renal cell carcinoma
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2019 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 19, article id 65Article in journal (Refereed) Published
Abstract [en]

Background: Clear cell renal cell carcinoma (ccRCC) is the most common subtype among renal cancer and is associated with poor prognosis if metastasized. Up to one third of patients with local disease at diagnosis will develop metastasis after nephrectomy, and there is a need for new molecular markers to identify patients with high risk of tumor progression. In the present study, we performed genome-wide promoter DNA methylation analysis at diagnosis to identify DNA methylation profiles associated with risk for progress.

Method: Diagnostic tissue samples from 115 ccRCC patients were analysed by Illumina HumanMethylation450K arrays and methylation status of 155,931 promoter associated CpGs were related to genetic aberrations, gene expression and clinicopathological parameters.

Results: The ccRCC samples separated into two clusters (cluster A/B) based on genome-wide promoter methylation status. The samples in these clusters differed in tumor diameter (p < 0.001), TNM stage (p < 0.001), morphological grade (p < 0.001), and patients outcome (5 year cancer specific survival (pCSS5yr) p < 0.001 and cumulative incidence of progress (pCIP5yr) p < 0.001. An integrated genomic and epigenomic analysis in the ccRCCs, revealed significant correlations between the total number of genetic aberrations and total number of hypermethylated CpGs (R = 0.435, p < 0.001), and predicted mitotic age (R = 0.407, p < 0.001). We identified a promoter methylation classifier (PMC) panel consisting of 172 differently methylated CpGs accompanying progress of disease. Classifying non-metastatic patients using the PMC panel showed that PMC high tumors had a worse prognosis compared with the PMC low tumors (pCIP5yr 38% vs. 8%, p = 0.001), which was confirmed in non-metastatic ccRCCs in the publically available TCGA-KIRC dataset (pCIP5yr 39% vs. 16%, p < 0.001).

Conclusion: DNA methylation analysis at diagnosis in ccRCC has the potential to improve outcome-prediction in non-metastatic patients at diagnosis.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Clear cell renal cell carcinoma, DNA methylation, Prognosis, Genetic
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-155957 (URN)10.1186/s12885-019-5291-3 (DOI)000455576500013 ()30642274 (PubMedID)
Funder
The Kempe FoundationsSwedish Cancer SocietyVästerbotten County Council
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-08Bibliographically approved
Dabestani, S., Beisland, C., Stewart, G. D., Bensalah, K., Gudmundsson, E., Lam, T. B., . . . Bex, A. (2019). Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR). European Urology, 75(2), 261-264
Open this publication in new window or tab >>Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR)
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2019 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 75, no 2, p. 261-264Article in journal (Refereed) Published
Abstract [en]

The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma(RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n = 1612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Recurrence occurred in 336 patients. Cross-sectional (computed tomography, magnetic resonance imaging) and conventional (chest X-ray, ultrasound) methods were used in 47% and 53%, respectively. More intensive FU imaging (more than twofold) than recommended by the European Association of Urology (EAU) was not associated with improved overall survival (OS) after recurrence. Overall, per patient treated for recurrence remaining alive with no evidence of disease, the number of FU images needed was 542, and 697 for high-risk patients. The study results suggest that use of more imaging during FU than that recommended in the 2017 EAU guidelines is unlikely to improve OS after recurrence. Prospective studies are needed to design optimal FU strategies for the future.

Patient summary: After curative treatment for localised kidney cancer, follow-up is necessary to detect any recurrence. This study illustrates that increasing the imaging frequency during follow-up, even to double the number of follow-up imaging procedures recommended by the European Association of Urology guidelines, does not translate into improved survival for those with recurrence.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Kidney cancer, Radical surgery, Follow-up, Imaging, Overall survival
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-155950 (URN)10.1016/j.eururo.2018.10.007 (DOI)000455852400025 ()30318330 (PubMedID)
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-08Bibliographically approved
Bergerot, C. D., Battle, D., Bergerot, P. G., Dizman, N., Jonasch, E., Hammers, H. J., . . . Staehler, M. D. (2019). Sources of Frustration Among Patients Diagnosed With Renal Cell Carcinoma. Frontiers in Oncology, 9, Article ID 11.
Open this publication in new window or tab >>Sources of Frustration Among Patients Diagnosed With Renal Cell Carcinoma
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2019 (English)In: Frontiers in Oncology, ISSN 2234-943X, E-ISSN 2234-943X, Vol. 9, article id 11Article in journal (Refereed) Published
Abstract [en]

Despite numerous therapeutic advances in renal cell carcinoma (RCC), little is known about patients' perspectives on cancer care. An international survey was conducted to identify points of frustration associated with cancer care reported by patients with RCC. Data were obtained from an online survey, conducted from April 1 to June 15, 2017, through social media and patient networking platforms. This survey obtained baseline demographic, clinicopathologic, and treatment-related information. Open-ended questions accessed sources of frustration in cancer-related care and patients' suggestions for amelioration. Responses were categorized and reviewed by independent reviewers. A qualitative analysis was performed and the Kruskal-Wallis test was used to define associations between baseline characteristics and sources of frustration. Among 450 patients surveyed, 71.5% reported sources of frustration, classified as either emotional (48.4%) or practical (23.1%). The most common were fear of recurrence/progression (15.8%), distrust of their cancer care system (12.9%), and lack of appropriate information (9.8%). Female gender and non-clear cell histology were associated with both types of frustration, and older age was linked to practical sources of frustration. Patients suggested solutions included greater compassion among health care practitioners (20.7%), better access to information (15.1%) and research to improve their chances of being cured (14.7%). Sources of frustration related to emotional and practical causes were identified amongst patients with RCC. Certain demographic and clinical characteristics were associated with more sources of frustration. This study provides the first characterization of specific ways to improve the patient experience by addressing common frustrations.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
renal cell carcinoma, health care survey, frustration, fear of cancer recurrence, qualitative study
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-156313 (URN)10.3389/fonc.2019.00011 (DOI)000456245700001 ()30723705 (PubMedID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-02-21Bibliographically approved
Johansson, M., Carreras-Torres, R., Scelo, G., Purdue, M. P., Mariosa, D., Muller, D. C., . . . Brennan, P. (2019). The influence of obesity-related factors in the etiology of renal cell carcinoma: A mendelian randomization study. PLoS Medicine, 16(1), Article ID e1002724.
Open this publication in new window or tab >>The influence of obesity-related factors in the etiology of renal cell carcinoma: A mendelian randomization study
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2019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 1, article id e1002724Article in journal (Refereed) Published
Abstract [en]

Background: Several obesity-related factors have been associated with renal cell carcinoma (RCC), but it is unclear which individual factors directly influence risk. We addressed this question using genetic markers as proxies for putative risk factors and evaluated their relation to RCC risk in a mendelian randomization (MR) framework. This methodology limits bias due to confounding and is not affected by reverse causation.

Methods and findings: Genetic markers associated with obesity measures, blood pressure, lipids, type 2 diabetes, insulin, and glucose were initially identified as instrumental variables, and their association with RCC risk was subsequently evaluated in a genome-wide association study (GWAS) of 10,784 RCC patients and 20,406 control participants in a 2-sample MR framework. The effect on RCC risk was estimated by calculating odds ratios (ORSD) for a standard deviation (SD) increment in each risk factor. The MR analysis indicated that higher body mass index increases the risk of RCC (ORSD: 1.56, 95% confidence interval [CI] 1.44–1.70), with comparable results for waist-to-hip ratio (ORSD: 1.63, 95% CI 1.40–1.90) and body fat percentage (ORSD: 1.66, 95% CI 1.44–1.90). This analysis further indicated that higher fasting insulin (ORSD: 1.82, 95% CI 1.30–2.55) and diastolic blood pressure (DBP; ORSD: 1.28, 95% CI 1.11–1.47), but not systolic blood pressure (ORSD: 0.98, 95% CI 0.84–1.14), increase the risk for RCC. No association with RCC risk was seen for lipids, overall type 2 diabetes, or fasting glucose.

Conclusions: This study provides novel evidence for an etiological role of insulin in RCC, as well as confirmatory evidence that obesity and DBP influence RCC risk.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-155372 (URN)10.1371/journal.pmed.1002724 (DOI)000457349900005 ()30605491 (PubMedID)2-s2.0-85059499698 (Scopus ID)
Funder
NIH (National Institute of Health), R01 CA170298
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-02-20Bibliographically approved
Marconi, L., de Bruijn, R., van Werkhoven, E., Beisland, C., Fife, K., Heidenreich, A., . . . Bex, A. (2018). External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. World journal of urology, 36(12), 1973-1980
Open this publication in new window or tab >>External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma
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2018 (English)In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726, Vol. 36, no 12, p. 1973-1980Article in journal (Refereed) Published
Abstract [en]

IntroductionRecent trials have emphasized the importance of a precise patient selection for cytoreductive nephrectomy (CN). In 2013, a nomogram was developed for pre- and postoperative prediction of the probability of death (PoD) after CN in patients with metastatic renal cell carcinoma. To date, the single-institutional nomogram which included mostly patients from the cytokine era has not been externally validated. Our objective is to validate the predictive model in contemporary patients in the targeted therapy era.MethodsMulti-institutional European and North American data from patients who underwent CN between 2006 and 2013 were used for external validation. Variables evaluated included preoperative serum albumin and lactate dehydrogenase levels, intraoperative blood transfusions (yes/no) and postoperative pathologic stage (primary tumour and nodes). In addition, patient characteristics and MSKCC risk factors were collected. Using the original calibration indices and quantiles of the distribution of predictions, Kaplan-Meier estimates and calibration plots of observed versus predicted PoD were calculated. For the preoperative model a decision curve analysis (DCA) was performed.ResultsOf 1108 patients [median OS of 27months (95% CI 24.6-29.4)], 536 and 469 patients had full data for the validation of the pre- and postoperative models, respectively. The AUC for the pre- and postoperative model was 0.68 (95% CI 0.62-0.74) and 0.73 (95% CI 0.68-0.78), respectively. In the DCA the preoperative model performs well within threshold survival probabilities of 20-50%. Most important limitation was the retrospective collection of this external validation dataset.ConclusionsIn this external validation, the pre- and postoperative nomograms predicting PoD following CN were well calibrated. Although performance of the preoperative nomogram was lower than in the internal validation, it retains the ability to predict early death after CN.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Metastatic renal cancer, Cytoreductive nephrectomy, Targeted therapy, Selection, Validation, Nomogram
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-154902 (URN)10.1007/s00345-018-2427-z (DOI)000452271200009 ()30069581 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-01-04Bibliographically approved
Inkiläinen, A., Styrke, J., Ljungberg, B. & Strigård, K. (2018). Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study. Scandinavian journal of urology, 52(1), 54-58
Open this publication in new window or tab >>Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study
2018 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 1, p. 54-58Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Abdominal bulging and incisional hernia are known sequelae after open partial nephrectomy (OPN) via a flank incision. Precise rates are not known. The aims of this study were to determine the rates of bulging and hernia after OPN, and to examine potential risk factors.

MATERIALS AND METHODS: A retrospective review was undertaken of 197 consecutive patients operated on with OPN via a flank incision between 2004 and 2014. After exclusion, 184 patients remained. Medical records and radiological images from the preoperative work-up, and follow-up after surgery at 3, 12 and 24 months, were reviewed.

RESULTS: A visible bulge was noted in 36 of the 184 patients at clinical examination. Only 20 cases (12%) remained at the last follow-up. Radiological changes interpreted as a bulge were initially seen in 50 patients, while only 35 (19%) remained at the last radiological examination. Clinical incisional hernia was reported in five patients (3%), and radiological hernia was seen in 10 patients (5%). Patients who developed a hernia had a higher body mass index (30 vs 26 kg/m(2), p = 0.02). Other demographic variables showed no significant correlation.

CONCLUSIONS: Bulging is a common sequela after flank incision. The rate of incisional hernia after flank incision is comparable to rates after other forms of abdominal surgery. Further studies are required to evaluate the psychological and physiological effects of bulging, the pain and weakness caused, and the cosmetic embarrassment suffered by the patient.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Bulge, flank incision, incisional hernia, open partial nephrectomy, renal cell carcinoma
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-140297 (URN)10.1080/21681805.2017.1376352 (DOI)000425799400010 ()28934886 (PubMedID)
Available from: 2017-10-04 Created: 2017-10-04 Last updated: 2018-09-28Bibliographically approved
Lin, C., Travis, R. C., Appleby, P. N., Tipper, S., Weiderpass, E., Chang-Claude, J., . . . Perez-Cornago, A. (2018). Pre-diagnostic circulating insulin-like growth factor-I and bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition. International Journal of Cancer, 143(10), 2351-2358
Open this publication in new window or tab >>Pre-diagnostic circulating insulin-like growth factor-I and bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition
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2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 10, p. 2351-2358Article in journal (Refereed) Published
Abstract [en]

Previous in vitro and case–control studies have found an association between the insulin‐like growth factor (IGF)‐axis and bladder cancer risk. Circulating concentrations of IGF‐I have also been found to be associated with an increased risk of several cancer types; however, the relationship between pre‐diagnostic circulating IGF‐I concentrations and bladder cancer has never been studied prospectively. We investigated the association of pre‐diagnostic plasma concentrations of IGF‐I with risk of overall bladder cancer and urothelial cell carcinoma (UCC) in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. A total of 843 men and women diagnosed with bladder cancer between 1992 and 2005 were matched with 843 controls by recruitment centre, sex, age at recruitment, date of blood collection, duration of follow‐up, time of day and fasting status at blood collection using an incidence density sampling protocol. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression with adjustment for smoking status. No association was found between pre‐diagnostic circulating IGF‐I concentration and overall bladder cancer risk (adjusted OR for highest versus lowest fourth: 0.91, 95% CI: 0.66–1.24, ptrend = 0.40) or UCC (n of cases = 776; 0.91, 0.65–1.26, ptrend = 0.40). There was no significant evidence of heterogeneity in the association of IGF‐I with bladder cancer risk by tumour aggressiveness, sex, smoking status, or by time between blood collection and diagnosis (pheterogeneity > 0.05 for all). This first prospective study indicates no evidence of an association between plasma IGF‐I concentrations and bladder cancer risk.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
bladder cancer, urothelial cell carcinoma, IGF-I, EPIC cohort, prospective
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-154945 (URN)10.1002/ijc.31650 (DOI)000450113100003 ()29971779 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Lindahl, O. A., Ramser, K., Bäcklund, T., Ljungberg, B. & Bergh, A. (2018). Prostate cancer detection ex vivo combining Raman spectroscopy and tactile resonance technology. In: Eskola, H Vaisanen, O Viik, J Hyttinen, J (Ed.), EMBEC & NBC 2017: . Paper presented at Joint Conference of the European Medical and Biological Engineering Conference (EMBEC) / Nordic-Baltic Conference on Biomedical Engineering and Medical Physics (NBC), JUN, 2017, Tampere, FINLAND (pp. 193-196). SPRINGER-VERLAG SINGAPORE PTE LTD
Open this publication in new window or tab >>Prostate cancer detection ex vivo combining Raman spectroscopy and tactile resonance technology
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2018 (English)In: EMBEC & NBC 2017 / [ed] Eskola, H Vaisanen, O Viik, J Hyttinen, J, SPRINGER-VERLAG SINGAPORE PTE LTD , 2018, p. 193-196Conference paper, Published paper (Refereed)
Abstract [en]

Prostate cancer is the most common cancer for men in the western world. The most prevalent curative treatment is radical prostatectomy. However, prostate surgery can give unwanted side effects and there is a need for an instrument that can provide decision support to the surgeon during surgery on the presence of cancer cells in the surgical margin. A dual modality probe, combining Raman spectroscopy and tactile resonance technology, has been used for detecting cancer in fresh human prostate tissue. The tactile resonance modality measures the tissue stiffness and Raman spectroscopy depicts the molecular content in tissue, both related to cancer. After ethical approval, the study investigated the potential of the dual-modality probe by testing its ability to differentiate between normal and cancerous prostate tissue ex vivo. It also investigated the minimal amount of measurement points needed to securely detect cancer on the surface of prostate tissue. Measurements on three prostate tissue slices show that the tactile resonance modality measuring stiffness was able to detect differences between normal and cancerous tissue on a significant level of 90%, but the sample size was too low to draw any firm conclusions. It was also suggested from the study results that the high wavenumber region in the Raman spectrum can give valuable information about cancer in prostate tissue. A number of 24 measurement points were enough for detecting cancer in prostate slices in this study. It can be suggested from this study that combining these two sensor modalities is promising for accurate detection of prostate cancer that is needed during prostate surgery, but more measurements including more prostates must be performed before the full value of the study result can be established.

Place, publisher, year, edition, pages
SPRINGER-VERLAG SINGAPORE PTE LTD, 2018
Series
IFMBE Proceedings, ISSN 1680-0737 ; 65
Keywords
Raman spectroscopy, tactile resonance technology, prostate cancer, radical prostatectomy, surgical margin
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:umu:diva-155049 (URN)10.1007/978-981-10-5122-7_49 (DOI)000449778900049 ()978-981-10-5121-0 (ISBN)978-981-10-5122-7 (ISBN)
Conference
Joint Conference of the European Medical and Biological Engineering Conference (EMBEC) / Nordic-Baltic Conference on Biomedical Engineering and Medical Physics (NBC), JUN, 2017, Tampere, FINLAND
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Bex, A., Albiges, L., Ljungberg, B., Bensalah, K., Dabestani, S., Giles, R. H., . . . Powles, T. (2018). Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. European Urology, 74(6), 805-809
Open this publication in new window or tab >>Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma
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2018 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 74, no 6, p. 805-809Article in journal (Refereed) Published
Abstract [en]

Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data.

Patient summary: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered. 

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Cytoreductive nephrectomy, EAU guidelines, Metastatic, Renal cell cancer, Sunitinib
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-154931 (URN)10.1016/j.eururo.2018.08.008 (DOI)000450121100028 ()30177291 (PubMedID)
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Powles, T., Albiges, L., Staehler, M., Bensalah, K., Dabestani, S., Giles, R. H., . . . Bex, A. (2018). Updated European Association of Urology Guidelines: Recommendations for the Treatment of First-line Metastatic Clear Cell Renal Cancer. European Urology, 73(3), 311-315
Open this publication in new window or tab >>Updated European Association of Urology Guidelines: Recommendations for the Treatment of First-line Metastatic Clear Cell Renal Cancer
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2018 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 73, no 3, p. 311-315Article in journal (Refereed) Published
Abstract [en]

The randomised phase III clinical trial Checkmate-214 showed a survival superiority for the combination of ipilimumab and nivolumab when compared with the previous standard of care in first-line metastatic/advanced clear cell renal cell carcinoma (RCC) (Escudier B, Tannir NM, McDermott DF, et al. CheckMate 214: efficacy and safety of nivolumab plus ipilimumab vs sunitinib for treatment-naive advanced or metastatic renal cell carcinoma, including IMDC risk and PD-L1 expression subgroups. LBA5, ESMO 2017, 2017). These results change the frontline standard of care for this disease and have implications for the selection of subsequent therapies. For this reason the European Association of Urology RCC guidelines have been updated. Patient summary: The European Association of Urology guidelines will be updated based on the results of the phase III Checkmate-214 clinical trial. The trial showed superior survival for a combination of ipilimumab and nivolumab (IN), compared with the previous standard of care, in intermediate-and poor-risk patients with metastatic clear cell renal cell carcinoma. When IN is not safe or feasible, alternative agents such as sunitinib, pazopanib, and cabozantinib should be considered. Furthermore, at present, the data from the trial are immature in favourable-risk patients. Therefore, sunitinib or pazopanib remains the favoured agent for this subgroup of patients.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Renal cell carcinoma, European Association of Urology guidelines, Nivolumab, Ipilimumab
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-145356 (URN)10.1016/j.eururo.2017.11.016 (DOI)000425085700019 ()
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2018-06-09Bibliographically approved
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