Amishi Yogesh Shah

Management and outcomes of patients with renal medullary carcinoma: a multicentre collaborative study

To describe the management strategies and outcomes of patients with renal medullary carcinoma (RMC) and characterise predictors of overall survival (OS).

Optimizing management of upper tract urothelial carcinoma

Upper tract urothelial cancer (UTUC) is a rare cancer of the urothelium, comprising only a fraction of cases as compared to urothelial tumors of the bladder. As a result, systemic treatment approaches in bladder cancer are often applied to patients with UTUC. Given the anatomical location of these tumors, the age, the comorbid conditions of these patients with UTUC, and the need for radical nephroureterectomy for treatment, most patients have substantial impairment of renal reserve. There is growing evidence for the benefit of perioperative chemotherapy in this disease. Patients with UTUC have high rates of microsatellite instability and fibroblast growth factor receptor 3 mutations as compared to their bladder counterparts presenting unique, important subsets in UTUC. Immune checkpoint inhibitors targeting the programmed death receptor 1 and ligand have provided a new second-line treatment option for patients with UTUC and appear particularly well suited for patients with microsatellite instability. More work in understanding the molecular gene signatures and its relationship to response to chemotherapy, immunotherapy, and targeted therapy is needed to continually optimize care for patients with all stages of disease. Advances in UTUC are possible, when one accounts for the unique clinical and biological features of this disease.

Phase 2 Trial of Capecitabine, Gemcitabine, and Bevacizumab in Sarcomatoid Renal-Cell Carcinoma

Background Patients with sarcomatoid renal‐cell carcinomas (sRCC) have poor outcomes and limited treatment options. Preclinical and clinical data suggest susceptibility to cytotoxic agents and vascular endothelial growth factor–targeted therapies. We designed a phase 2 trial to evaluate the efficacy and safety of capecitabine, gemcitabine, and bevacizumab in sRCC. Patients and Methods Patients with metastatic or unresectable sRCC were eligible for inclusion. Patients received oral capecitabine 800 mg/m2 twice daily on days 1 to 21 of a 28‐day cycle, intravenous gemcitabine 900 mg/m2 on days 1 and 15, and intravenous bevacizumab 10 mg/kg on days 1 and 15. Primary end points were progression‐free survival and time to treatment failure (TTF). Secondary end points were safety, objective response rate, and overall survival. Results Thirty‐four patients were enrolled onto the trial. One patient was excluded from survival analysis and 4 from response analysis as a result of missing data. Median progression‐free survival was 5.5 months (95% confidence interval [CI], 3.4‐7.7), median TTF was 4.2 months (95% CI, 2.4‐6.0), and median overall survival was 12 months (95% CI, 10.6‐13.4). Objective response rate was 20% (5 partial responses, 1 complete response), and disease control rate was 73%. Thirty‐one (91%) of the 34 patients discontinued treatment. The most common reason for treatment discontinuation was progressive disease, which occurred in 24 patients (71%). The most common grade 3 toxicity was rash (including hand–foot syndrome) in 24% patients. Conclusion The combination of capecitabine, gemcitabine, and bevacizumab is an option for patients with sRCC; however, response rates are low. Novel therapies are needed to improve outcomes in patients with sRCC. Micro‐Abstract Patients with sarcomatoid renal‐cell carcinomas (sRCC) have poor outcomes. We enrolled 34 patients onto a phase 2 trial of capecitabine, gemcitabine, and bevacizumab. Median progression‐free survival was 5.5 months, median overall survival was 12 months, and objective response rate was 20%. This regimen is an option in sRCC; however, response rates are low. Novel therapies are needed.

Clinical and pathological complete remission in a patient with metastatic renal cell carcinoma (mRCC) treated with sunitinib: Is mRCC curable with targeted therapy?

We report a patient with metastatic clear-cell renal cell carcinoma (mRCC) who presented with primary tumor in situ in the left kidney and metastases to bone, liver, lungs, and brain. After over 5 years of sunitinib therapy and subsequent cytoreductive left nephrectomy, the patient achieved radiographic complete response (CR) and had pathologic CR in the nephrectomy specimen. Durable clinical and pathological CRs are possible with targeted agents, even with primary tumor in situ and widely disseminated metastases. Ongoing research will define the optimal duration of systemic therapy in exceptional responders and identify the molecular determinants of response and resistance.

Long-term survivorship in patients (pts) with metastatic renal cell cancer (mRCC): A retrospective study from the MD Anderson Cancer Center (MDACC).

510 Background: The overall survival (OS) of pts with mRCC has improved since the introduction of targeted therapies (TT). We sought to characterize the baseline characteristics, management, and outcomes of pts who survived > 4 yrs from date of diagnosis of metastatic disease (Met Dx). Methods: We retrospectively reviewed medical records of consecutive pts who were diagnosed with mRCC and evaluated at MDACC from 1/1/2001 to 12/31/2008. Descriptive statistics and Kaplan-Meier methods were used to estimate OS times. Results: For 729 mRCC pts identified, median OS was 2.3 years (95% CI: 2.1, 2.5); 219 (30.0%) pts have survived >4 yrs, and 167 (22.9%) pts have survived >5 yrs. For pts diagnosed in the cytokine era (2000 to 2004) median OS was 2.3 yrs (95%CI: 2-2.6) compared to median OS 2.4 yrs (95%CI: 2.0-3.0) for pts diagnosed in the targeted era (2005-2008). Of the 219 pts, 205 pts had adequate baseline information. Conclusions: Since 2000, approximately 30% of mRCC pts have survived >4 yrs and 23% have su...

Managing seminomatous and nonseminomatous germ cell tumors

Purpose of review In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs). Recent findings Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs, with recent evidence showing that the adverse health outcomes of etoposide and cisplatin for four cycles in comparison to bleomycin, etoposide, and cisplatin for three cycles appear to be similar. Recent data showed that multidisciplinary clinic approach and management in experienced academic centers were associated with improved overall survival in GCT patients. There are currently multiple conventional-dose chemotherapy options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy regimens continue to be developed. The role of salvage conventional-dose chemotherapy versus high-dose chemotherapy is currently being investigated prospectively. Recent reports suggested that brentuximab vedotin could be a potential salvage option for cluster of differentiation 30 positive refractory GCTs. On the other hand the results of the first phase II clinical trial investigating pembrolizumab in refractory GCTs were disappointing showing no clinical activity. Finally, deep exploration of the immune profile of GCTs using immunohistochemistry and gene expression profiling has identified that advanced GCT stage was associated with decreased T-cell and Natural killer-cell signatures, whereas T regulatory, neutrophil, mast cell, and macrophage signatures increased with advanced stage. Even though these results indicated that activated T-cell infiltration correlated with seminoma histology and good prognosis, and could be used in the future as a biomarker, this approach needs to be validated in a large cohort. Summary Remaining challenges to be addressed include minimizing therapeutic toxicity, and improving outcomes in patients with refractory/recurrent GCTs.

Survival Rates and Health Care Costs for Patients With Advanced Bladder Cancer Treated and Untreated With Chemotherapy

Micro‐Abstract The objective of this retrospective cohort study was to estimate survival and health care costs for patients with stage IV bladder cancer. Approximately two thirds of patients were not treated with systemic chemotherapy. Patients who received chemotherapy had a longer median survival rate, fewer per‐patient–per‐month health care visits, and lower per‐patient–per‐month costs than patients not treated with systemic chemotherapy. Background: Systemic chemotherapy has long been the standard of care for advanced bladder cancer, but its cost implications are poorly understood. The objective of this analysis was to estimate survival and health care costs for patients with stage IV bladder cancer who did or did not receive chemotherapy. Patients and Methods: This was a retrospective cohort study of patients identified in the Surveillance, Epidemiology, and End Results–Medicare database with a new primary diagnosis of stage IV bladder cancer between January 2007 and December 2011. Survival and health care visits and costs following the date of diagnosis were determined for treated and untreated patients. Costs were expressed in 2016 US dollars. Results: A total of 1215 patients were diagnosed with stage IV bladder cancer, of whom 411 (33.8%) were treated with chemotherapy and 804 (66.2%) were untreated. Median overall survival was 10 months longer for treated than for untreated patients: 13.2 (95% confidence interval, 12.3‐14.1) months versus 3.2 (95% confidence interval, 3.0‐3.5) months. Treated patients had fewer per‐patient–per‐month (PPPM) health care visits than untreated patients (7.5 vs. 10.2, P < .01) and lower total PPPM health care costs (

Increase in blood pressure with sorafenib exposure in renal cell carcinoma versus other solid tumors.

10,707 vs.

Long-term survivorship in patients with metastatic renal cell cancer (mRCC) managed with metastasectomy: A retrospective study from the MD Anderson Cancer Center (MDACC).

18,935). Overall mean total lifetime costs were greater for treated than for untreated patients (

Outcomes of patients (pts) with metastatic clear-cell renal cell carcinoma (mCCRCC) treated with second-line (2L) vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKI) after first-line (1L) immune checkpoint inhibitors (ICI).

139,893 vs.