Christine Theodore

Sunitinib Alone or after Nephrectomy in Metastatic Renal-Cell Carcinoma

BACKGROUND Cytoreductive nephrectomy has been the standard of care in metastatic renal‐cell carcinoma for 20 years, supported by randomized trials and large, retrospective studies. However, the efficacy of targeted therapies has challenged this standard. We assessed the role of nephrectomy in patients with metastatic renal‐cell carcinoma who were receiving targeted therapies. METHODS In this phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with confirmed metastatic clear‐cell renal‐cell carcinoma at presentation who were suitable candidates for nephrectomy to undergo nephrectomy and then receive sunitinib (standard therapy) or to receive sunitinib alone. Randomization was stratified according to prognostic risk (intermediate or poor) in the Memorial Sloan Kettering Cancer Center prognostic model. Patients received sunitinib at a dose of 50 mg daily in cycles of 28 days on and 14 days off every 6 weeks. The primary end point was overall survival. RESULTS A total of 450 patients were enrolled from September 2009 to September 2017. At this planned interim analysis, the median follow‐up was 50.9 months, with 326 deaths observed. The results in the sunitinib‐alone group were noninferior to those in the nephrectomy–sunitinib group with regard to overall survival (stratified hazard ratio for death, 0.89; 95% confidence interval, 0.71 to 1.10; upper boundary of the 95% confidence interval for noninferiority, ≤1.20). The median overall survival was 18.4 months in the sunitinib‐alone group and 13.9 months in the nephrectomy–sunitinib group. No significant differences in response rate or progression‐free survival were observed. Adverse events were as anticipated in each group. CONCLUSIONS Sunitinib alone was not inferior to nephrectomy followed by sunitinib in patients with metastatic renal‐cell carcinoma who were classified as having intermediate‐risk or poor‐risk disease. (Funded by Assistance Publique–Hôpitaux de Paris and others; CARMENA ClinicalTrials.gov number, NCT00930033.)

Traitement des cancers infiltrants non métastatiques de la vessie chez les patients âgés

Resume La cystectomie totale est le traitement de reference des cancers infiltrants de la vessie non metastatiques. Grace aux progres de l’anesthesie et de la reanimation post operatoire ce traitement est applicable a une population de sujets âges sous couvert d’une evaluation onco-geriatrique pre operatoire stricte. Les series recentes de cystectomies totales chez des sujets âges de plus de 75 ans rapportent des taux de morbidites et de mortalite comparable avec ceux de la population generale. Des strategies de conservation du reservoir vesical peuvent etre indiquees dans des cas selectionnes. Leurs buts sont de garantir un controle local et une survie identiques a ceux de la cystectomie radicale, en conservant une vessie fonctionnelle et une bonne qualite de vie. Les strategies incluent la resection transuretrale avec radiochimiotherapie sont analysees. Ainsi grâce a une concertation multidisciplinaire et une prise en charge adaptee les patients âges et porteurs de comorbidites significatives ne doivent pas etre automatiquement exclus de l’acces a des traitements efficaces de ces cancers.

Avancées et synthèse des derniers congrès : ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale des cancers urothéliaux

Resume Lors des congres de l’EAU et de l’AUA 2009, les principaux travaux concernant les carcinomes urotheliaux s’interessait a l’interet de la classification T1a/b et ses consequences therapeutiques, aux dernieres donnees des resultats de la BCG therapie et au diagnostic photodynamique. A l’ASCO, les principaux travaux presentes portaient sur les traitements systemiques en adjuvants, en premiere ligne dans le traitement du cancer de vessie metastatique, notamment avec l’adjonction d’anti-angiogenique a la chimiotherapie, et dans le traitement conservateur en association a la radiotherapie.