Cristiane Decat Bergerot

The Role of Circulating Tumor DNA in Renal Cell Carcinoma

Opinion statementNext-generation sequencing (NGS) of circulating tumor DNA (ctDNA) is a novel technology that can complement tumor tissue NGS and has the potential to influence diagnosis and treatment of both localized and metastatic renal cell carcinoma (mRCC). ctDNA NGS is an attractive alternative to tumor tissue NGS because it circumvents the need for repeated, invasive tissue biopsies while providing a contemporary mutational profile of a patient’s tumors. While the role of ctDNA NGS in non-small cell lung cancer and colorectal cancer is well established, studies of ctDNA NGS in mRCC are only hypothesis-generating to date. In the localized RCC setting, ctDNA has demonstrated potential as a surveillance biomarker for disease recurrence. Earlier detection of mRCC, prior to the onset of symptoms, may lead to improved clinical outcomes. NGS of ctDNA in mRCC is even more promising in patients with metastatic disease. The majority of patients with mRCC have detectable ctDNA. Thus, ctDNA could be used to select patients for biomarker-guided clinical trials, such as savolitinib in MET-positive papillary RCC. Furthermore, studies have shown that the mutational profile of mRCC in ctDNA evolves after treatment progression. The most exciting potential role for ctDNA in mRCC is as a predictive biomarker for response to immunotherapy. Studies have shown that tumor mutational burden (TMB) is predictive of response to immune checkpoint inhibitors, and hypermutated ctDNA can act as a surrogate biomarker for TMB and response to immunotherapy. While studies of ctDNA in RCC are still in their infancy, there are many promising roles for ctDNA in localized and metastatic RCC.

Exceptional Response to Nivolumab Rechallenge in Metastatic Renal Cell Carcinoma with Parallel Changes in Genomic Profile

A 44-yr-old man was noted to have headaches, and computerized tomography imaging of the brain revealed a 1.6-cm frontal lesion. Complete staging revealed a 7.5-cm left-sided renal mass and extensive retroperitoneal adenopathy. The patient received a craniotomy and nephrectomy, with pathology from both procedures revealing clear cell renal cell carcinoma (RCC). The patient received high-dose interleukin-2 approximately 1 mo thereafter (Fig. 1), but progressed within a span of 2 mo. He then received pazopanib, which stabilized his disease for approximately 5 mo. The patient then received bevacizumab monotherapy but progressed within 2 mo. He then received nivolumab/ ipilimumab in a phase 1 clinical trial with a marked radiographic response in retroperitoneal nodes with no new findings on neuroimaging [1]. However, he developed grade 3 hepatoxicity requiring cessation of immunotherapy and initiation of chronic steroids, ultimately tapered after 6 mo. In the intervening period, while off of systemic therapy, the patient developed 14 new brain metastases which were treated with stereotactic radiosurgery. Eighteen months after initial receipt of nivolumab/ ipilimumab, the patient developed further systemic progression and was rechallenged with bevacizumab. He progressed on bevacizumab monotherapy after 4 mo and then received bevacizumab in combination with trebananib [2]. He progressed on this regimen within 4 mo and then received radiation to retroperitoneal lymph nodes. After 8 mo, the patient developed further progression and was started on an investigational antibody drug conjugate. The patient had relatively rapid progression on this with new brain metastases. After craniotomy and stereotactic radiosurgery to these new lesions, the patient was started on cabozantinib. While he had some stabilization of disease with cabozantinib, his disease ultimately progressed after 11 mo. He was then rechallenged with nivolumab and once again developed grade 3 hepatoxicity after just two doses. Nivolumab was discontinued. However, after 3 mo, the

Construction and validation of clinical contents for development of learning objects

OBJECTIVE to describe the process of construction and validation of clinical contents for health learning objects, aimed at patients in the treatment of head and neck cancer. METHOD descriptive, methodological study. The development of the script and the storyboard were based on scientific evidence and submitted to the appreciation of specialists for validation of content. The agreement index was checked quantitatively and the suggestions were qualitatively evaluated. RESULTS The items described in the roadmap were approved by 99% of expert experts. The suggestions for adjustments were inserted in their entirety in the final version. The free-marginal kappa statistical test, for multiple evaluators, presented value equal to 0.68%, granting a substantial agreement. CONCLUSION The steps taken in the construction and validation of the content for the production of educational material for patients with head and neck cancer were adequate, relevant and suitable for use in other subjects.

Assessment of distress and quality of life in rare cancers

Rare cancers are a heterogeneous group of conditions that can be associated with emotional and physical impairments. In view of the dearth of research in this area, we investigated the quality of life and prevalence of distress in a cohort of patients diagnosed with a rare cancer, classified by the RARECARE definition.

Distress in patients with renal cell carcinoma: a curious gap in knowledge

Over the last fourteen years, distress has been considered the 6th vital sign in oncology care. It has also been used to identify patients in need of psychosocial support and improve quality of life (1). Since the initial publication of the National Comprehensive Cancer Network (NCCN) distress guidelines in 1999, multiple studies have been published related to the extent of distress in multiple cancer types and settings (2). However, it is curious to note that few studies have addressed this topic in patients diagnosed with renal cell carcinoma (RCC) (3). This study sought to ascertain the prevalence of distress among a cohort of patients diagnosed with RCC from an international survey. We also explore the relationship between levels of distress and clinicopathologic characteristics. This article is protected by copyright. All rights reserved.