bonemets   13

An Interdisciplinary Consensus on the Management of Bone Metastases From RCC | PracticeUpdate
Bone is a major site of haematogenous tumour cell spread in renal cell carcinoma (RCC), and most patients with RCC will develop painful and functionally disabling bone metastases at advanced disease stages. The prognosis of these patients is generally poor and the treatment is, therefore, aimed at palliation. However, RCC-associated bone metastases can be curable in select patients. Current data support a multimodal management strategy that includes wide resection of lesions, radiotherapy, systemic therapy, and other local treatment options, which can improve quality of life and survival. Nevertheless, the optimal approach for metastatic bone disease in RCC has not yet been defined and practical recommendations are rare. To improve the management and outcomes of patients with RCC and bone metastases, the International Kidney Cancer Coalition and the interdisciplinary working group on renal tumours of the German Cancer Society convened a meeting of experts with a global perspective to perform an unstructured review and elaborate on current treatment strategies on the basis of published data and expertise. The panel formulated recommendations for the diagnosis and treatment of patients with RCC and metastasis to the bone. Furthermore, the experts summarized current challenges and unmet patient needs that should be addressed in the future.
RCC  boneMets 
october 2018 by cnk
Radium-223 Dichloride in Combination With VEGF-Targeting Therapy in Advanced RCC With Bone Metastases | PracticeUpdate
PURPOSE
This study investigates the biologic activity of radium-223 with vascular endothelial growth factor (VEGF)-targeted therapy in patients with advanced renal cell carcinoma (aRCC) and bone metastases.

EXPERIMENTAL DESIGN
Fifteen treatment-naïve patients (n=15) received pazopanib 800 mg orally once-daily and 15 previously-treated patients received sorafenib 400 mg orally twice-daily. Radium-223 55 kilobecquerel/kg was administered concurrently every four weeks for up to 6 infusions in both cohorts. The primary endpoint was decline in bone turnover markers (Procollagen I Intact N-Terminal, N-telopeptide, C-telopeptide, osteocalcin and bone-specific alkaline phosphatase) compared to baseline. Secondary endpoints included safety, rate of symptomatic-skeletal event (SSE) and time to first SSE, objective response rate, change in analgesic use and quality of life. Exploratory analysis of tumor genomic alterations was performed.

RESULTS
Of the 30 patients enrolled, 83% had IMDC intermediate- or poor-risk disease, 33% had liver metastases and 83% had a history of SSE prior to enrolment. No dose-limiting toxicity was observed. All bone turnover markers significantly declined from baseline at week 8 and 16. Forty percent of patients experienced treatment-related grade ≥3 adverse events. Response rates were 15% and 18% per RECIST v1.1 and bone response was 50% and 30% per MD Anderson criteria, in the pazopanib and sorafenib cohort, respectively. Median SSE-free interval was 5.8 months and not reached, respectively. Analgesic use remained stable over the study time.

CONCLUSIONS
Radium-223 combined with VEGF-targeted therapy is biologically active and safe. Randomized-controlled trials are needed to define the role of radium-223 in aRCC with skeletal metastases.
cancer  radiation  boneMets  TKInhibitors 
june 2018 by cnk
Effect of TKIs in Patients With Metastatic Renal Cell Carcinoma and Bone Metastases | PracticeUpdate
TAKE-HOME MESSAGE

In this retrospective analysis, investigators assessed OS in patients with metastatic renal cell carcinoma (mRCC) who began treatment with TKIs (n = 188) compared with those who began treatment prior to the use of TKIs (n = 187). OS was significantly longer in patients treated with TKIs (22 months; 95% CI, 17–25 months) than in those treated prior to TKIs (14 months; 95% CI, 10–19 months; P < .01). Similarly, in a subset of mRCC patients with bone metastases (48% of each cohort), median OS was longer in those treated with TKIs (24 months; 95% CI, 17–28 months) than in those treated prior to TKIs (18 months; 95% CI, 10–21 months; P < .01).

TKI therapy improved the outcomes of patients with mRCC and bone metastases. However, the rate of new bone metastases was not affected by the introduction of TKI therapy.
RCC  boneMets  cancer  sunitinib 
march 2017 by cnk
Cabozantinib Superior to Sunitinib for Metastatic RCC
Dr. Choueiri and colleagues compared cabozantinib with standard-of-care sunitinib in 157 intermediate and poor risk patients with advanced RCC as first-line treatment in a randomized, open-label phase 2 trial.

Median PFS, the primary endpoint, was 8.2 months with cabozantinib versus 5.6 months with sunitinib. Cabozantinib reduced the rate of disease progression or death by 34% compared with sunitinib (p=0.012), the researchers report in the Journal of Clinical Oncology, online November 14.

Cabozantinib significantly improved ORR: 46% of patients treated with cabozantinib had complete or partial responses, compared with only 18% of patients treated with sunitinib.

After a median follow-up of surviving patients of 21.4 months, median overall survival was 30.3 months with cabozantinib versus 21.8 months with sunitinib, a difference that fell short of statistical significance.

The incidence of adverse events was virtually identical for cabozantinib and sunitinib.

"Cabozantinib is already FDA-approved for use in patients with advanced renal cell carcinoma who have received prior antiangiogenic therapy, and the CABOSUN trial now demonstrates that cabozantinib is also active in patients who are untreated," Dr. Choueiri said.

"The subset of renal cell carcinoma patients with bone metastases is particularly difficult to treat," he explained. "Patients with bone metastases have reduced progression-free survival and overall survival compared to patients without bone metastases, and often have significant cancer-related symptoms."

"This subset of patients showed meaningful improvement with cabozantinib compared with sunitinib, demonstrating an almost doubling of median progression-free survival in the CABOSUN trial in the cabozantinib arm," Dr. Choueiri said. "Hence, treatment with cabozantinib would be an important option for renal cell cancer patients with bone metastases."
RCC  cabozantinib  boneMets  cancer 
december 2016 by cnk

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cabozantinib  cancer  labtests  mopt  pca  pt  radiation  rcc  sunitinib  tkinhibitors 

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