Stereotactic Radiotherapy for Oligoprogression in Metastatic Renal Cell Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Phase 2 Prospective Multicenter Study.

Carcinoma, Renal Cell / drug therapy Female Humans Kidney Neoplasms / drug therapy Male Prospective Studies Protein Kinase Inhibitors / therapeutic use Radiosurgery / adverse effects Retrospective Studies
Kidney cancer Oligoprogression SABR SBRT Stereotactic ablative radiotherapy Stereotactic body radiotherapy Stereotactic radiotherapy Tyrosine kinase inhibitor

Journal

European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719

Informations de publication

Date de publication:
Dec 2021
Historique:
received: 14 04 2021
accepted: 29 07 2021
pubmed: 18 8 2021
medline: 19 4 2022
entrez: 17 8 2021
Statut: ppublish

Résumé

Despite the paucity of prospective evidence, stereotactic radiotherapy (SRT) is increasingly being considered in the setting of oligoprogression to delay the need to change systemic therapy. To determine the local control (LC), progression-free survival (PFS), cumulative incidence of changing systemic therapy, and overall survival (OS) after SRT to oligoprogressive metastatic renal cell carcinoma (mRCC) lesions in patients who are on tyrosine kinase inhibitor (TKI) therapy. A prospective multicenter study was performed to evaluate the use of SRT in oligoprogressive mRCC patients. Patients with mRCC who had previous stability or response after ≥3 mo of TKI therapy were eligible if they developed progression of five of fewer metastases. Thirty-seven patients with 57 oligoprogressive tumors were enrolled. Oligoprogressive tumors were treated with SRT, and the same TKI therapy was continued afterward. Competing risk analyses and the Kaplan-Meir methodology were used to report the outcomes of interest. The median duration of TKI therapy prior to study entry was 18.6 mo; 1-yr LC of the irradiated tumors was 93% (95% confidence interval [CI] 71-98%). The median PFS after SRT was 9.3 mo (95% CI 7.5-15.7 mo). The cumulative incidence of changing systemic therapy was 47% (95% CI 32-68%) at 1 yr, with a median time to change in systemic therapy of 12.6 mo (95% CI 9.6-17.4 mo). One-year OS was 92% (95% CI 82-100%). There were no grade 3-5 SRT-related toxicities. LC of irradiated oligoprogressive mRCC tumors was high, and the need to change systemic therapy was delayed for a median of >1 yr. The use of stereotactic radiotherapy in metastatic kidney cancer patients, who develop growth of a few tumors while on oral targeted therapy, can significantly delay the need to change to the next line of drug therapy.

Sections du résumé

BACKGROUND BACKGROUND
Despite the paucity of prospective evidence, stereotactic radiotherapy (SRT) is increasingly being considered in the setting of oligoprogression to delay the need to change systemic therapy.
OBJECTIVE OBJECTIVE
To determine the local control (LC), progression-free survival (PFS), cumulative incidence of changing systemic therapy, and overall survival (OS) after SRT to oligoprogressive metastatic renal cell carcinoma (mRCC) lesions in patients who are on tyrosine kinase inhibitor (TKI) therapy.
DESIGN, SETTING, AND PARTICIPANTS METHODS
A prospective multicenter study was performed to evaluate the use of SRT in oligoprogressive mRCC patients. Patients with mRCC who had previous stability or response after ≥3 mo of TKI therapy were eligible if they developed progression of five of fewer metastases. Thirty-seven patients with 57 oligoprogressive tumors were enrolled.
INTERVENTION METHODS
Oligoprogressive tumors were treated with SRT, and the same TKI therapy was continued afterward.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS METHODS
Competing risk analyses and the Kaplan-Meir methodology were used to report the outcomes of interest.
RESULTS AND LIMITATIONS CONCLUSIONS
The median duration of TKI therapy prior to study entry was 18.6 mo; 1-yr LC of the irradiated tumors was 93% (95% confidence interval [CI] 71-98%). The median PFS after SRT was 9.3 mo (95% CI 7.5-15.7 mo). The cumulative incidence of changing systemic therapy was 47% (95% CI 32-68%) at 1 yr, with a median time to change in systemic therapy of 12.6 mo (95% CI 9.6-17.4 mo). One-year OS was 92% (95% CI 82-100%). There were no grade 3-5 SRT-related toxicities.
CONCLUSIONS CONCLUSIONS
LC of irradiated oligoprogressive mRCC tumors was high, and the need to change systemic therapy was delayed for a median of >1 yr.
PATIENT SUMMARY RESULTS
The use of stereotactic radiotherapy in metastatic kidney cancer patients, who develop growth of a few tumors while on oral targeted therapy, can significantly delay the need to change to the next line of drug therapy.

Identifiants

DOI: 10.1016/j.eururo.2021.07.026 PMID: 34399998
pubmed: 34399998
pii: S0302-2838(21)01929-1
doi: 10.1016/j.eururo.2021.07.026
pii:
doi:

Substances chimiques

Protein Kinase Inhibitors 0

Types de publication

Clinical Trial, Phase II Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

693-700

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Auteurs

Patrick Cheung (P)

Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.

Samir Patel (S)

Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

Scott A North (SA)

Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

Arjun Sahgal (A)

Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.

William Chu (W)

Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.

Hany Soliman (H)

Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.

Belal Ahmad (B)

Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada.

Eric Winquist (E)

Division of Medical Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada.

Tamim Niazi (T)

Division of Radiation Oncology, Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.

Francois Patenaude (F)

Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.

Gerald Lim (G)

Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.

Daniel Yick Chin Heng (DYC)

Division of Medical Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.

Arbind Dubey (A)

Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada.

Piotr Czaykowski (P)

Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada.

Rebecca K S Wong (RKS)

Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Anand Swaminath (A)

Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.

Scott C Morgan (SC)

Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.

Rupi Mangat (R)

Ozmosis Research Inc., Toronto, ON, Canada.

Sareh Keshavarzi (S)

Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Georg A Bjarnason (GA)

Division of Medical Oncology, Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada. Electronic address: georg.bjarnason@sunnybrook.ca.

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Classifications MeSH

questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs du rein › Néphrocarcinome › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Maladies urogénitales › Maladies urologiques › Tumeurs urologiques › Tumeurs du rein › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Mécanismes moléculaires de l'action pharmacologique › Antienzymes › Inhibiteurs de protéines kinases › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Techniques d'investigation › Techniques stéréotaxiques › Radiochirurgie › Stereotactic Radiotherapy for Oligoprogression...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Stereotactic Radiotherapy for Oligoprogression...