Evolving Patterns of Metastasis in Renal Cell Carcinoma
Advance diagnostic and treatment modalities have improved outcomes for renal cell carcinoma (RCC) patients, but the prognosis for those with metastatic disease (mRCC) remains poor. As given metastatic distribution is critical in guiding treatment decisions for mRCC patients, we evaluated evolving me...
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| Format: | Article |
| Language: | English |
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Codon Publications
2021-10-01
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| Series: | Journal of Kidney Cancer and VHL |
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| Online Access: | https://jkcvhl.com/index.php/jkcvhl/article/view/202 |
| _version_ | 1818566889293479936 |
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| author | Justin Lin Yue Zhang Wei Hou Qian Qin Matthew Galsky William Oh Che-Kai Tsao |
| author_facet | Justin Lin Yue Zhang Wei Hou Qian Qin Matthew Galsky William Oh Che-Kai Tsao |
| author_sort | Justin Lin |
| collection | DOAJ |
| description | Advance diagnostic and treatment modalities have improved outcomes for renal cell carcinoma (RCC) patients, but the prognosis for those with metastatic disease (mRCC) remains poor. As given metastatic distribution is critical in guiding treatment decisions for mRCC patients, we evaluated evolving metastatic patterns to assess if our current practice standards effectively address patient needs. A systematic literature review was performed to identify all publicly available prospective clinical trials in metastatic renal cell carcinoma (mRCC) from 1990 to 2018. A total of 16,899 mRCC patients from 127 qualified phase I–III clinical trials with metastatic site documentations were included for analysis for incidence of metastases to lung, liver, bone, and lymph nodes (LNs) over time. Studies were categorized into three treatment eras based on the timing of regulatory approval: Cytokine Era (1990-2004), vascular endothelial growth factor/tyrosine kinase inhibitor (TKI) Era (2005-2016), and immune checkpoint inhibitor/TKI Era (ICI-TKI, 2017-2018) and also classified as first-line only (FLO) or second-line and beyond (SLB). Overall, an increase in the incidence of bone and LNs metastases in FLO and SLB, and lung metastases in FLO, was seen over the three treatment eras. Generally, the burden of disease is higher in SLB when compared with FLO. Importantly, in the ICI-TKI era, the incidences of bone metastasis are 28% in FLO and 29% in SLB settings. The disease burden in patients with mRCC has increased steadily over the past three decades. Given the unexpectedly high rate of bone metastasis, routine dedicated bone imaging should be considered in all patients with mRCC. |
| first_indexed | 2024-12-14T06:16:30Z |
| format | Article |
| id | doaj.art-95c76cf3ac5a4abb9018b1464cf150d1 |
| institution | Directory Open Access Journal |
| issn | 2203-5826 |
| language | English |
| last_indexed | 2024-12-14T06:16:30Z |
| publishDate | 2021-10-01 |
| publisher | Codon Publications |
| record_format | Article |
| series | Journal of Kidney Cancer and VHL |
| spelling | doaj.art-95c76cf3ac5a4abb9018b1464cf150d12022-12-21T23:14:00ZengCodon PublicationsJournal of Kidney Cancer and VHL2203-58262021-10-018410.15586/jkcvhl.v8i4.202Evolving Patterns of Metastasis in Renal Cell CarcinomaJustin Lin0Yue Zhang1Wei Hou2Qian Qin3Matthew Galsky4William Oh5Che-Kai Tsao6The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NYState University of New York at Stony Brook, NYState University of New York at Stony Brook, NYThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NYThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NYThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NYThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NYAdvance diagnostic and treatment modalities have improved outcomes for renal cell carcinoma (RCC) patients, but the prognosis for those with metastatic disease (mRCC) remains poor. As given metastatic distribution is critical in guiding treatment decisions for mRCC patients, we evaluated evolving metastatic patterns to assess if our current practice standards effectively address patient needs. A systematic literature review was performed to identify all publicly available prospective clinical trials in metastatic renal cell carcinoma (mRCC) from 1990 to 2018. A total of 16,899 mRCC patients from 127 qualified phase I–III clinical trials with metastatic site documentations were included for analysis for incidence of metastases to lung, liver, bone, and lymph nodes (LNs) over time. Studies were categorized into three treatment eras based on the timing of regulatory approval: Cytokine Era (1990-2004), vascular endothelial growth factor/tyrosine kinase inhibitor (TKI) Era (2005-2016), and immune checkpoint inhibitor/TKI Era (ICI-TKI, 2017-2018) and also classified as first-line only (FLO) or second-line and beyond (SLB). Overall, an increase in the incidence of bone and LNs metastases in FLO and SLB, and lung metastases in FLO, was seen over the three treatment eras. Generally, the burden of disease is higher in SLB when compared with FLO. Importantly, in the ICI-TKI era, the incidences of bone metastasis are 28% in FLO and 29% in SLB settings. The disease burden in patients with mRCC has increased steadily over the past three decades. Given the unexpectedly high rate of bone metastasis, routine dedicated bone imaging should be considered in all patients with mRCC.https://jkcvhl.com/index.php/jkcvhl/article/view/202Bone ImagingImmune Checkpoint InhibitorsMetastatic DistributionRenal Cell CarcinomaTyrosine Kinase Inhibitors |
| spellingShingle | Justin Lin Yue Zhang Wei Hou Qian Qin Matthew Galsky William Oh Che-Kai Tsao Evolving Patterns of Metastasis in Renal Cell Carcinoma Journal of Kidney Cancer and VHL Bone Imaging Immune Checkpoint Inhibitors Metastatic Distribution Renal Cell Carcinoma Tyrosine Kinase Inhibitors |
| title | Evolving Patterns of Metastasis in Renal Cell Carcinoma |
| title_full | Evolving Patterns of Metastasis in Renal Cell Carcinoma |
| title_fullStr | Evolving Patterns of Metastasis in Renal Cell Carcinoma |
| title_full_unstemmed | Evolving Patterns of Metastasis in Renal Cell Carcinoma |
| title_short | Evolving Patterns of Metastasis in Renal Cell Carcinoma |
| title_sort | evolving patterns of metastasis in renal cell carcinoma |
| topic | Bone Imaging Immune Checkpoint Inhibitors Metastatic Distribution Renal Cell Carcinoma Tyrosine Kinase Inhibitors |
| url | https://jkcvhl.com/index.php/jkcvhl/article/view/202 |
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