Survival Improves in mRCC With Surgical Metastasectomy

Ana Molina MDThis is an excerpt of an article that appeared in Medscape in which Dr. Ana Molina comments on recent research published in the Journal of Urology. Read the full story here.

In patients with metastatic renal cell carcinoma (mRCC), the surgical removal of metastases — complete metastasectomy (CM) — is associated with significantly longer overall survival compared with incomplete metastasectomy. This conclusion comes from a meta-analysis that included more than 2000 patients and was reported in the January issue of the Journal of Urology.

Patients who did not undergo CM were 2.4 times more likely to die of their disease than were patients with mRCC who underwent CM, report the authors.

Medscape Medical News reached out to medical oncologists who were not associated with the study for their expert insights.

“Although there are limitations to the observational data presented in this article, the work reflects our move away from the conventional thinking that surgery is reserved for localized disease and systemic therapy is for metastatic disease,” Ana Molina, MD, medical oncologist at Weill Cornell Medicine and New York-Presbyterian, New York City, told Medscape Medical News. “The role of surgery in the management of patients with advanced RCC is of great interest and significance,” she added.

The researchers argue that although the National Comprehensive Cancer Network already recommends this approach (and nephrectomy), it may also be appropriate in patients with metastases at multiple organ sites. Indeed, in six of the studies chosen for the meta-analysis, 36% to 56% of patients had metastases to multiple organs. A sensitivity analysis, which excluded patients with single-organ metastases, found a persistent survival benefit for patients who underwent CM.

“In our clinical practice, we are referring patients to undergo metastasectomy when possible. Typically these patients have oligometastatic RCC,” Dr Molina said.

Dr Molina indicated that the role of systemic therapy after metastasectomy is being formally studied in a prospective study. The ECOG-ACRIN (NCT01575548) cooperative group study is enrolling patients with completely resected metastatic clear cell RCC to pazopanib vs placebo for 12 months.

In addition, a randomized study comparing the programmed cell death ligand-1 antibody atezolizumab vs placebo recently opened for patients with high-risk RCC after nephrectomy. This study is also enrolling fully resected patients after metastasectomy (NCT03024996), Dr Molina pointed out.

“Results from these studies will provide much-needed information on the role of systemic therapy and metastasectomy for patients with advanced RCC,” Dr Molina said.

Thinking Beyond Survival – Cerebrovascular Complications of Cancer

Babak Navi_headshotBabak B. Navi, MD, MS
Stroke Center Director
Assistant Professor of Neurology
Weill Cornell Medicine | NewYork-Presbyterian

Over the past decade, there has been tremendous progress in cancer therapeutics. This includes targeted agents that act on specific receptors in cancer cells, immunotherapy which harnesses the body’s immune system to attack cancer cells, and personalized medicine whereby oncologists use different combinations of cancer drugs to optimize the chance of success based on the molecular profile of the tumor. These amazing scientific advances have led to prolonged survival for people with several cancer types, and it is possible that in the not-too-distant future, cancer will become more of a chronic disease with periodic flare-ups similar to what has occurred with diabetes and HIV. However, with this paradigm shift, long-term quality of life and well-being has become more important, and preventing diseases and complications that can affect these factors is paramount.

Stroke is the leading cause of disability in the United States. In addition, in many parts of the world, including Asia, it is the leading cause of death. In the United States alone, 800,000 people each year suffer stroke and this number is expected to rise as average life expectancy increases. Many factors can increase a person’s risk for stroke including age, hypertension, diabetes, high cholesterol, obesity, and smoking. Besides these traditional stroke risk factors, we now know that cancer and its treatments also increase the risk of stroke. In particular, patients with certain types of cancer, such as lung, pancreatic, and bladder cancers, as well as patients with metastatic disease, tend to have the highest risk. For instance, elderly patients with newly-diagnosed lung cancer face roughly an 8% risk of stroke in the first year after being diagnosed with cancer. In addition, cancer patients’ stroke risk varies with time and is highest in the first 3 months after diagnosis, when some cancer patients face up to a 3-fold higher risk of stroke than usual. It also turns out that certain necessary and potentially life-saving cancer treatments, including some forms of chemotherapy and radiation, can increase stroke risk.

At the moment, the exact reasons why cancer patients face a heightened risk of stroke are unclear. It is well known that circulating cancer cells can alter individuals’ clotting systems to promote clot formation but exactly how they do this is uncertain. Furthermore, doctors know that certain chemotherapy and radiotherapy treatments can damage blood vessels, but once again, the exact mechanisms underlying these processes are poorly understood.

At Weill Cornell Medicine and NewYork-Presbyterian, my team is actively working to determine what the exact risks of stroke are in people with newly diagnosed cancer, what clinical factors and biomarkers in blood can help doctors identify high-risk patients, and what the optimal strategies are to prevent and treat stroke in cancer patients. One particular study that we are currently enrolling into is entitled MOST-Cancer. This study uses cutting-edge ultrasound and blood tests to evaluate the predictors and mechanisms of stroke in people with cancer. If you or a loved one has cancer and are interested in learning more about these studies, please email our team at stroketrials@med.cornell.edu or call 212-746-6757.

May is National Stroke Awareness Month. The main intent of this campaign is to raise awareness about the symptoms and signs of stroke and to educate the public to call 911 if they suspect stroke. The most popular campaign is FAST, which stands for Face, Arm, Speech, and Time – Time to call 911.

If you or a companion develops unexplained facial asymmetry, arm weakness, or speech changes, you should call 911 immediately so that an ambulance is activated to provide rapid delivery to the closest stroke center. This is imperative as there are medicines and surgical procedures that have been proven to improve outcomes after stroke but these are only effective in the first few hours after stroke onset. Therefore, if stroke is suspected, do not hesitate, call 911, as it could be life saving!

Furthermore, I recommend that cancer patients have a frank discussion with their doctors about their individual risks for stroke and other cardiovascular diseases, as well as potential strategies to reduce their risks through medicines and lifestyle modifications.

We’ve made great strides in oncological care so that patients routinely get cured or live many years with their disease. Therefore, it is now time that we turn our attention to long-term quality of life, and in particular, to preventing stroke and the other secondary complications of cancer.

Stroke_BE FAST SIGN NEW

AACR 2017: PSMA Update

Jaspreet Batra_AACR 2017_PSMA
Jaspreet Batra presents this research at AACR 2017

At the 2017 Annual Meeting for the Annual Association for Cancer Research (AACR), we presented research highlighting how we’re targeting PSMA – a marker on the surface of most prostate cancer cells – with radioimmunotherapy to kill cancer cells.

Radioimmunotherapy involves attaching radioactive particles to targeted immunotherapies that go directly to the cancer cells. The monoclonal antibody we use is called J591 and will bind only to PSMA. In this research, we attached the radioactive isotope actinium-225 (225Ac) to J591. We have used J591 linked with lutetium 177 (177Lu) and yttrium 90 (90Y) to treat patients in many clinical trials in the past. We believe that since 225Ac is an alpha particle emitter with much greater energy released that each individual antibody will lead to more tumor cell death. In our experimental models presented at the 2017 AACR meeting, 225Ac-J591 was not significantly more toxic than control (similar to placebo) in mice without tumors. When we treated mice with prostate cancer tumors, there was significant tumor killing following a single injection of 225Ac-J591.

Given our long history of administering radiolabeled J591 to hundreds of men in different clinical trials, we have plans to launch a phase I dose-escalation clinical trial (to determine safe doses and later look at tumor response) later this year. We and others are quite enthusiastic about this approach.