4.2 Article

Survival benefit with resection of brain metastases from renal cell carcinoma in the setting of molecular targeted therapy and/or immune

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CURRENT PROBLEMS IN CANCER
卷 46, 期 2, 页码 -

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MOSBY-ELSEVIER
DOI: 10.1016/j.currproblcancer.2021.100805

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Brain metastases; Checkpoint inhibition; Renal cell carcinoma; Radiation therapy; Immunotherapy

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Patient survival with renal cell carcinoma (RCC) has improved with the use of molecular targeted agents and immunotherapy. The role of aggressive local management with surgery and/or radiation may diminish in the treatment of brain metastases. A retrospective study found that surgical resection may benefit RCC patients with brain metastasis in the setting of molecular targeted agents and immunotherapy. Prospective clinical trials are needed to further understand the role of aggressive treatment for RCC brain metastasis.
Patient survival with renal cell carcinoma (RCC) has improved with the use of molecular targeted agents and immunotherapy. Given the potential activity of these agents in treating brain metastases, the role of aggressive local management with surgery and/or radiation may diminish. The aim of this study was to evaluate the role of aggressive local therapy for RCC brain metastasis in the setting of molecular targeted agents and/or checkpoint inhibitor therapy. A retrospective single-center review between 2011-2018 identified patients that developed brain metastasis from RCC. Data analyzed included demographic information, systemic treatments, intracranial interventions, progression free survival and overall survival (OS). Of 1194 patients, 108(9.0%) were diagnosed with brain metastasis from RCC. OS from diagnosis of brain metastasis (OSBM) was 12.3 months. OSBM was analyzed based on three treatment groups: systemic therapy (ST) only (2.0 months, n = 23), systemic and radiotherapy (RT + ST) (12.3 months, n = 52), and systemic and radiotherapy plus resection (Surg + RT + ST) (21.7 months, n = 33). Survival benefit was seen with Surg + RT + ST compared to ST ( P = 0.001), but not RT + ST ( P = 0.081). Progression free survival was significantly prolonged with Surg + RT + ST compared to RT + ST (10.9 vs 5.9 months, respectively, P = 0.04). Variables such as performance status and number of brain metastases at the time of brain metastasis diagnosis did not differ significantly. In the setting of molecular targeted agents and immunotherapy, resection may benefit the appropriate surgical candidate. Prospective clinical trials are necessary to better understand the role of aggressive RCC brain metastasis treatment. Micro Abstract center dot Renal cell brain metastasis is often excluded from studies and brain metastases effect a large portion of RCC patients center dot Retrospective study of 1194 RCC patients, 108 patients had brain metastasis, determination of the role of surgical resection in the setting of recent advances in check point inhibitors. center dot A benefit was seen in overall survival in patients that had surgical while undergoing radiation therapy and systemic therapies. center dot In the setting of molecular targeted agents and immunotherapy, resection may benefit the appropriate surgical candidate(s). (c) 2021 Elsevier Inc. All rights reserved.

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