Evolving Patterns of Metastasis in Renal Cell Carcinoma: Do We Need to Perform Routine Bone Imaging?
| Autor: | Qian Qin, Matthew D. Galsky, Che-Kai Tsao, Yue Zhang, William Oh, Wei Hou, Justin Lin |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Oncology
medicine.medical_specialty renal cell carcinoma bone imaging medicine.drug_class business.industry Incidence (epidemiology) metastatic distribution Bone metastasis Kidney Cancer: Original Article Disease medicine.disease urologic and male genital diseases Tyrosine-kinase inhibitor Metastasis Clinical trial Vascular endothelial growth factor immune checkpoint inhibitors chemistry.chemical_compound chemistry Renal cell carcinoma Internal medicine tyrosine kinase inhibitors medicine business |
| Zdroj: | Journal of Kidney Cancer and VHL |
| ISSN: | 2203-5826 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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