Long-Term Efficacy and Safety of Enzalutamide Monotherapy in Elderly Patients with Metastatic Castration-Resistant Prostate Cancer: A Case Report.

Introduction: Prostate cancer is one of the most common cancers in men. Despite the sharp rise in incidence, mortality is decreasing. ARTA preparations are preferred options for asymptomatic or mildly symptomatic patients with mCRPC. The use of enzalutamide in elderly patients with mCRPC is risky and depends on a number of factors. An increased risk of falls and fractures has been shown. Case Presentation: We present a case report of an elderly patient with mCRPC treated with enzalutamide with very good long-term tolerance and efficacy. Conclusion: Despite the older age, no reduction of therapy was necessary in the patient due to good tolerance. Administration of enzalutamide in full doses resulted in a very good effect of therapy.

Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study.

Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6-89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan-Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65-5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.

The use of cisplatin in patients after kidney transplantation with chronic renal insufficiency: Is the benefit higher than potential risks in therapy of non-seminomatous germ cell tumors?

RATIONALE: The use of cisplatin in patients with chronic kidney disease (CKD) is risky and depends on a number of factors. The optimal procedure in stage I of a non seminomatous germ cell tumor without proven lymphangioinvasion after orchiectomy is controversial and is the subject of a number of discussions due to the lack of randomized studies assessing individual treatment options. The adjuvant method of choice is surveillance or application of cisplatin-based chemotherapy with the risk of treatment related nephrotoxicity. Information about cisplatin safety in renal transplant patients is particularly limited. The aim of this paper is to share the experience with the application of adjuvant chemotherapy Bleomycin, Etoposide, Cisplatin (BEP) in high-risk patient with nonseminoma after kidney transplantation. PATIENT CONCERNS: We report a case report of rare group of high-risk patient with non-seminomatous germ cell testicular tumor (NSGCT) after kidney transplantation before application of adjuvant chemotherapy BEP. Patient presented with month-long discomfort in the scrotal area. Previously, he was treated with chronic kidney disease based on chronic glomerulonephritis, which was treated with repeated kidney transplantation. DIAGNOSIS: The ultrasound examination for a month-long discomfort in the scrotal area found a solid mass of the left testis. Radical inguinal orchiectomy confirmed NSGCT with the presence of lymphovascular invasion (LVI). Postoperative staging with computed tomography of the chest and abdomen did not show obvious dissemination of the disease. INTERVENTIONS: Reducing original dose of chemotherapeutics according to the recommendations of the summary of product characteristics led to only a transient increase in creatinine levels. OUTCOMES: The 5-year risk of relapse in surveillance was reduced to around 3% by applying cisplatin-based chemotherapy. LESSONS: Application of cisplatin-based chemotherapy is safe and effective in patients with CKD and in patients with a kidney transplant.

Tyrosine kinase inhibitors in the first-line treatment for metastatic nonclear cell renal carcinoma: A retrospective analysis of a national database.

BACKGROUND: Nonclear cell renal cell carcinoma (nccRCC) is a heterogeneous group of primary kidney tumors. The aim of the present retrospective study was to analyze outcomes of patients with nccRCC treated with tyrosine-kinase inhibitors (TKIs) based on a national registry. METHODS: The registry contained evaluable data of 93 nccRCC patients treated with first-line TKIs, including 87 patients with papillary renal cell carcinoma (RCC) and 6 patients with chromophobe RCC. The control cohort consisted of 1,788 patients with clear-cell RCC treated with first-line TKIs. Multivariable Cox proportional hazard model was used to evaluate the effect of potential prognostic factors on the survival measures. RESULTS: Median progression-free survival was 11.8 and 6.5 months in the clear cell renal cell carcinoma and nccRCC patients, respectively (P = 0.018), and median overall survival was 33.2 and 22.0 months, respectively (P = 0.007). In the multivariate analysis, independent factors associated with inferior progression-free survival included high tumor grade, worse Memorial Sloan Kettering Cancer Center risk group, absence of nephrectomy, and sunitinib (as opposed to pazopanib) as first-line targeted therapy. Independent predictors of inferior overall survival included nonclear cell histology, tumor grade, worse Memorial Sloan Kettering Cancer Center risk group, absence of nephrectomy, older age, and sunitinib as first-line targeted therapy. CONCLUSIONS: The present retrospective, registry-based study confirms that patients with nccRCC treated with TKIs have worse clinical outcomes compared to clear cell renal cell carcinoma patients with similar baseline characteristics.

[Cancer Treatment-induced Changes in Renal Function in Patients with Tumors - Update on Current Knowledge]. / Protinádorovou lécbou indukované zmeny renálních funkcí u pacientu s tumory - update aktuálních poznatku.

BACKGROUND: Renal abnormalities associated with malignancy are common with renal impairment occurring in about 60% of patients with tumors. Kidney disease may occur as a result of direct or indirect effects of tumors on kidneys and the urinary tract. Systematic oncology treatment can affect renal function in two ways, via direct toxic effects on kidney structure and indirectly via dehydration or tumor lysis syndrome. Since 2004, the Food and Drug Administration has approved a number of potentially nephrotoxic chemotherapeutics, targeted drugs, and immunotherapeutics for the treatment of solid tumors. AIM: This article provides an overview of the latest information on the nephrotoxicity associated with the use of new drugs. CONCLUSION: Despite the development of new drug treatments, including targeted therapy and immunotherapy, the risk of kidney involvement persists. The mechanisms of action of these new drugs are different from those of classical chemotherapy, and their use is usually associated with only mild to moderate side effects. In clinical trials, patients with pre-existing renal insufficiency are not present in most cases. Deterioration of renal function may significantly affect the treatment strategy and therefore careful renal function monitoring should be an integral part of each clinical trial.Key words: renal failure - toxicity - immunotherapy - chemotherapySubmitted: 7. 7. 2017Accepted: 7. 9. 2017 The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.