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1.
In Vivo ; 35(3): 1805-1810, 2021.
Article in English | MEDLINE | ID: covidwho-1207960

ABSTRACT

BACKGROUND/AIM: Kidney cancers account for about 2% of human malignancies. In recent decades, the incidence of this cancer type has gradually increased, mainly due to advances in imaging. The metastatic potential of these cancers is significant: a quarter of patients will immediately present with metastases and more than one third of patients treated with nephrectomy for a localized disease will develop metastases during their course. In total, more than half of patients will suffer from the consequences of metastasis. The median survival at this stage is only thirteen months, so the therapeutic challenge is immense. CASE REPORT: The present case report describes a case of left renal clear cell carcinoma with brain, lung, right adrenal, bone and lymph node metastases in a 55-year-old male. The patient received only one line of anticancer treatment with sunitinib, which could not be continued due to haemorrhagic manifestations in brain metastases. The treatment was changed with immunotherapy which showed its effect even if it was stopped due to the patient wishes in the context of the COVID-19 epidemic. CONCLUSION: Immunotherapy opens the doors to a new era in treatment of metastatic renal cancer and shows efficiency even after it has been stopped.


Subject(s)
COVID-19 , Carcinoma, Renal Cell , Kidney Neoplasms , Carcinoma, Renal Cell/drug therapy , Humans , Immunotherapy , Kidney Neoplasms/drug therapy , Male , Middle Aged , SARS-CoV-2
2.
Front Immunol ; 12: 627186, 2021.
Article in English | MEDLINE | ID: covidwho-1094168

ABSTRACT

After the COVID-19 outbreak, non-evidence based guidelines were published to advise clinicians on the adjustment of oncological treatment during this pandemic. As immune checkpoint inhibitors directly affect the immune system, concerns have arisen about the safety of immunotherapy during this pandemic. However, data on the immune response in oncology patients treated with immunotherapy are still lacking. Here, we present the adaptive immune response in a SARS-CoV-2 infected patient who was treated with immune checkpoint inhibitors for advanced renal cell cancer. To evaluate the immune response in this patient, the number of T cells and their major subsets were measured according to expression of markers for co-signalling, maturation, and chemotaxis at baseline, during therapy, and during the SARS-CoV-2 infection. In addition, plasma samples were analyzed for IgM and IgG antibodies and the ability of these antibodies to neutralise SARS-CoV-2. Despite several risk factors for an impaired immune response to SARS-CoV-2, both T- and B-cell responses were observed. Moreover, after treatment with immune checkpoint inhibitors, a sufficient cellular and humoral immune response was achieved in this SARS-CoV-2 infected patient. These findings warrant renewed discussion on withholding of immune checkpoint inhibitors during an ongoing COVID-19 pandemic.


Subject(s)
Antibiotics, Antineoplastic/therapeutic use , B-Lymphocytes/immunology , COVID-19/diagnosis , Carcinoma, Renal Cell/diagnosis , Immunotherapy/methods , Ipilimumab/therapeutic use , Kidney Neoplasms/diagnosis , Nivolumab/therapeutic use , SARS-CoV-2/physiology , T-Lymphocytes/immunology , Antibodies, Viral/blood , Carcinoma, Renal Cell/drug therapy , Cells, Cultured , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Kidney Neoplasms/drug therapy , Lymphocyte Activation , Male , Middle Aged , Neoplasm Staging
3.
BMJ Case Rep ; 13(12)2020 Dec 10.
Article in English | MEDLINE | ID: covidwho-971145

ABSTRACT

A 70-year-old man presented with gradually worsening throat discomfort. He had no prior diagnosis of cancer and no travel history of note. Examination revealed a right-sided painless neck lump. He underwent an MRI of the neck, revealing a gadolinium-enhancing tonsillar mass and two brain lesions. Biopsy of the tonsil lesion was in keeping with an epithelial neoplasm, suggesting metastatic renal cell carcinoma. This was confirmed following a staging CT, which revealed a left renal mass and lung metastases. Due to his brain metastases, the patient has been started on the tyrosine kinase inhibitor cabozantinib. A brief discussion on the diagnostic evaluation of a tonsil mass as a rare presentation of renal cell cancer follows this report.


Subject(s)
Brain Neoplasms/secondary , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/secondary , Lung Neoplasms/secondary , Palatine Tonsil/pathology , Aged , Anilides/therapeutic use , Brain Neoplasms/drug therapy , Carcinoma, Renal Cell/drug therapy , Humans , Kidney Neoplasms/drug therapy , Lung Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Palatine Tonsil/drug effects , Pyridines/therapeutic use , Receptor Protein-Tyrosine Kinases/therapeutic use , Tomography, X-Ray Computed , Treatment Outcome
4.
Biomed Res Int ; 2020: 2054376, 2020.
Article in English | MEDLINE | ID: covidwho-949235

ABSTRACT

Purpose: Owing to its worldwide spread, the coronavirus disease (COVID-19) epidemic was declared a pandemic by the World Health Organization on March 11, 2020. Angiotensin-converting enzyme 2 (ACE2) is the outer surface protein of the cell membrane that is abundantly distributed in the heart, lungs, and kidneys and plays an important role in molecular docking of the severe acute respiratory syndrome coronavirus 2. In this study, we aimed to analyze the difference in the survival rate according to ACE2 expressions in pan-cancer. Materials and Methods: We downloaded clinical and genomic data from The Cancer Genome Atlas. We used Kaplan-Meier with a log-rank test, and the Cox proportional hazards regression to analyze prognostic significance. Results: In the Kaplan-Meier curve, clear cell renal cell carcinoma (ccRCC), uveal melanoma, and prostate adenocarcinoma showed statistical significance. In the Cox regression, thyroid carcinoma and glioblastoma multiforme and ccRCC showed significant results. Only ccRCC had statistical significance, and high ACE2 expression is related to good prognosis. It is known that the ACE inhibitor, a primary antihypertensive agent, increases ACE2 expression. Conclusion: Based on these results, we believe that the ACE inhibitor will be important to increase the lifespan of ccRCC patients. This study is the first research to offer a recommendation on the use of anti-hypertensive drugs to ccRCC patients.


Subject(s)
Angiotensin-Converting Enzyme 2/biosynthesis , Antihypertensive Agents/administration & dosage , COVID-19 , Carcinoma, Renal Cell , Gene Expression Regulation, Neoplastic/drug effects , Kidney Neoplasms , Neoplasm Proteins/biosynthesis , COVID-19/drug therapy , COVID-19/metabolism , COVID-19/mortality , Carcinoma, Renal Cell/drug therapy , Carcinoma, Renal Cell/metabolism , Carcinoma, Renal Cell/mortality , Disease-Free Survival , Female , Humans , Kidney Neoplasms/drug therapy , Kidney Neoplasms/metabolism , Kidney Neoplasms/mortality , Male , Survival Rate
5.
J Cancer Res Clin Oncol ; 146(11): 3075-3078, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-724705

ABSTRACT

This letter summarizes recommendations from the interdisciplinary working group of renal tumors (IAGN) of the German Cancer Society for the systemic treatment of advanced/metastatic renal cell carcinoma in the context of the current SARS-CoV-2 pandemic.


Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/drug therapy , Coronavirus Infections , Kidney Neoplasms/drug therapy , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , SARS-CoV-2
6.
ESMO Open ; 5(Suppl 3)2020 07.
Article in English | MEDLINE | ID: covidwho-646077

ABSTRACT

BACKGROUND: The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic. METHODS: We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19. FINDINGS: For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both. CONCLUSION: mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.


Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/drug therapy , Coronavirus Infections/epidemiology , Kidney Neoplasms/drug therapy , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Betacoronavirus , COVID-19 , Carcinoma, Renal Cell/secondary , Clinical Decision-Making , Coronavirus Infections/prevention & control , Humans , Immunologic Factors/therapeutic use , Kidney Neoplasms/pathology , Medical Oncology/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Protein Kinase Inhibitors/therapeutic use , SARS-CoV-2 , Urology/statistics & numerical data
7.
Eur Urol ; 78(2): 276-280, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-598133

ABSTRACT

Preliminary data suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with higher mortality among cancer patients, particularly in those on systemic therapy. It is unclear whether this applies to patients receiving immune checkpoint inhibitors (ICIs). In this case series, 74 patients from a single institution with genitourinary (GU) cancer on ICI were followed up during a 12-wk period. During this period, 11 patients (15%) developed symptoms consistent with coronavirus disease 2019 (COVID-19) and four (5%) tested positive. Two patients had metastatic urothelial cancer (treated with atezolizumab) and two had metastatic renal cancer (treated with ipilimumab and nivolumab). All had additional risk factors associated with COVID-19 mortality and two received steroids within 1 mo of infection. Two patients developed symptoms requiring hospitalisation. All four are alive 32-45 d after their first symptoms and 28-38 d after testing positive. These patients all had multiple risk factors associated with severe COVID-19. These data suggest that the higher risk of COVID-19 death associated with systemic therapy in cancer may not apply to patients on ICIs. Assessment of COVID-19 severity in these patients can be complicated by the underlying cancer and its treatment.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Immunologic Factors/therapeutic use , Kidney Neoplasms/drug therapy , Pneumonia, Viral/complications , Aged , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Female , Follow-Up Studies , Humans , Kidney Neoplasms/complications , Kidney Neoplasms/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
8.
Clin Nucl Med ; 45(8): e381-e382, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-590185

ABSTRACT

Within a few months, coronavirus disease 2019 (COVID-19) has become a pandemic with more than 2 million patients infected and a high mortality rate. Early detection of COVID-19 in oncologic patients is crucial in order to rapidly apply isolation measures and avoid nosocomial spread. However, early diagnosis may be challenging, especially in cancer patients under treatment with immunotherapy as drug-induced pneumonitis can present similar clinical and radiological features. We describe the findings of a SARS-CoV-2 infection on PET/CT with F-FDG in a 51-year-old man with metastatic renal cell carcinoma under treatment with nivolumab.


Subject(s)
Betacoronavirus , Carcinoma, Renal Cell/drug therapy , Coronavirus Infections/diagnostic imaging , Immunotherapy/adverse effects , Kidney Neoplasms/drug therapy , Nivolumab/adverse effects , Pneumonia, Viral/diagnostic imaging , Pneumonia/diagnostic imaging , COVID-19 , Carcinoma, Renal Cell/complications , Coronavirus Infections/complications , Diagnosis, Differential , Fluorodeoxyglucose F18 , Humans , Kidney Neoplasms/complications , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Positron Emission Tomography Computed Tomography , SARS-CoV-2
9.
Eur Urol Focus ; 6(5): 1086-1096, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-591878

ABSTRACT

CONTEXT: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic that erupted in December 2019 has affected more than a million people from over 200 countries, claiming over 70 000 lives (by April 7, 2020). As the viral infection is driven by increased angiotensin-converting enzyme-2 (ACE2) expression, with the kidney exhibiting the highest expression, it is crucial to gain insights into the mechanisms underlying renal cell carcinoma (RCC) and coronavirus disease 2019 (COVID-19). OBJECTIVE: This study considers up-to-date information on the biological determinants shared by COVID-19 and renal disease, and aims to provide evidence-based recommendations for the clinical management of RCC patients with COVID-19. EVIDENCE ACQUISITION: A literature search was performed using all sources (MEDLINE, EMBASE, ScienceDirect, Cochrane Libraries, and Web of Science). As of March 31, 2020, the Center for Disease Control reported that of the adults hospitalized for COVID-19 with underlying conditions in the USA, 74.8% had chronic renal disease. EVIDENCE SYNTHESIS: Evidence is discussed from epidemiological studies on SARS-CoV-2 pandemic and molecular studies on the role of kidney in facilitating routes for SARS-CoV-2 entry, leading to increased virulence of SARS-CoV-2 and clinical manifestation of symptoms in RCC. CONCLUSIONS: This analysis will advance our understanding of (1) the molecular signatures shared by RCC and COVID-19 and (2) the clinical implications of overlapping signaling pathways in the therapeutic management of RCC and COVID-19 patients. PATIENT SUMMARY: Amid the coronavirus disease 2019 (COVID-19) pandemic, patients diagnosed with renal cell carcinoma and infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may receive complimentary treatment modalities to enhance therapeutic response.


Subject(s)
Betacoronavirus/metabolism , Carcinoma, Renal Cell/metabolism , Coronavirus Infections/metabolism , Kidney Neoplasms/metabolism , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/metabolism , Renal Insufficiency, Chronic/metabolism , Spike Glycoprotein, Coronavirus/metabolism , Acute Kidney Injury/epidemiology , Acute Kidney Injury/metabolism , Acute Kidney Injury/therapy , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antibodies, Neutralizing/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Antiviral Agents/therapeutic use , COVID-19 , Carcinoma, Renal Cell/epidemiology , Comorbidity , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Endothelin Receptor Antagonists/therapeutic use , Hospitalization , Humans , Ipilimumab/therapeutic use , Kidney Neoplasms/drug therapy , Kidney Neoplasms/epidemiology , Liquid Biopsy , Nivolumab/therapeutic use , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Protein Kinase Inhibitors/therapeutic use , Renal Dialysis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , SARS-CoV-2 , Serine Endopeptidases/metabolism , Severity of Illness Index , Sunitinib/therapeutic use
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