A phase II trial of first-line sorafenib in patients with metastatic renal cell carcinoma unwilling to receive or with early intolerance to immunotherapy: SOGUG Study 06-01

AIMS: Our aim was to evaluate first-line treatment of metastatic renal cell carcinoma (mRCC) with sorafenib in patients unwilling to receive immunotherapy or with early in

[Current treatment in high risk and locally advanced prostate cancer]. / Tratamiento actual del cáncer de próstata de alto riesgo y localmente avanzado.

Treatment of locally advanced prostate cancer remains controversial. Treatment options include radical prostatectomy (PR), radiotherapy (RT) and hormonotherapy (HT). A Medline database search with key words "prostate cancer", "locally advanced", "high risk" and "treatment" in articles published during the last 15 years was done. Fifty one out of 329 papers were selected and reviewed. Selection criteria were a minimum of scientific evidence level of IIa, except for some specific level IV reference. Numerous randomized studies show that patients may benefit of a combined therapy with RT and HT. RP has shown its usefulness in selected cases of locally advanced prostate cancer. Results of long follow-up series are similar to those obtained with RT and HT. Furthermore, the possibility of clinical over staging is an argument in favour of RP. We perform an updated revision of every possible choice available in the treatment of these tumours.

[Molecular biology of the clear cell renal cell carcinoma: principles for a selective treatment]. / Biología molecular del carcinoma de células claras renales: principios para un tratamiento selectivo.

Renal cell carcinoma (RCC) and its most frequent subtype, the clear cell hystology type, has shown resistance to chemotherapy and radiotherapy treatment when disease was already spread in patients. Recently, a huge advance in the molecular biology of this tumor has been performed. This fact allowed a deeper and better knowledge of the disease and the development of new drugs that work against the growth factors involved in tumor origin. In this review article it is summarized the molecular milestones that are involved in the development of clear cell renal cell carcinomas.

Tratamiento actual del cáncer de próstata de alto riesgo y localmente avanzado / Current treatment in high risk and locally advanced prostate cancer

El tratamiento del cáncer de próstata localmente avanzado continúa siendo controvertido. Las opciones terapéuticas comprenden desde la prostatectomía radical (PR), a la radioterapia (RT) y la hormonoterapia (HT). Se ha efectuado una revisión en la base de datos Medline de los trabajos publicados en los últimos 15 años, con las palabras clave en inglés: “cáncer de próstata”, “localmente avanzado”, “alto riesgo” y “tratamiento”. Cincuenta y uno de 329 artículos fueron seleccionados y revisados. El criterio de selección incluía un mínimo nivel de evidencia científica IIa, destacando alguna referencia puntual con evidencia IV. Como demuestran múltiples estudios aleatorios, estos pacientes se pueden beneficiar de una terapia combinada con RT y HT. La PR en enfermedad localmente avanzada ha demostrado su utilidad en algunos casos seleccionados. Los resultados a largo plazo de algunas series son equiparables a los obtenidos con RT y HT. Además, la posibilidad de sobreestadiaje clínico también es un argumento a favor de la PR. Se realiza una revisión actualizada de todas las posibles opciones disponibles en el tratamiento de estos tumores

Treatment of locally advanced prostate cancer remains controversial. Treatment options include radical prostatectomy (PR), radiotherapy (RT) and hormonotherapy (HT). A Medline database search with key words “prostate cancer”, “locally advanced”, “high risk” and “treatment” in articles published during the last 15 years was done. Fifty one out of 329 papers were selected and reviewed. Selection criteria were a minimum of scientific evidence level of IIa, except for some specific level IV reference. Numerous randomized studies show that patients may benefit of a combined therapy with RT and HT. RP has shown its usefulness in selected cases of locally advanced prostate cancer. Results of long follow-up series are similar to those obtained with RT and HT. Furthermore, the possibility of clinical over staging is an argument in favour of RP. We perform an updated revision of every possible choice available in the treatment of these tumours

Biología molecular del carcinoma de células claras renales: principios para un tratamiento selectivo / Molecular biology of the clear cell renal cell carcinoma: selective treatment

El cáncer de células renales (CCR) y más concretamente el subtipo más frecuente de células claras, se he mostrado resistente al tratamiento con quimioterapia y radioterapia cuando afecta a pacientes con metástasis a distancia. En los últimos años se han realizado grandes avances en el campo de la biología molecular que origina este tipo de tumores. Esto ha conducido a un mejor conocimiento del origen de la enfermedad y ha permitido el desarrollo de nuevos fármacos que actúan sobre los factores de crecimiento implicados en el desarrollo del tumor. En este artículo de revisión se resumen de manera concisa los hitos a nivel molecular que originan el desarrollo de los tumores renales de células claras

Renal cell carcinoma (RCC) and its most frequent subtype, the clear cell hystology type, has shown resistance to chemotherapy and radiotherapy treatment when disease was already spread in patients. Recently, a huge advance in the molecular biology of this tumor has been performed. This fact allowed a deeper and better knowledge of the disease and the development of new drugs that work against the growth factors involved in tumor origin. In this review article it is summarized the molecular milestones that are involved in the development of clear cell renal cell carcinomas

[Hormone-refractory prostate cancer. Modifications of the therapeutic strategies since chemotherapy proved its usefulness]. / Cancer de próstata hormonorresistente. Cambios en las estrategias terapéuticas desde la demostración de la utilidad de la quimioterapia.

Back in the 90's it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice.

Cáncer de próstata hormonorresistente. Cambios en las estrategias terapéuticas desde la demostración de la utilidad de la quimioterapia / Hormone-refractory prostate cancer. Modifications of the therapeutic strategies since chemotherapy proved its usefulness

En la década de los 90 fue difícil obtener conclusiones de las publicaciones sobre CPHR, existía una falta de homogeneidad en cuestiones tan importantes como la propia definición de CPHR, la selección de pacientes o la valoración de las respuestas a los tratamientos. En la actualidad ya existen criterios consensuados al respecto que se exponen en el trabajo. A finales de 2004 se publicaron 2 trabajos que demostraron que la quimioterapia basada en docetaxel mejoraba la supervivencia en el CPHR con metástasis. Hasta entonces los distintos tratamientos utilizados únicamente conseguían paliación de síntomas. Pero probablemente no todos los pacientes con CPHR sean candidatos a quimioterapia con docetaxel de entrada. El debate actual se centra en determinar a qué pacientes y en qué instante debe iniciarse la quimioterapia para excluir a los que corran el riesgo de sufrir sus efectos adversos sin ventajas clínicas. Pacientes con CPHR sin metástasis pueden ser candidatos a recibir maniobras hormonales secundarias antes de iniciar quimioterapia En esta revisión analizamos qué cambios se han producido en las estrategias terapéuticas en CPHR, desde la demostración de la utilidad de la quimioterapia, mostrando también cual es en la práctica diaria nuestra actitud en el tratamiento de estos pacientes

Back in the 90’s it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice

[Treatment decision in advanced testicular germ cell tumors]. / Decisión terapéutica en tumores de células germinales testiculares avanzados.

OBJECTIVE: To review the classifications of the risk groups of different prestigious institutions and collaborative groups that have had a major impact on our knowledge and therapeutic approach to germ cell tumors of the testis. METHODS: We reviewed the different classifications of renowned institutions and collaborative groups and the literature published over the last 15 years that provide evidence for the optimal therapeutic approach for each subgroup at risk. RESULTS/CONCLUSIONS: Germ cell testicular tumors is the paradigm of curable tumors of the adult. Patients with stage I tumors have an excellent prognosis with more than 98% probability of cure. The prognosis for the advanced stage tumors is superior to that of other solid tumors with a similar volume due to their exquisite chemosensitivity. Patients with advanced disease can be divided into two or three groups (low and high, or low, intermediate and high risk) with different probability of cure after treatment with cisplatin-based regimens, according to the location of the primary tumor, extent of the disease and serum levels of the markers. The standard treatment for the advanced disease consists of first line chemotherapy with cisplatin, etoposide and bleomycin (BEP) followed by surgery in cases with residual tumor. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors will not cure after first line chemotherapy, although rescue with second line chemotherapy can be utilized in some of these patients. The search for more effective chemotherapeutic regimens for high risk patients and regimens with a lower toxicity for the low risk patients has been hampered by the lack of consensus among the working groups on the criteria for the classification of these patients into subgroups according to prognosis. The recent International Germ Cell Consensus Classification will permit studies on homogeneous risk groups of patients and will allow us to obtain reliable and reproducible results.

[Rescue chemotherapy in testicular germ cell tumors]. / Quimioterapia de rescate en tumores de células germinales testiculares.

OBJECTIVE: To review the different salvage chemotherapy regimens according to the prognostic factors based on the response to the different therapeutic alternatives. METHODS: The conventional rescue chemotherapy regimens, as well as the role of surgery, new drugs and therapeutic modalities, particularly high dose second and third line chemotherapy, were reviewed. RESULTS/CONCLUSIONS: Germ cell testicular tumor is the paradigm of curable tumors of the adult. Whereas the cure rate for stage I tumors is higher than 98%, patients with advanced stage tumors have a lower cure rate. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors show tumor progression or recurrence after first line chemotherapy using cisplatin-based combinations. Patients who have recurrence after first line chemotherapy have a 40% probability of achieving second complete remission with second line chemotherapy, but will be sustained in only 20% of the patients, although rare cases of advanced pure seminoma that recurred have shown a cure rate of 55% with second line chemotherapy. New strategies have been developed using new drugs such as taxanes or high doses of well-known chemotherapeutic agents with autologous hematopoietic rescue that have been utilized with success in patients with refractory germ cell testicular tumors. A global analysis of the patients treated with third line chemotherapy shows a sustained complete remission rate of 22%. However, this percentage can only be increased to up to 50% for patients with no adverse factors.