A well organised effort to metastatic non-clear-cell renal cell carcinoma
Menée aux Etats-Unis et en Belgique à partir de données portant sur 112 patients atteints d'un carcinome rénal à cellules non claires (carcinome tubulo-papillaire, carcinome chromophobe, carcinome médullaire) de stade métastatique, cette étude de cohorte rétrospective analyse l'efficacité, du point de vue de la proportion de patients ayant obtenu une réponse objective, de la durée avant échec du traitement et de la survie globale, et la toxicité du cabozantinib
Our understanding of renal cortical tumours and their variable metastatic potential has dramatically evolved over the past 25 years, with concurrent advances in pathology, molecular biology, and genomics. What was once considered a single disease with different histopathological features (eg, chromophilic or granular) is now understood to be a heterogenous group of more than 30 tumours with distinct genomic and metabolic defects and clinical behaviours ranging from benign, to indolent with limited metastatic potential, to highly malignant and metastatic. Conventional clear-cell renal cell carcinoma accounts for 70% of renal cortical tumours that metastasise, and is characterised by a loss of chromosome 3p with dysregulation of the hypoxia inducible factor
α pathway with subsequent stimulation of downstream growth and angiogenic factors that promote growth, progression, and metastases of renal cancer. Clear-cell renal cell carcinoma and its molecular pathways have been the focus of randomised and prospective clinical trials of cytokines, tyrosine kinase inhibitors, mTOR inhibitors, and immunologically active checkpoint blockade inhibitors, alone or in combination, with a dramatic three-fold increase in median overall survival achieved in the past decade depending on risk group.
The Lancet Oncology , commentaire, 2018