UROLOGICAL SURVEY
Urological Oncology
High frequency of intracerebral hemorrhage in metastatic renal carcinoma patients with brain metastases treated with tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor
Pouessel D, Culine S
Department of Medical Oncology, C.R.L.C. Val d'Aurelle, Montpellier, France
Eur Urol. 2008; 53: 376-81
OBJECTIVES: To report the high incidence of intracerebral hemorrhage (ICH) in patients with metastatic renal cell carcinoma (RCC) treated with the tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor (VEGFR).
METHODS AND RESULTS: Between October 2005 and December 2006, 67 patients with metastatic RCC were treated with sorafenib or sunitinib at the Montpellier Cancer Center in compassionate access programs. The medical records of five (7%) patients who died of ICH during therapy were reviewed retrospectively. Four of them had known brain metastases. Previous radiation therapy had been indicated in two patients. Two patients had a history of hypertension. Death from ICH occurred in the first 2 wk following the onset of treatment. Three other patients with brain metastases who received sorafenib or sunitinib during the same period did not experience ICH.
CONCLUSIONS: The frequency of fatal ICH in RCC patients with brain metastases treated with tyrosine kinase inhibitors targeting the VEGFR seems high. Prospective clinical trials will be necessary for assessing the true incidence and predictive factors related to this toxicity.
Editorial Comment
Modern treatment of metastatic renal cancer involves tyrosine kinase inhibitors (TKI). This is an early report on possible lethal complications associated with this therapy in patients with brain metastases. Five cases with lethal brain hemorrhage while under TKI are reported and compared to 3 patients with brain metastases who did had not (yet) experienced any complications. No risk factors could be identified so far. Importantly, brain hemorrhage occurred within 2 14 days after onset of TKI medication. Urologists involved in the medical therapy of patients with renal cancer and brain metastases should be aware of immediate the risk of such complications and should report them to the community.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Predictive factors for progression in patients with clinical stage T1a prostate cancer in the PSA era
Descazeaud A, Peyromaure M, Salin A, Amsellem-Ouazana D, Flam T, Viellefond A, Debré B, Zerbib M
Department of Urology, Cochin Hospital, Paris, France
Eur Urol. 2008; 53: 355-61
OBJECTIVE: In the literature, most data regarding the outcome of patients with clinical stage T1a prostate cancer were established before the prostate-specific antigen (PSA) era. The aim of our study was to determine the predictive factors of progression in patients with T1a prostate cancer diagnosed in the PSA era.
METHODS: Consecutive patients (n=144) with newly diagnosed T1a prostate cancer (tumor involving < or =5% of the resected prostatic tissue) were included. None of them was treated before evidence of tumor progression confirmed by prostate needle biopsies. The associations between tumor characteristics and time to cancer progression were assessed using Cox regression analysis.
RESULTS: With a mean follow-up of 5.1 yr, 30 patients (21%) experienced cancer progression. Five adverse parameters were significantly associated with cancer progression: preoperative PSA> or =10 ng/ml, postoperative PSA> or =2 ng/ml, prostate weight > or =60 g, weight of resected tissue > or =40 g, and Gleason score> or =6. The 5-yr progression rate was 12% if fewer than two of these parameters were present, whereas it was 47% if two or more parameters were present (p<0.001).
CONCLUSION: In the PSA era the risk of progression associated with T1a prostate cancer can be predicted using five criteria, and two groups of patients can be defined. The patients at low risk of progression may be good candidates for surveillance. In those with a high risk of progression, a more aggressive treatment should be discussed.
Editorial Comment
Therapeutic options in pT1a prostate cancer vary from watchful waiting to immediate radical therapy. Because of (sometimes falsely) pathologically confirmed small tumor volume, conservative follow-up is not uncommon. These autors report on the clinical course of 144 patients with pT1a prostate cancer. This cohort is impressively low-risk with 71% Gleason score smaller or equal to 5. Still, a 25% 5 year progression rate was observed. The relative risk (RR) was increased in patients with initial PSA > 10 (RR 3.3, 40 % 5-year progression rate), Gleason score 6 or more (RR 2, 54 % 5-year progression rate) or postoperative PSA > 2 (RR 3.2, 44 % 5-year progression rate).
These figures caution anyone to recommend watchful waiting if more than 1 risk factor is involved.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de
Publication Dates
-
Publication in this collection
28 Sept 2009 -
Date of issue
Aug 2009
