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Nephron-sparing surgery can be performed safely and withmaximum
preservation of renal function
O
pen nephron-sparing surgery and
laparoscopic radical nephrectomy are
relatively recent, significant develop-
ments for treating renal tumours and represent
acceptable standards of care in cases of small
renal mass and normal contralateral kidney,
report results of a retrospective, single-cen-
tre review.
X. Cuni, MD, of the University of Pristina,
Kosovo, explained that conservative renal sur-
gery has become the gold standard treatment
of small and peripheral malignant kidney
lesions, cases of reduced renal function, and
bilateral lesions.
Nephron-sparing surgery provides effective
therapy in patients with solitary sporadic
renal tumours
≤
4 cm and in the presence of
normal contralateral kidney or an anatomi-
cally functional solitary kidney. The optimal
selection criteria for nephron-sparing surgery,
however, have not been defined.
Dr Cuni reviewed the use of nephron-sparing
surgery in 33 patients of a total of 216 patients
operated for renal tumours in a cohort study
from 2000 through 2015. The records of all
patients were reviewed.
All patients exhibited a single renal mean
tumour size 3.6 cm (range 3.2–4.3) and a
normal contralateral kidney. In Dr Cuni’s
series, this size corresponded to 26% of partial
nephrectomies. In other series, this size corre-
sponded to 20–32% of partial nephrectomies.
Thirty-three nephron-sparing surgeries were
performed in 216 patients (16 female and
17 male). Mean patient age was 49 ± 9.5
years, and the surgery was elective in all. In
19 patients, lesions were located in the upper
pole, 13 in the lower pole. One case was in a
mesorenal location. The open approach was
used in all cases. Mean tumour size was 3.6
cm (range 3.2–4.3).
Pathologic findings demonstrated renal cell
carcinoma in 30 cases and benign lesions in
three patients (9%). One patient experienced
delayed bleeding for 2 days, and subsequent
nephrectomy was performed. In that case, the
tumour was 4.3 cm with mesorenal location.
Subsequent nephrectomy was positive for a
residual renal cell carcinoma tumour.
Ultrasonography was performed 1–3 months
postoperatively. Contrast-enhanced CT and
MRI were performed subsequently every 6
months for 2 years and then yearly. Radiologi-
cal investigations showed no local recurrence
or metastasis. None of these patients devel-
oped a tumour in the contralateral kidney
after nephron-sparing surgery.
Mean follow-up examination incorporating
Pembrolizumab yields long-lasting responses
inmetastatic triple-negative breast cancer
P
embrolizumab has been shown
to provide long-lasting responses
in patients with metastatic triple-
negative breast cancer, reports the phase 1b
KEYNOTE-012 study.
Rita Nanda, MD, of the University of
Chicago Medical Center, explained that in
the multicentre, multicohort, nonrandomised
phase 1b KEYNOTE-012 study, the anti-
programmed death-1 (PD-1) antibody
pembrolizumab demonstrated promising
antitumour activity (18.5% objective response
rate in patients with measurable disease at
baseline, based on Response Evaluation
Criteria in Solid Tumors v1.1 and assessed
by central radiology review).
As later-line therapy in previously treated
patients with PD-1–ligand 1–positive
metastatic triple-negative breast cancer,
the progression-free survival rate was 24%
and 12-month overall survival rate 43.1%.
The toxicity profile was manageable. Dr
Nanda presented updated follow-up data for
KEYNOTE-012.
Patients
≥
18 years of age with oestrogen
and progesterone receptor-negative, HER2-
negative, recurrent or metastatic breast
cancer, measurable disease per Response
Evaluation Criteria in Solid Tumors v1.1,
Eastern Cooperative Oncology Group
performance status 0–1, any number of prior
systemic treatments in the metastatic setting,
and PD-L1–positive tumours (defined as
expression in stroma or
≥
1% of tumour by
immunohistochemistry using the 22C3
antibody) received pembrolizumab 10 mg
per kilogram of body weight every 2 weeks
for 2 weeks or until disease progression or
unacceptable toxicity.
Response was assessed every 8 weeks by
central radiology review per Response
Evaluation Criteria in Solid Tumors v1.1.
Survival was assessed every 3 months. Overall
survival was estimates using the Kaplan-
Meier method.
Of the 32 female patients (median age 50.5
years, range 29–72 years) enrolled, 46.9%
had received at least three lines of therapy,
and 25.0% had received at least five lines of
therapy for metastatic disease.
The duration of median follow-up was 10.7
months (range 0.4–32.7). Median overall
survival was 10.2 months (95% CI 5.3–17.5).
Twelve-month overall survival was 41.1%.
Twenty-five (78.1%) patients had died as of
the data cutoff.
Median progression-free survival was 1.9
months (95% CI 1.3–4.3); and the 12-month
progression-free survival rate was 15.0%.
Of the five responders (one complete and
four partial responders) three have had
long-lasting benefit from pembrolizumab.
The patient with a complete response
discontinued pembrolizumab 11 months
after achieving a complete response and
has remained in complete response for
approximately 15 months without receiving
additional anticancer treatment.
Two patients with a partial response
discontinued pembrolizumab after
completing 2 years of treatment. The first
patient has maintained response for 22.7
months; the second patient experienced
disease progression after 7.7 months.
The median duration of response has
not been reached (range 15 to at least 58
weeks). Thirty (93.8%) patients discontinued
pembrolizumab: 27 (84.4%) for progressive
disease and three (9.4%) for adverse events
before reaching 2 years of treatment.
Six (18.8%) patients experienced grade
3–5 treatment-related adverse events.
One treatment-related death occurred
(disseminated intravascular coagulation with
decreased blood fibrinogen).
Dr Nanda concluded that pembrolizumab
was shown to provide long-lasting responses
in patients with metastatic triple-negative
breast cancer. Twenty-two percent of patients
were alive at 2 years, supporting further
development of the drug in heavily pretreated
patients who experience a poor prognosis.
The phase 2 KEYNOTE-086 study is ongoing
and is evaluating efficacy and safety of single
pembrolizumab as later-line treatment for
metastatic triple-negative breast cancer.
PracticeUpdate Editorial Team
CONFERENCE COVERAGE
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PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY