First-line pazopanib in patients with advanced non-clear cell renal carcinoma:An Italian case series

BACKGROUND Non-clear cell(ncc)metastatic renal-cell carcinoma(RCC)has dismal results with standard systemic therapies and a generally worse prognosis when compared to its clear-cell counterpart.New systemic combination therapies have emerged for metastatic RCC(mRCC),but the pivotal phase III trials excluded patients with nccRCC,which constitute about 30%of metastatic RCC cases.AIM To provide a piece of real-life evidence on the use of pazopanib in this patient subgroup.METHODS The present study is a multicenter retrospective observational analysis aiming to assess the activity,efficacy,and safety of pazopanib as first-line therapy for advanced nccRCC patients treated in a real-life setting.RESULTS Overall,48 patients were included.At the median follow-up of 40.6 mo,the objective response rate was 27.1%,the disease control rate was 83.3%,and the median progression-free survival and overall survival were 12.3(95%confidence interval[CI]:3.6-20.9)and 27.7(95%CI:18.2-37.1)mo,respectively.Grade 3 adverse events occurred in 20%of patients,and no grade 4 or 5 toxicities were found.CONCLUSION Pazopanib should be considered as a good first-line option for metastatic RCC with variant histology.

“Targeting” renal cell carcinoma patients with “targeted” agents: Are we there yet?

The rapid approval of several novel agents, targeting the vascular endothelial growth factor or mammalian target of rapamycin pathways(sunitinib, pazopanib, sorafenib, axitinib, bevacizumab, everolimus, temsirolimus) has given to metastatic renal cell carcinoma(m RCC) patients and their treating physicians many new and effective therapeutic options. The treatment paradigm for these patients is rapidly evolving, with future studies needed to defi ne the optimal sequencing of these new agents. Despite progresses, no validated biomarkers able to predict clinical outcome or useful to guide patient selection for treatment are currently available. Recent studies have suggested that some biomarkers, including cytokines, circulating proangio-genic factors, markers of hypoxia or targets of signaling pathways are potentially promising prognostic or predictive factors in m RCC. We present an overview of the most recent developments in identifying biomarkers for targeted therapies in advanced RCC.

Contemporary grading of prostate cancer:2017 update for pathologists and clinicians

The Gleason grading system for prostate cancer(PCa)was.developed in the 1960s by DF Gleason.Due to changes in PCa detection and treatment,the application of the Gleason grading system has changed considerably in pathology routine practice.Two consensus conferences were held in 2005 and in 2014 to update PCa Gleason grading.This review provides a summary of the changes in the grading of PCa from the original Gleason grading system to the prognostic grade grouping,as well as a discussion of the clinical significance of the percentage of Gleason patterns 4 and 5.

Prophylactic use of mTOR inhibitors and other mmunosuppressive agents in heart transplant patients

Cardiac transplantation is currently the preferred choice of treatment for end-stage cardiac disease. Despite great advances have been made in the prevention and treatment of acute transplant rejection, accelerated cardiac allograft vasculopathy （CAV） still limits the long-term success of heart transplantation. CAV is a rapidly progressive form of atherosclerosis described by vascular remodeling of the graft coronary arteries that occurs uniquely in transplant recipi- ents. In the early stages, CAV is characterized by intimal proliferation, while luminal stenosis of epicardial branches, occlusion of smaller arteries and myocardial infarction occur in the later stages.