Based on the GLOBOCAN statistics 2023, prostate cancer is the first and most commonly diagnosed cancer and the second cause of cancer death in men, with estimated 288 300 new cancer cases and 34 700 deaths.1 Interesti...Based on the GLOBOCAN statistics 2023, prostate cancer is the first and most commonly diagnosed cancer and the second cause of cancer death in men, with estimated 288 300 new cancer cases and 34 700 deaths.1 Interestingly, the incidence rate of prostate cancer decreased around 40% from 2007 to 2014. This reflects the recommendation of the United States Preventive Services Task Force (USPSTF) to avoid prostate-specific antigen (PSA) testing screening for ≥75 years old men in 2008 and for all men in 2012.1 In the 1990s, PSA testing for screening purpose was widely adopted. In a few years, considering how common prostate cancer is, many issues related to overdiagnosis and overtreatment of early detected localized prostate cancer raised in scientific community.2 Several studies showed that patients with early moderately and highly differentiated prostate cancer who did not undergo local treatment have a low death rate. Considering that curative treatment options such as surgery or radiotherapy are at risk of significant side effects, definition of deferred treatment approach for those patients started to become a medical need. Two different conservative approaches with different goals and inclusion criteria are considered with the aim to reduce overtreatment: active surveillance (AS) and watchful waiting (WW), as shown in Table 1. In this opinion, we will focus on AS.3,4.展开更多
The introduction of first-line combinations had improved the outcomes for metastatic renal cell carcinoma (mRCC) compared to sunitinib. However, some patients either have inherent resistance or develop resistance as a...The introduction of first-line combinations had improved the outcomes for metastatic renal cell carcinoma (mRCC) compared to sunitinib. However, some patients either have inherent resistance or develop resistance as a result of the treatment. Depending on the kind of therapy employed, many factors underlie resistance to systemic therapy. Angiogenesis and the tumor immune microenvironment (TIME), nevertheless, are inextricably linked. Although angiogenesis and the manipulation of the tumor microenvironment are linked to hypoxia, which emerges as a hallmark of renal cell carcinoma (RCC) pathogenesis, it is only one of the potential elements involved in the distinctive intra- and inter-tumor heterogeneity of RCC that is still dynamic. We may be able to more correctly predict therapy response and comprehend the mechanisms underlying primary or acquired resistance by integrating tumor genetic and immunological markers. In order to provide tools for patient selection and to generate hypotheses for the development of new strategies to overcome resistance, we reviewed the most recent research on the mechanisms of primary and acquired resistance to immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) that target the vascular endothelial growth factor receptor (VEGFR).We can choose patients’ treatments and cancer preventive strategies using an evolutionary approach thanks to the few evolutionary trajectories that characterize ccRCC.展开更多
文摘Based on the GLOBOCAN statistics 2023, prostate cancer is the first and most commonly diagnosed cancer and the second cause of cancer death in men, with estimated 288 300 new cancer cases and 34 700 deaths.1 Interestingly, the incidence rate of prostate cancer decreased around 40% from 2007 to 2014. This reflects the recommendation of the United States Preventive Services Task Force (USPSTF) to avoid prostate-specific antigen (PSA) testing screening for ≥75 years old men in 2008 and for all men in 2012.1 In the 1990s, PSA testing for screening purpose was widely adopted. In a few years, considering how common prostate cancer is, many issues related to overdiagnosis and overtreatment of early detected localized prostate cancer raised in scientific community.2 Several studies showed that patients with early moderately and highly differentiated prostate cancer who did not undergo local treatment have a low death rate. Considering that curative treatment options such as surgery or radiotherapy are at risk of significant side effects, definition of deferred treatment approach for those patients started to become a medical need. Two different conservative approaches with different goals and inclusion criteria are considered with the aim to reduce overtreatment: active surveillance (AS) and watchful waiting (WW), as shown in Table 1. In this opinion, we will focus on AS.3,4.
文摘The introduction of first-line combinations had improved the outcomes for metastatic renal cell carcinoma (mRCC) compared to sunitinib. However, some patients either have inherent resistance or develop resistance as a result of the treatment. Depending on the kind of therapy employed, many factors underlie resistance to systemic therapy. Angiogenesis and the tumor immune microenvironment (TIME), nevertheless, are inextricably linked. Although angiogenesis and the manipulation of the tumor microenvironment are linked to hypoxia, which emerges as a hallmark of renal cell carcinoma (RCC) pathogenesis, it is only one of the potential elements involved in the distinctive intra- and inter-tumor heterogeneity of RCC that is still dynamic. We may be able to more correctly predict therapy response and comprehend the mechanisms underlying primary or acquired resistance by integrating tumor genetic and immunological markers. In order to provide tools for patient selection and to generate hypotheses for the development of new strategies to overcome resistance, we reviewed the most recent research on the mechanisms of primary and acquired resistance to immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) that target the vascular endothelial growth factor receptor (VEGFR).We can choose patients’ treatments and cancer preventive strategies using an evolutionary approach thanks to the few evolutionary trajectories that characterize ccRCC.
