Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study

Objective:The purpose of the study was to identify the best sequence of therapy beginning with a tyrosine kinase inhibitor(TKI)as the first-line therapy for patients with metastatic renal cell carcinoma(mRCC)in terms of overall survival(OS),progression-free survival(PFS),and rates of discontinuation and adverse effects during the treatment period.Methods:This is a retrospective,nationwide multicenter study of patients with mRCC after diagnosis at 10 different tertiary medical centers in Korea from January 1992 to December 2017.We focused on patients at either“favorable”or“intermediate”risk according to the International mRCC Database Consortium criteria,and they were followed up(median 335 days).Finally,a total of 1409 patients were selected as the study population.We generated a Cox proportional hazard model adjusted for covariates,and the different therapy schemes were statistically tested in terms of OS as well as PFS.In addition,frequencies of discontinuation and adverse events were compared among the therapy schemes.Results:Of the primary patterns of treatment sequences(24 sequences),“sunitinib epazopanib”and“sunitinibeeverolimuseimmunotherapy”showed the most beneficial results in both OS and PFS with significantly lower hazards than“sunitinib”,which is the most commonly treated agent in Korea.Considering that the“TKIeTKI”structure showed relatively higher discontinuation rates with higher adverse effects,the overall beneficial sequence would be“sunitinibeeverolimuseimmunotherapy”.Conclusion:Among several sequential therapy starting with TKIs,“sunitinibeeverolimuse immunotherapy”was found to be the best scheme for mRCC patients with“favorable”or“intermediate”risks.

Anti-inflammatory and Antimicrobial Effects of Anthocyanin Extracted from Black Soybean on Chronic Bacterial Prostatitis Rat Model

Objective： To investigated the anti-inflammatory and antimicrobial effects of anthocyanins extracted from black soybean on the chronic bacterial prostatitis（CBP） rat model.Methods： The SpragueDawley rats were divided into 4 groups,including control,ciprofloxacin,anthocyanins and anthocyanins with ciprofloxacin groups（n=8 in each group）.Then,drip infusion of bacterial suspension（Escherichia coli Z17O2：K1：H^-） into Sprague-Dawley rats was conducted to induce CBP.In 4 weeks,results of prostate tissue,urine culture,and histological analysis on the prostate were analyzed for each group.Results： The use of ciprofloxacin,anthocyanins,and anthocyanins with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in the reduction of prostatic inflammation compared with the control group（P〈0.05）.The anthocyanins with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the ciprofloxacin group（P〈0.05）.Conclusions： These results suggest that anthocyanins may have anti-inflammatory and antimicrobial effects,as well as a synergistic effect with ciprofloxacin.Therefore,we suggest that the combination of anthocyanins and ciprofloxacin may be effective in treating CBP to obtain a higher rate of treatment success.

The current status of hormone treatment for prostate cancer patients in Korean real-world practice:a multi-institutional observational study

We aimed to evaluate the current nationwide trend,efficacy,safety,and quality of life(QoL)profiles of hormone treatment in real-world practice settings for prostate cancer(PCa)patients in Korea.A total of 292 men with any biopsy-proven PCa(TanyNanyMany)from 12 institutions in Korea were included in this multi-institutional,observational study of prospectively collected data.All luteinizing hormone-releasing hormone(LHRH)agonists were allowed to be investigational drugs.Efficacy was defined as(1)the rate of castration(serum testosterone≤50 ng dl^-1)at 4-week visit and(2)breakthrough(serum testosterone>50 ng dl^-1 after castration).Safety assessments included routine examinations for potential adverse events,laboratory tests,blood pressure,body weight,and bone min era I density(BMD,at baseli ne and at the last follow-up visit).QoL was assessed using the Expa nded Prostate Cancer Index Composite-26(EPIC-26).The most comm on initial therapeutic regimen was LHRH agonist with an ti-androge n(78.0%),and the most commonly used LHRH agonist for combination and mono therapy was leuprolide(64.0%for combi natio n and 58.0%for monotherapy).The castration and breakthrough rates were 78.4%and 6.6%,respectively.The laboratory results related to dyslipidemia worsened after 4 weeks of hormone treatment.In addition,the mean BMD T-score was significantly lower at the last follow-up(mean:-1.950)compared to baseline(mean:-0.195).The mean total EPIC-26 score decreased from 84.8(standard deviation[s.d.]:12.2)to 78.3(s.d.:8.1),with significant deterioration only in the urinary domain(mean:23.5 at baseli ne and 21.9 at the 4-week visit).These findi ngs dem on strate the n ationwide trend of current practice setti ngs in hormone treatment for PCa in Korea.