1,720,998 research outputs found
Hepatocellular carcinoma, vascular endothelial growth factor receptors‐targeting agents, and hypertension: A much more complicated relationship than expected
No full textHepatocellular carcinoma (HCC) relationship with hypertension is a complicated phenomenon, mainly depending on the causes of the primary liver disease and the potential for drug interactions between concomitant medications and vascular endothelial growth factor receptor inhibitors. Another interesting point worth exploring is how to treat hypertension in HCC patients under anticancer multikinase inhibitor therapy and the possible impact of certain antihypertensive agents on patients' outcome
Single nucleotide polymorphisms in angiogenesis-related genes and outcomes from antiangiogenic therapies in renal cell carcinoma: really a step towards personalized oncology, or not at all?
No full textN
Editorial Comment from Dr Porta et al. to Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA
Full text linkManagement of cytotoxic chemotherapy in patients undergoing dialysis: a still unresolved issue of onconephrology
Full text linkThe incidence of tumors increases signifcantly in individuals with chronic kidney disease (CKD), particularly among those undergoing dialysis. This dialysis-associated condition not only impacts therapy but also infuences the prognosis of oncological patients, contributing to heightened mortality rates related to both cancer and non-cancer causes. Importantly, it stands as a primary factor leading to suboptimal utilization of therapies. Dosage adjustment for many types of chemotherapy is a necessity in patients with kidney impairment. However, due to a lack of comprehensive knowledge about the pharmacokinetic and pharmacodynamic properties of these drugs in dialysis, adjustments are often made empirically, and in many cases, chemotherapy is avoided altogether. In this review, we highlight the current challenges and gaps in knowledge, and emphasize the imperative need for dedicated research to establish evidence-based guidelines for chemotherapy management in this vulnerable patient population
Sarcoidosis-like reactions in metastatic renal cell carcinoma patients treated with immune-based combinations
No full textAim: The incidence of drug-induced sarcoidosis-like reactions (DISR) in patients treated with immune checkpoint inhibitors (ICIs) is rising. We determine the incidence and characteristics of DISR in a metastatic renal cell carcinoma (mRCC) population. Methods: We retrospectively reviewed clinico-radiological data of 83 mRCC patients treated at a single institution with immune-based combinations. Results: 15 patients received immune-doublet (ipilimumab-nivolumab), while 68 patients received other immune-based combinations. Two cases of DISR (2.4%) were evidenced, with enlargement of mediastinal lymph nodes that mimicked disease progression, thus requiring a biopsy which showed histological features of DISR. Conclusion: In our series of the incidence of DISR, radiological and clinical features, are in line with literature. DISR diagnosis is often only radiological, and its occurrence is possibly associated with a better outcome.The development of sarcoidosis-like lesions (DISR) is a rare event observed in cancer patients receiving immunotherapy. DISR occurrence represents a huge diagnostic issue, because its clinical and radiological features simulate disease progression. We present a series of 83 patients with kidney cancer receiving immunotherapy. During the therapy, two of these patients showed enlargement of chest lymph nodes that could be interpreted as disease progression. However, the microscopic analysis of these lymph nodes showed evidence of DISR. In conclusion, DISR should be adequately recognized to correctly manage patients who receive immunotherapy.The development of sarcoidosis-like lesions is a rare event in cancer patients receiving immunotherapy. The occurrence of DISR may mimic disease progression, and it represents a diagnostic issue, considering the growing number of resected RCC treated with adjuvant immunotherapy
Il trattamento del carcinoma renale avanzato: un aggiornamento [The Treatment of Metastatic Renal Cell Carcinoma: An Update]
No full textIl panorama terapeutico del carcinoma a cellule renali si è modificato drasticamente nel corso degli ultimi anni. In questa revisione della Letteratura offriamo una sintesi delle più recenti evidenze scientifiche nel settore. L’introduzione di uno standard terapeutico nel setting adiuvante, basato sull’immunoterapia con immune checkpoint inhibitors, è stata una delle maggiori novità degli ultimi anni. L’efficacia di tale trattamento, in termini di riduzione del rischio di recidiva, è però variabile in base a molteplici fattori, che devono essere considerati con attenzione dal clinico al momento della scelta terapeutica. Un’altra grande novità riguarda il trattamento di prima linea della malattia metastatica, il cui standard è al momento costituito da combinazioni di due ICI o di un ICI con un VEGFR-TKI). La scelta della migliore opzione tra quelle disponibili nella pratica clinica richiede un’attenta valutazione, al fine di impostare la strategia terapeutica più adatta ad ogni paziente. L’analisi critica dei più recenti studi clinici è uno strumento fondamentale nel delineare una corretta condotta clinica nei due setting sopra menzionati. Infine, questa revisione si focalizza sul ruolo del Nefrologo nella gestione del paziente con RCC, in tutti i setting di malattia considerati.The therapeutic landscape for renal cell carcinoma (RCC) has undergone significant changes in recent years. In this Literature review, we offer a synopsis of the latest scientific evidence in this field. The introduction of a standard of care in the adjuvant setting, based on immune checkpoint inhibitors (ICI), was a breakthrough. The efficacy of this treatment, calculated as the relapse risk reduction, can vary depending on multiple factors, whose knowledge is important for the clinician in the therapeutic choice. Another innovation concerns the first-line therapy for metastatic RCC. In this setting, the new standard is represented by an immune combination, a therapy based either on a doublet of ICIs or on a combination between an ICI and one VEGFR-TKI. Making the best choice between the available options requires careful evaluation, in order to tailor the most appropriate treatment for each patient. The critical analysis of the most recent clinical trials is a fundamental tool to tailor the correct clinical management of localized and advanced RCC. Finally, this review focuses on the role of the nephrologist in the management of RCC patients, across different disease settings
Acute kidney injury in cancer patients
No full textBackground: Renal complications are a relevant clinical issue in patients with cancer; conversely, cancer in patients affected by kidney diseases is a growing problem mainly due to the aging of the general population. Onco-Nephrology is a novel subspecialty addressing these issues. Summary: Acute kidney injury (AKI) is an important cause of morbidity and mortality in cancer patients, and recognizes a number of different causes, which can impact, directly and indirectly, on kidney function. Furthermore, the appearance of AKI may have a tremendously negative impact on oncological treatments, often denying cancer patients active and life-prolonging treatments. Overall, patients with cancer are at risk of AKI, which could be caused by antineoplastic treatments, sepsis, metabolic disturbances, hematopoietic stem cell transplantation, primary thrombotic micro-angiopathies, and direct involvement of the kidney by hematological malignancies and also by solid cancer, in particular kidney and urothelial malignancies. Key Messages: (1) AKI is a frequent and increasing complication of cancer. (2) There is a bidirectional relationship between cancer and kidney disease, and in both cases, AKI is more likely to happen. (3) AKI in patients with cancer is associated with increased morbidity and mortality. (4) In cancer patients, a multidisciplinary approach and early intervention may reduce the incidence of AKI and its life-threatening consequences. (5) Onco-Nephrology is a growing area of nephrology that requires clinicians to have a better understanding of the renal complications of cancer including AKI
Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies
Full text linkPatients with cancer are subjected to several imaging
examinations which frequently require the administration
of contrast medium (CM). However, it has been estimated
that acute kidney injury (AKI) due to the injection of
iodinated CM accounts for 11% of all cases of AKI,
and it is reported in up to 2% of all CT examinations.
Remarkably, the risks of developing AKI are increased
in the elderly, in patients with chronic kidney disease
or diabetes, and with dehydration or administration of
nephrotoxic chemotherapeutics. Given the common
occurrence of postcontrast acute kidney injury (PCAKI) in clinical practice, primary care physicians and all
specialists involved in managing patients with cancer
should be aware of the strategies to reduce the risk
of this event. In 2018, a panel of four experts from the
specialties of radiology, oncology and nephrology were
speakers at the annual meeting of the Italian Society of
Medical Radiology (Società Italiana di Radiologia Medica
e Interventistica), with the aim of commenting on existing
evidence and providing their experience on the incidence
and management of PC-AKI in patients with cancer. The
discussion represented the basis for this white paper,
which is intended to be a practical guide organised by
statements describing methods to reduce renal injury risks
related to CM-enhanced CT examinations in patients with
cancer
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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