Synchronous Renal Cell Carcinoma Research Articles

Impact of Synchronous versus Metachronous Metastasis on Outcomes in Patients with Metastatic Renal Cell Carcinoma Treated with First-line Immune Checkpoint Inhibitor–based Combinations

Background and objectiveThe impact of time of metastasis onset with respect toprimary renal cell carcinoma (RCC) diagnosis on survival outcomes is not well characterized in the era of immune checkpoint inhibitor (ICI)-based combinations. Herein, we assessed differences in clinical outcomes between synchronous and metachronous metastatic RCC (mRCC). MethodsData for patients with mRCC treated with first-line ICI-based combination therapies between 2014 and 2023 were retrospectively collected. Patients were categorized as having synchronous metastasis if present within 3 mo of RCC diagnosis; metachronous metastasis was defined as metastasis >3 mo after primary diagnosis. Time to treatment failure (TTF), overall survival (OS), and the disease control rate (DCR) were assessed. Key findings and limitationsOur analysis included 223 eligible patients (126 synchronous and 97 metachronous). Median TTF did not significantly differ between the synchronous and metachronous groups (9 vs 19.8 mo; p = 0.063). Median OS was significantly shorter in the synchronous group (28.0 vs 50.9 mo; p = 0.001). Similarly, patients with synchronous metachronous metastasis (58.7% vs. 78.4%; p = 0.002). On multivariable analyses, synchronous metastasis remained independently associated with worse OS and DCR. Conclusions and clinical implicationsIn this hypothesis-generating study, patients with mRCC with synchronous metastasis who were treated with first-line ICI-based combinations have a poorer OS and worse DCR than those with metachronous mRCC. If these results are externally validated, time to metastasis could be included in prognostic models for mRCC. Patient summaryOur study demonstrates that patients treated with current first-line immunotherapies, who present with metastasis at the initial diagnosis of kidney cancer have worse overall survival compared to those who develop metastasis later. These results can help physicians and patients understand life expectancy.

Breast cancer with synchronous renal cell carcinoma: a rare case of dual malignancy

Synchronous breast and kidney carcinomas are extremely rare with only 11 cases have been reported in the literature so far in the world. We present a case of a 40-year-old lady diagnosed with right invasive ductal cell carcinoma. During the workup of the patient, an incidental renal mass was identified. After appropriate investigations, the patient underwent a right modified radical mastectomy with a right partial nephrectomy. The patient recovered successfully and was put on regular follow-up post-discharge. We are reporting a case of synchronous presentation of carcinoma breast with RCC which is rare since in world literature, most of the multiple malignancies reported are metastasis/metachronous breast carcinoma with RCC. The aetiology of synchronous malignancy is complex, some primary tumours may not be symptomatic and detected in the routine metastatic workup, and this poses a challenge for the surgical team. Hence with the histopathological report and with the other clinical and radiological parameters, we made a final diagnosis of carcinoma right breast pT2N0M0 with synchronous renal cell carcinoma (RCC) pT1aN0M0. the patient was planned for adjuvant chemotherapy and advised regular follow-up.

MP64-17 THE ROLE OF 18-FDG PET/CT SCAN IN EARLY RESPONSE TO SYSTEMIC THERAPY FOR METASTATIC RENAL CELL CARCINOMA: BEYOND SUV max

You have accessJournal of UrologyCME1 Apr 2023MP64-17 THE ROLE OF 18-FDG PET/CT SCAN IN EARLY RESPONSE TO SYSTEMIC THERAPY FOR METASTATIC RENAL CELL CARCINOMA: BEYOND SUVmax Sanjoy Kumar Sureka, Sumit Mandal, and Uday Pratap Singh Sanjoy Kumar SurekaSanjoy Kumar Sureka More articles by this author , Sumit MandalSumit Mandal More articles by this author , and Uday Pratap SinghUday Pratap Singh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In metastatic renal cell carcinoma (RCC), the CECT scan evaluates lesions in their anatomic context while FDG-PET/CT scan demonstrates metabolic component. Often the size of the lesion may take time to respond and metabolic activity changes first. We evaluated the role of FDG PET/CT scan in this setting with an objective to evaluate the role of FDG-PET/CT as a monitoring tool for early response to systemic therapy in metastatic RCC. METHODS: From January 2017 to Dec 2021, 48 patients with synchronous and metachronous metastatic RCC with ECOG <2 underwent a baseline 18-FDG/PET-CT scan followed by repeat scan for response assessment 3 months later. Pregnant and nursing mothers, hypothyroid, diabetics and those with brain metastasis or another malignancy were excluded. Response evaluation was done with both RECIST version 1.1 (for CECT) and PERCIST (for PET-CT) criteria. Also, total lesion glycolysis (TLG), and metabolic tumour volume (MTV) were assessed. Interrater agreement was done using Cohen’s kappa between the scores. RESULTS: Mean age of 48 patients was 55.3±5.6 years and 28(58.3%) were males. Clear cell histology was present in 44 patients. Sunitinib, Pazopanib, Everolimus and Axitinib were given to 12, 22, 6 and 8 patients respectively. Out of 22 patients with partial response (PR) in RECIST, 8 patients were upgraded to Stable disease (SD) in 2 and Progressive disease (PD) in 6 as per PERCIST, subsequently leading to a change in their management. All 14 patients with PR in PERCIST had better long-term survival as compared to the rest upgraded 8. There was a significant decline in median SUVmax, MTV and TLG after 3 months in these patients. CONCLUSIONS: 18-FDG PET/CT scan is useful for monitoring the early response to systemic therapy in metastatic RCC based on 18-FDG avidity including TLG & MTV and correctly identifying partial responders. Changes in the metabolic parameters detect response to therapy earlier and guide subsequent changes in therapy. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e887 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjoy Kumar Sureka More articles by this author Sumit Mandal More articles by this author Uday Pratap Singh More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinicopathological features of our renal cell carcinoma metastasis cases: A single-center experience

Renal cell carcinoma (RCC) is the most common renal tumor in adults, arising from renal tubular epithelial cells. Approximately 30% of patients with RCC have metastases at the time of diagnosis, while metastases can be seen in 40% of patients during follow-up after nephrectomy. Metastases most commonly occur in the lung, bone, and lymph nodes. In our study, we aimed to retrospectively examine the cases diagnosed with RCC metastasis and evaluate their clinicopathological features. Age, gender, metastasis site, number of metastatic foci, localization of primary kidney tumor, histopathological type of primary kidney tumor, diameter of primary kidney tumor, grade of primary kidney tumor, and survival status of 52 patients diagnosed with RCC metastasis were recorded. Eleven (21.2%) of the cases had primary RCC and simultaneous (synchronous) RCC metastasis in the kidney. In 27 (51.9%) cases, RCC metastasis was detected in the follow-up period (metachronous) after nephrectomy due to the diagnosis of primary. The number of patients who were initially diagnosed with RCC metastasis and then were found to have primary RCC in the kidney was 14 (26.9%). Thirty-nine (75%) cases had a single metastatic focus. Metastasis site distribution of the cases; bone 18 (34.6%), lung 16 (30.8%), lymph nodes 8 (15.4%), liver 6 (11.5%), adrenal gland 6 (11.5%), brain 4 (7.7%) was. RCC metastases can occur as metastatic disease before primary tumor diagnosis, at the time of primary tumor diagnosis, or years after nephrectomy.

Synchronous Serous Carcinoma of Ovary and Clear Cell Carcinoma of Kidney

Synchronous dual primary cancers have been reported in the past while majority of these are sporadic only few are hereditary. There have been a couple of case reports of synchronous primary ovarian cancer and renal cell carcinoma (RCC) and the first reported case was in 1988 by Myoga et al. Currently there is no clear explanation about synchronous RCC and ovarian cancers but steroid hormones &amp; its receptors are thought to play a role. It is important for the clinician and the pathologist to rule out the possibility of metastatic deposits for the better management of the disease. Here we report a rare presentation of dual synchronous primaries of Clear cell RCC and High grade serous ovarian cancer in a 48year old female.

Clinicopathological characteristics and outcomes of synchronous renal cell carcinoma and urothelial carcinoma: A population-based analysis.

To better understand the characteristics, and survival outcomes of synchronous renal cell carcinoma (RCC) and urothelial carcinoma (UC), we described and analyzed the clinical features, factors, and prognosis of patients with synchronous RCC and UC using a large population-based database. Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016), we identified patient with concurrent RCC and UC at initial diagnosis. Their clinicopathological features and prognosis were evaluated. A logistic regression model was used to examine risk factors for the occurrence of concomitant RCC and UC, and Kaplan-Meier survival curves were used to estimate overall survival. A total of 61,454 RCC patients were identified from the SEER database, 704 (1.1%) patients presented with synchronous RCC and UC. Among these patients, concurrent bladder tumors (566/704) are more common. Subsequently, subgroup analysis based on the location of UC indicated that patients with concurrent RCC and upper tract urothelial carcinoma (UTUC) had unfavorable UC characteristics (higher tumor stage and grade), compared with patients with concomitant bladder cancer. An increased risk of concurrent UC was observed among older age, male sex, and white race. Meanwhile, papillary RCC histology [odds ratio (OR) 3.23; 95% confidence interval (CI) 2.13-4.90], and smaller tumor (OR 6.63; 95% CI 4.46-9.87) were independent risk factors for concomitant UTUC. In addition, we found that synchronous RCC and UTUC was associated with worse survival by using Kaplan-Meier and multivariable analysis [hazard ratio (HR) 2.36, 95% CI 1.89-2.95]. However, concomitant bladder cancer did not affect survival outcomes of patients with RCC (HR 1.00, 95% CI 0.86-1.17). We found that synchronous concurrent RCC and UC is relatively uncommon and mostly located in the bladder. Older age, male sex, and white race increase the risk of synchronous RCC and UC. Meanwhile, patients with papillary RCC histology, and smaller tumors are more likely to have concomitant RCC and UTUC. Furthermore, our findings suggest that synchronous RCC and UTUC has a worse prognosis, while, concomitant bladder tumor did not affect the oncological outcomes of RCC.

Predicting Oncologic Outcomes in Small Renal Tumors

BackgroundMost patients diagnosed with renal cancer today present with small renal masses (SRMs). Although these patients have a low risk of dying from their disease and many are followed with active surveillance protocols, a small subset of renal cell carcinomas (RCCs) behave aggressively. Knowledge regarding features of aggressive behavior would enable better adoption of active surveillance strategies among these patients. ObjectiveWe sought to improve prognostic models to predict metastasis-free survival after nephrectomy through focused analyses of clinicopathologic characteristics of SRMs associated with adverse outcomes. Design, setting, and participantsWe identified consecutive patients with surgically resected SRMs (≤4 cm) at the University of Texas Southwestern Kidney Cancer Program between 1998 and 2020. In addition, we evaluated the ability of SRMs to form tumors when implanted in mice, an indicator of tumor aggressiveness. Outcome measurements and statistical analysisWe examined the clinicopathologic factors associated with metastasis including prospectively performed BAP1 immunohistochemistry at our Clinical Laboratory Improvement Amendments laboratory. Multivariable Cox proportional hazard regression was used to predict metastasis-free survival. Results and limitationsA total of 3900 evaluable nephrectomies (from 3674 ethnically diverse patients) were identified, of which 1984 (51%) were SRMs including 1720 RCC. Of these patients with RCC (SRMRCC), 1576 did not have synchronous or metachronous larger RCCs and among these, 37 (2%) developed metastases. SRMRCC that metastasized were significantly enriched for aggressive morphologic phenotypes and engrafted in mice at comparable rates as larger metastatic tumors. BAP1 loss remained significantly associated with metastasis-free survival after accounting for TNM (tumor-node-metastasis) stage and SSIGN (stage, size, grade, and necrosis) score in multivariable analysis. ConclusionsWe identified clinicopathologic features that influence metastasis-free survival for patients with SRMRCC. If validated independently, these data should assist with patient prognosis and help with active surveillance strategies. Patient summaryWe report the identification of features of aggressiveness in small renal tumors that influence the likelihood of metastases after surgery.

Synchronous Clear Cell Renal Carcinoma And Bilateral Invasive Duct Carcinoma Breast- Rare association

Occurrence of multiple primary malignant tumors is very uncommon .Co occuring tumors can be synchronous or non synchronous.Tumors presenting within a period less than or equal to 6 months are called synchronous and if they occur after 6 months they are termed as metachronous. Synchronous malignancies are rarer than metachronous. For defining tumors as synchronous both the tumors should show criteria of malignancy, possibility of metastasis must have been ruled out and both the tumors should be pathologically distinct. Breast cancer is the commonest tumor to be associated with other malignancies such as colorectal, endometrial, ovarian carcinoma, yet occurrence of invasive ductal carcinoma with clear cell renal carcinoma is rare. We present a 70 year old female with synchronous Breast carcinoma and Renal clear cell carcinoma .

Multi-detector computed tomography (MDCT) evaluation of synchronous renal cell carcinoma and other solid malignancies

BackgroundMultiple primary malignant neoplasms (MPMNs) became more prevalent as the population aged and medical technology progressed. The purpose of this research was to review the findings of multidetector computed tomography (MDCT) in synchronous renal cell carcinoma and other solid tumors.Results31 individuals with synchronous renal cell carcinoma and additional solid cancers were included in this retrospective analysis. CT scanning was carried out using 64 MDCT scanners. All sixty-two malignancies were undergoing pathological assessment. Out of 685 patients with renal cell carcinoma, 31 individuals were identified with another primary solid cancer that occurred concurrently. All of our instances were pathologically verified. In all 31 individuals, clear renal cell carcinoma was found. The most frequent extra-renal malignancies were hepatocellular carcinoma (10/31), followed by breast carcinoma (4/31), non-Hodgkin lymphoma (4/31), bronchogenic carcinoma (3/31), colonic carcinoma (3/31), prostatic carcinoma (2/31), urinary bladder carcinoma (1/31), periampullary carcinoma (1/31), mucoepidermoid carcinoma (1/31) and skin squamous cell carcinoma (1/31) as well as malignant hemangioendothelioma (1/31).ConclusionMDCT scanning was an accurate imaging method for diagnosing synchronous renal cell carcinoma and other solid tumors. Even in the face of numerous cancers, the goal of therapy in cancer patients must always be curative. During the pretreatment examination, the potential of synchronous double malignancies with renal cell carcinoma should be explored.

Synchronous renal cell carcinoma and urothelial carcinoma in a female: A rare case

Synchronous renal cell carcinoma and urothelial carcinoma in a female: A rare case

Synchronous breast carcinoma (with Paget’s disease) and renal cell carcinoma with tubercular axillary lymphadenitis: a rare presentation

Synchronous malignancy are defined as two primary malignancy of two different organs occurring concurrently or within 6 months duration. Reports of synchronous breast carcinoma with RCC (renal cell carcinoma) are very limited. We presented here the first case of non-metastatic synchronous RCC with breast carcinoma and Paget’s disease associated with tubercular axillary lymphadenitis in a 62 year old female for which she underwent right MRM and right partial nephrectomy. She received chemotherapy and anti-tubercular therapy post-surgery and currently on oral hormonal therapy. Follow up scans showed stable disease. There have been cases of breast cancer with TB lymphadenitis as well as of double synchronous malignancies involving breast carcinoma and RCC. Most of the multiple malignancies reported in literature are metastatic tumours or metachronous breast malignancy with RCC. A case of synchronous primary ca breast with pages disease coexisting with primary RCC along with tubercular lymphadenopathy is yet to be reported in literature. This might just be the first one.

Signet ring cell carcinoma of rectum metastasizing to synchronous renal cell carcinoma: a case report

BackgroundRectal signet ring cell carcinoma is a rare type of colorectal adenocarcinoma characterized by an aggressive biological behavior and poor prognosis. The co-occurrence of colorectal carcinoma and renal cell carcinoma (RCC) has found in many hundreds of patients, many of whom also have additional malignancies. Cancer to cancer metastasis is rare and an uncommon phenomenon in malignancy, especially at the time of initial diagnosis, suggesting a genetic susceptibility.Case presentationWe present the case of a 66-year-old Macedonian man with synchronous rectal signet ring cell carcinoma and RCC with tumor to tumor metastasis feature. He underwent a left nephrectomy and anterior rectal resection after complaining of constipation for 3–4 months and the appearance of synchronous tumors on the imaging studies. Morphology and immunohistochemical analysis of specimens from the RCC revealed signet ring cells identical to the rectal signet ring cell carcinoma. The next-generation sequencing study revealed mutations in TP53 and ERBB2, and microsatellite stable signet ring cell carcinoma was determined by deoxyribonucleic acid (DNA) sequencing.ConclusionsCancer to cancer metastasis, although rare, needs to be considered in synchronous tumors. RCC, when diagnosed in multiple synchronous tumors, should be examined carefully. The paucity of reported cases indicates the need for advanced research in imaging methods for metastasis and new therapeutic approaches.

Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how?

Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2years after SBRT). Further research on SBRT dose escalation is warranted.

Bilateral Single-Stage Nephrectomy for Synchronous Bilateral Renal Cell Carcinoma.

Bilateral synchronous renal cell carcinoma (RCC) is uncommonly encountered. Debate exists among urologists in managing these cases in a single surgery versus staged surgeries. We aim to report our experience in managing encountered cases using single-stage surgeries. Retrospective collection of cases with pathologically confirmed RCC that had single-stage bilateral renal surgery over the past 2 years. Three cases were identified. Patients were managed using bilateral transverse lateral lumbotomy. All patients did not have intraoperative or postoperative complications. Kidney function stayed stable after surgery. Single-stage bilateral renal surgery is a safe procedure. Bilateral transverse lateral lumbotomy allows for a fast and safe surgery with minimal complications. There is a possible histological dis-concordance in bilateral synchronous RCC.

Comparison of immediate vs. deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma

Comparison of immediate vs. deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma

Diagnostic and therapeutic challenges of synchronous renal mass and pancreatic mass: a review

Objective: Synchronous renal cell carcinoma (RCC) and pancreatic tumors are rare clinical events and have been described scarcely in the literature. Our institution has recently encountered one case. This review aims to summarize and present the diagnostic and therapeutic approaches that have been presented in the literature for these synchronous solid malignancies. Methods: After reviewing the literature using PubMed, 16 papers were collected that showed a total of 21 patients with a synchronous solid renal and pancreatic mass. The diagnostic and treatment data were then evaluated and analyzed. Results: Overall, 13 patients (59%) had two independent primary malignancies consisting of RCC and a pancreatic tumor, seven (31%) were diagnosed with primary RCC with synchronous metastasis to pancreas, one (5%) was found to have a primary pancreatic adenocarcinoma with synchronous metastasis to the kidney, and one (5%) was diagnosed with primary RCC with a benign solid pancreatic lesion. Of the 22 patients that were treated, 18 (81%) underwent surgery, one (5%) had no treatment, and three (14%) underwent chemotherapy without surgery. In the cohort of patients with surgical treatment 12 (66%) had no adjuvant therapy, one (6%) had adjuvant chemotherapy, four (22%) had adjuvant immunotherapy, and one (6%) had adjuvant radiation treatment. Conclusions: The occurrence of synchronous malignancies of the kidney and pancreas is rare. No clear guidelines have evolved in the literature in regard to diagnostics and treatment of these patients. This review presents recommended diagnostic and treatment guidelines for these rare clinical cases. Level of evidence: Not applicable for this multicenter review.

Primary Adenocarcinoma of Lung with Synchronous Renal Cell Carcinoma: A Case Report and Review of the Literature

Introduction: The simultaneous occurrence of two distinct tumors is rare. Distinguishing between the concomitances of two primary malignancies from metastatic disease is very important for disease management and overall survival improvement. Case Presentation: We report a case of a lung adenocarcinoma patient, who incidentally has renal cell carcinoma (RCC). This report includes clinical, radiological, and histological diagnostic challenges in an unexpected lesion and a review of the literature. Conclusions: The possibility of primary cancer should be taken into account when a lesion is detected in the lung or the kidneys. Thus, both the radiographic appearance and clinical behavior of a lesion may hold clues that can help distinguish synchronous cancers.

Adenocarcinoma of the Gastroesophageal Junction with Synchronous Renal Cell Carcinoma: A Case Report and Literature Review

Abstract Gastroesophageal junction adenocarcinoma is a rare type of cancer of the esophagus. It is usually diagnosed in advanced stages and much less frequently in the earlier stage, where surgical treatment is essential. Surgical treatment is also essential in kidney cancer. The occurrence of synchronous malignancies with an esophageal malignancy is a well-described phenomenon with an incidence ranging from 3.6 to 27.1%. To the best of our knowledge, only 11 cases of synchronous esophageal and renal cell carcinoma (RCC) have been previously described. We present a patient operated simultaneously for cancer of the gastroesophageal junction with synchronous renal cell carcinoma. The finding in the kidney was accidentally discovered by the routine CT scan on the occasion of the relatively early carcinoma of the gastroesophageal junction detected by upper endoscopy. The patient was admitted to the Thoracic Surgery Department, where Ivor-Lewis gastroesophagoplasty and right nephrectomy simultaneously were performed. The patient was followed for 5 years without evidence of disease progression.

Real-world safety and efficacy data of patients with synchronous metastatic renal cell carcinoma (mRCC) treated with nivolumab and ipilimumab (N+I) and the primary tumour (PT) in place.

e17083 Background: Following CARMENA and SURTIME, upfront cytoreductive nephrectomy (CN) is no longer standard of care. Intermediate and poor risk patients (pts) receive systemic therapy with the PT in place with the option to perform deferred CN in responding pts. This practice has been adopted after the recent shift to immune checkpoint inhibitor combination in frontline for mRCC. We assessed the safety and efficacy of this approach in a real-world population. Methods: A retrospective analysis of a clinical audit from 3 institutional datasets of pts treated with first-line N+I and the PT in place. Pts and tumour characteristics, International Metastatic RCC Database Consortium (IMDC) risk, overall response rate (ORR) in the PT and metastatic sites, time to response (TTR) of the PT, PT- and immune related- (ir) adverse events (AE), deferred CN rate, progression free- (PFS) and overall survival (OS) were assessed. Results: Of 41 pts treated with N+I and the PT in place, 46.3% were IMDC poor risk and 51.2% had &gt; 3 metastatic sites. After a median follow-up of 5.9 (2-10.3) months, 29 had at least 1 CT scan from baseline. Of those, 7 (24.3% [95% confidence interval [CI] 0.10-0.43]) had a partial response (PR) of the PT with a median TTR of 5.3 (2.5-8.6) months. Mean and median PT reduction were 16.9% (+7.6 to -70.3%) and 10% from a baseline mean tumour size of 9.5 (3.8-16.1) cm. Pts with a PT reduction &gt; median (n = 14) had a PR at metastatic sites in 86% (CI 0.57-0.98) and no progressive disease (PD). Pts with PT reduction &lt; median (n = 14) had PR in only 21% and PD at metastatic sites in 57% (CI 0.28-0.82). None of the PT progressed. There was no complete response (CR) at metastatic sites . No CN was performed; 5 pts (12%) developed hematuria grade 1-3, requiring embolisation in 2 (4.9%). Grade 3-4 irAE were observed in 22% of pts. Median PFS and OS are 8.6 months and not reached. Conclusions: N+I with the PT in place is safe and PT reduction is associated with response at metastatic sites. Most PT responded by 6 months. No CR at metastatic sites were observed (compared to a 9% CR rate in the pivotal trial) in this real-world population with a relatively high percentage of poor-risk pts. Furthermore, no deferred CN has been performed, neither for near-CR at metastatic sites nor for PT symptoms.

Synchronous Renal Cell Carcinoma with Carcinoma Cervix: An Unusual Clinical Presentation

Synchronous Renal Cell Carcinoma with Carcinoma Cervix: An Unusual Clinical Presentation