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Voor de zorgverleners en patiënten Historisch gezien hebben zowel patiënten als clinici de voordelen van procedures zoals coronaire angiografie en PCI overschat en de risico's onderschat. Dit heeft geleid tot beperkingen in de adoptie van strategieën om bloedingen en contrast-geassocieerde acute kidney injury (acute nierbeschadiging; AKI) te vermijden bij patiënten met het hoogste risico. Het […]
Patiënten met urinewegstenen komen vaak op de spoedeisende hulp. Indien mogelijk wordt meestal als eerste gekozen voor observatie met een poging tot ...
Non-Hodgkin lymfoom Non-Hodgkin lymfoom (NHL) dat zich ontwikkelt na niertransplantatie behoort tot de post-transplantatie lymfoproliferatieve aandoen...
Researchers report that all nine patients in a clinical trial being treated for stage III or IV clear cell renal cell carcinoma (a form of kidney cancer), generated a successful anti-cancer immune response after initiation of a personalized cancer vaccine.
New research looked at how cancers arise in children who are predisposed to developing the childhood kidney cancer, Wilms tumor, which could help anticipate the development of tumors before they fully form.
AbstractNon-small cell lung cancer (NSCLC) with BRAF V600E mutations is responsive to targeted therapies, such as dabrafenib and trametinib. However, these treatments can lead to serious adverse events, including cytokine release syndrome (CRS). Herein, we report the case of a 75-year-old man with stage IVB NSCLC and a BRAF V600E mutation who developed severe CRS, manifesting hepatic and renal dysfunction, following treatment with dabrafenib and trametinib. Despite initial fever management, the patient’s renal function deteriorated rapidly, necessitating hemodialysis. Elevated cytokine levels, including interleukin-6, interferon-?, and tumor necrosis factor ?, were detected. The patient was treated with steroid pulse therapy, which resulted in fever resolution, and his renal function gradually improved. Hemodialysis was discontinued as renal function recovered. This case underscores the importance for early recognition and management of CRS in patients receiving targeted therapies. Prompt intervention with steroids may prevent CRS progression and mitigate associated organ dysfunction. Further investigation is required to clarify the mechanisms of CRS in patients receiving targeted therapy, particularly in the absence of prior immune checkpoint inhibitor use.
AbstractBackgroundThe phase 3 open-label KEYNOTE-426 study demonstrated that first-line pembrolizumab plus axitinib improved overall survival (OS) and progression-free survival (PFS) versus sunitinib for metastatic renal cell carcinoma (mRCC) in a global population. This subgroup analysis investigated the efficacy and safety of pembrolizumab-axitinib versus sunitinib in patients enrolled in KEYNOTE-426 in East Asia (Japan, South Korea, and Taiwan).MethodsAdults with clear cell mRCC were randomly assigned 1:1 to receive intravenous pembrolizumab 200 mg every 3 weeks with oral axitinib 5 mg twice daily or oral sunitinib 50 mg once daily (4 weeks on/2 weeks off). Dual primary endpoints were OS and PFS, assessed by blinded independent central review. Secondary endpoints were objective response rate (ORR) and safety.ResultsThe East Asian subgroup comprised 130 patients (pembrolizumab-axitinib, n = 62; sunitinib, n = 68; 15.1% of the global intention-to-treat population). Compared with sunitinib, pembrolizumab-axitinib OS hazard ratio (HR) was 0.85 [95% confidence interval (CI) 0.50–1.44; 36-month rates, 62.9% and 58.8%, respectively] and PFS HR was 0.59 (95% CI 0.38–0.92) in favor of pembrolizumab-axitinib. ORR favored pembrolizumab-axitinib (64.5% vs 44.1% for sunitinib). The results were generally consistent with the intention-to-treat population. Grade ?3 treatment-related adverse events (TRAEs) occurred in 69.4% of patients on pembrolizumab-axitinib and 74.6% on sunitinib; 16 (25.8%) patients on pembrolizumab-axitinib and 17 (25.4%) patients on sunitinib discontinued due to adverse events. No deaths from TRAEs occurred.ConclusionPembrolizumab-axitinib improved efficacy for East Asian patients with untreated clear cell mRCC, consistent with results from the global population. Safety was manageable.ClinicalTrials.gov identifier: NCT02853331.
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