Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma
Abstract Background Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity. Objective The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC. Design, setting, and p...
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| Veröffentlicht in: | European urology 2014-09, Vol.66 (3), p.502-509 |
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| creator | McKay, Rana R Lin, Xun Perkins, Julia J Heng, Daniel Y.C Simantov, Ronit Choueiri, Toni K |
| description | Abstract Background Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity. Objective The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC. Design, setting, and participants We conducted a pooled analysis of patients with mRCC treated from 2003 to 2011 in phase 2 and 3 trials. Outcome measurements and statistical analysis Statistical analyses were performed using Cox regression and the Kaplan-Meier method. Results and limitations We identified 2749 patients treated with sunitinib ( n = 1059), sorafenib ( n = 355), axitinib ( n = 359), temsirolimus ( n = 208), temsirolimus plus interferon-α (IFN-α) ( n = 208), or IFN-α ( n = 560), with 28% ( n = 781) having BMs. A total of 285 patients (10.4%) received BT. The presence of BMs in patients was associated with shorter overall survival (OS) when compared with patients without BMs (13.2 vs 20.2 mo, respectively; p < 0.0001) and shorter progression-free survival (PFS) (5.1 vs 6.7 mo, respectively; p < 0.0008). When stratified by risk groups, the presence of BMs was associated with shorter OS in all risk groups. The use of BT in patients with BMs was not associated with improved OS compared with patients who did not receive BT (13.3 vs 13.1 mo, respectively; p = 0.3801) or improved PFS (5.1 vs 4.9 mo, respectively; p = 0.1785). Bisphosphonate users with BMs did not have a decreased rate of skeletal-related events (SREs) compared with nonusers (8.6% vs 5.8%, respectively; p = 0.191). In addition, BT was associated with increased rates of hypocalcemia, renal insufficiency, and osteonecrosis of the jaw ( p < 0.0001). Data were analyzed retrospectively. Conclusions We confirm that the presence of BMs is associated with shorter survival in mRCC. BT did not affect survival or SRE prevention and was associated with increased toxicity. Patient summary In this analysis, we demonstrate that bone metastases are associated with shorter survival in patients with metastatic renal cell carcinoma. In addition, we call into question the utility of bisphosphonate therapy in this population. |
| doi_str_mv | 10.1016/j.eururo.2014.02.040 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4145043</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0302283814001699</els_id><sourcerecordid>24613250</sourcerecordid><originalsourceid>FETCH-LOGICAL-c618t-66c8558c6315db1f4ea3c5e2e5119c58ad0e357df52fe4537b984aab10e00b03</originalsourceid><addsrcrecordid>eNqFkk1v1DAQhi0EotvCP0DIF44J4_gjyQWJrqAgFVHRvVuOM9n1Nmuv7GzR_nscbWmBC5I_Dp73nfEzQ8gbBiUDpt5vSzzEQwxlBUyUUJUg4BlZsKbmRS0VPCcL4FAVVcObM3Ke0hYAuGz5S3JWCcV4JWFB7m5iWPuQJmfprVt7NzhrvEUaBnoZPNJvOJmUFyZqfE8vXdpvwry9mZCuNhjN_kidpzdmcuinRH-6aUN_oDcjXeKYDxOt82FnXpEXgxkTvn64L8jq86fV8ktx_f3q6_LjdWEVa6ZCKdtI2VjFmew7Ngg03EqsUDLWWtmYHpDLuh9kNaCQvO7aRhjTMUCADvgF-XCy3R-6HfY2FxXNqPfR7Uw86mCc_vvFu41eh3stmJAgeDYQJwMbQ0oRh0ctAz2z11t9Yq9n9hoqndln2ds_8z6KfsPOAe8eAkyyZhxiBu3SU1yjWqVY_fQBzJDuHUadbEZrsXcR7aT74P5Xyb8GdnQ-N3a8wyOmbTjE3J2kmU5ZoG_nOZnHhAnInm3LfwHL9bv9</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>McKay, Rana R ; Lin, Xun ; Perkins, Julia J ; Heng, Daniel Y.C ; Simantov, Ronit ; Choueiri, Toni K</creator><creatorcontrib>McKay, Rana R ; Lin, Xun ; Perkins, Julia J ; Heng, Daniel Y.C ; Simantov, Ronit ; Choueiri, Toni K</creatorcontrib><description>Abstract Background Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity. Objective The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC. Design, setting, and participants We conducted a pooled analysis of patients with mRCC treated from 2003 to 2011 in phase 2 and 3 trials. Outcome measurements and statistical analysis Statistical analyses were performed using Cox regression and the Kaplan-Meier method. Results and limitations We identified 2749 patients treated with sunitinib ( n = 1059), sorafenib ( n = 355), axitinib ( n = 359), temsirolimus ( n = 208), temsirolimus plus interferon-α (IFN-α) ( n = 208), or IFN-α ( n = 560), with 28% ( n = 781) having BMs. A total of 285 patients (10.4%) received BT. The presence of BMs in patients was associated with shorter overall survival (OS) when compared with patients without BMs (13.2 vs 20.2 mo, respectively; p < 0.0001) and shorter progression-free survival (PFS) (5.1 vs 6.7 mo, respectively; p < 0.0008). When stratified by risk groups, the presence of BMs was associated with shorter OS in all risk groups. The use of BT in patients with BMs was not associated with improved OS compared with patients who did not receive BT (13.3 vs 13.1 mo, respectively; p = 0.3801) or improved PFS (5.1 vs 4.9 mo, respectively; p = 0.1785). Bisphosphonate users with BMs did not have a decreased rate of skeletal-related events (SREs) compared with nonusers (8.6% vs 5.8%, respectively; p = 0.191). In addition, BT was associated with increased rates of hypocalcemia, renal insufficiency, and osteonecrosis of the jaw ( p < 0.0001). Data were analyzed retrospectively. Conclusions We confirm that the presence of BMs is associated with shorter survival in mRCC. BT did not affect survival or SRE prevention and was associated with increased toxicity. Patient summary In this analysis, we demonstrate that bone metastases are associated with shorter survival in patients with metastatic renal cell carcinoma. In addition, we call into question the utility of bisphosphonate therapy in this population.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2014.02.040</identifier><identifier>PMID: 24613250</identifier><identifier>CODEN: EUURAV</identifier><language>eng</language><publisher>Kidlington: Elsevier B.V</publisher><subject>Aged ; Antineoplastic Agents - therapeutic use ; Biological and medical sciences ; Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology ; Bisphosphonates ; Bone Density Conservation Agents - adverse effects ; Bone Density Conservation Agents - therapeutic use ; Bone metastases ; Bone Neoplasms - drug therapy ; Bone Neoplasms - secondary ; Carcinoma, Renal Cell - drug therapy ; Carcinoma, Renal Cell - secondary ; Diphosphonates - adverse effects ; Diphosphonates - therapeutic use ; Disease-Free Survival ; Diseases of the osteoarticular system ; Female ; Humans ; Hypocalcemia - chemically induced ; Imidazoles - therapeutic use ; Indazoles - therapeutic use ; Indoles - therapeutic use ; Interferon-alpha - therapeutic use ; Kidney Neoplasms - drug therapy ; Kidney Neoplasms - pathology ; Kidneys ; Male ; Medical sciences ; Middle Aged ; mTOR inhibitors ; Nephrology. Urinary tract diseases ; Niacinamide - analogs & derivatives ; Niacinamide - therapeutic use ; Phenylurea Compounds - therapeutic use ; Prognosis ; Pyrroles - therapeutic use ; Renal cell carcinoma ; Renal Insufficiency - chemically induced ; Retrospective Studies ; Sirolimus - analogs & derivatives ; Sirolimus - therapeutic use ; Survival Rate ; TOR Serine-Threonine Kinases - antagonists & inhibitors ; Tumors of striated muscle and skeleton ; Tumors of the urinary system ; Urology ; Vascular Endothelial Growth Factor A - antagonists & inhibitors ; VEGF-targeted therapy</subject><ispartof>European urology, 2014-09, Vol.66 (3), p.502-509</ispartof><rights>European Association of Urology</rights><rights>2014 European Association of Urology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c618t-66c8558c6315db1f4ea3c5e2e5119c58ad0e357df52fe4537b984aab10e00b03</citedby><cites>FETCH-LOGICAL-c618t-66c8558c6315db1f4ea3c5e2e5119c58ad0e357df52fe4537b984aab10e00b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0302283814001699$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28696617$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24613250$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McKay, Rana R</creatorcontrib><creatorcontrib>Lin, Xun</creatorcontrib><creatorcontrib>Perkins, Julia J</creatorcontrib><creatorcontrib>Heng, Daniel Y.C</creatorcontrib><creatorcontrib>Simantov, Ronit</creatorcontrib><creatorcontrib>Choueiri, Toni K</creatorcontrib><title>Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma</title><title>European urology</title><addtitle>Eur Urol</addtitle><description>Abstract Background Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity. Objective The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC. Design, setting, and participants We conducted a pooled analysis of patients with mRCC treated from 2003 to 2011 in phase 2 and 3 trials. Outcome measurements and statistical analysis Statistical analyses were performed using Cox regression and the Kaplan-Meier method. Results and limitations We identified 2749 patients treated with sunitinib ( n = 1059), sorafenib ( n = 355), axitinib ( n = 359), temsirolimus ( n = 208), temsirolimus plus interferon-α (IFN-α) ( n = 208), or IFN-α ( n = 560), with 28% ( n = 781) having BMs. A total of 285 patients (10.4%) received BT. The presence of BMs in patients was associated with shorter overall survival (OS) when compared with patients without BMs (13.2 vs 20.2 mo, respectively; p < 0.0001) and shorter progression-free survival (PFS) (5.1 vs 6.7 mo, respectively; p < 0.0008). When stratified by risk groups, the presence of BMs was associated with shorter OS in all risk groups. The use of BT in patients with BMs was not associated with improved OS compared with patients who did not receive BT (13.3 vs 13.1 mo, respectively; p = 0.3801) or improved PFS (5.1 vs 4.9 mo, respectively; p = 0.1785). Bisphosphonate users with BMs did not have a decreased rate of skeletal-related events (SREs) compared with nonusers (8.6% vs 5.8%, respectively; p = 0.191). In addition, BT was associated with increased rates of hypocalcemia, renal insufficiency, and osteonecrosis of the jaw ( p < 0.0001). Data were analyzed retrospectively. Conclusions We confirm that the presence of BMs is associated with shorter survival in mRCC. BT did not affect survival or SRE prevention and was associated with increased toxicity. Patient summary In this analysis, we demonstrate that bone metastases are associated with shorter survival in patients with metastatic renal cell carcinoma. In addition, we call into question the utility of bisphosphonate therapy in this population.</description><subject>Aged</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology</subject><subject>Bisphosphonates</subject><subject>Bone Density Conservation Agents - adverse effects</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Bone metastases</subject><subject>Bone Neoplasms - drug therapy</subject><subject>Bone Neoplasms - secondary</subject><subject>Carcinoma, Renal Cell - drug therapy</subject><subject>Carcinoma, Renal Cell - secondary</subject><subject>Diphosphonates - adverse effects</subject><subject>Diphosphonates - therapeutic use</subject><subject>Disease-Free Survival</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Humans</subject><subject>Hypocalcemia - chemically induced</subject><subject>Imidazoles - therapeutic use</subject><subject>Indazoles - therapeutic use</subject><subject>Indoles - therapeutic use</subject><subject>Interferon-alpha - therapeutic use</subject><subject>Kidney Neoplasms - drug therapy</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>mTOR inhibitors</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Niacinamide - analogs & derivatives</subject><subject>Niacinamide - therapeutic use</subject><subject>Phenylurea Compounds - therapeutic use</subject><subject>Prognosis</subject><subject>Pyrroles - therapeutic use</subject><subject>Renal cell carcinoma</subject><subject>Renal Insufficiency - chemically induced</subject><subject>Retrospective Studies</subject><subject>Sirolimus - analogs & derivatives</subject><subject>Sirolimus - therapeutic use</subject><subject>Survival Rate</subject><subject>TOR Serine-Threonine Kinases - antagonists & inhibitors</subject><subject>Tumors of striated muscle and skeleton</subject><subject>Tumors of the urinary system</subject><subject>Urology</subject><subject>Vascular Endothelial Growth Factor A - antagonists & inhibitors</subject><subject>VEGF-targeted therapy</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhi0EotvCP0DIF44J4_gjyQWJrqAgFVHRvVuOM9n1Nmuv7GzR_nscbWmBC5I_Dp73nfEzQ8gbBiUDpt5vSzzEQwxlBUyUUJUg4BlZsKbmRS0VPCcL4FAVVcObM3Ke0hYAuGz5S3JWCcV4JWFB7m5iWPuQJmfprVt7NzhrvEUaBnoZPNJvOJmUFyZqfE8vXdpvwry9mZCuNhjN_kidpzdmcuinRH-6aUN_oDcjXeKYDxOt82FnXpEXgxkTvn64L8jq86fV8ktx_f3q6_LjdWEVa6ZCKdtI2VjFmew7Ngg03EqsUDLWWtmYHpDLuh9kNaCQvO7aRhjTMUCADvgF-XCy3R-6HfY2FxXNqPfR7Uw86mCc_vvFu41eh3stmJAgeDYQJwMbQ0oRh0ctAz2z11t9Yq9n9hoqndln2ds_8z6KfsPOAe8eAkyyZhxiBu3SU1yjWqVY_fQBzJDuHUadbEZrsXcR7aT74P5Xyb8GdnQ-N3a8wyOmbTjE3J2kmU5ZoG_nOZnHhAnInm3LfwHL9bv9</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>McKay, Rana R</creator><creator>Lin, Xun</creator><creator>Perkins, Julia J</creator><creator>Heng, Daniel Y.C</creator><creator>Simantov, Ronit</creator><creator>Choueiri, Toni K</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20140901</creationdate><title>Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma</title><author>McKay, Rana R ; Lin, Xun ; Perkins, Julia J ; Heng, Daniel Y.C ; Simantov, Ronit ; Choueiri, Toni K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c618t-66c8558c6315db1f4ea3c5e2e5119c58ad0e357df52fe4537b984aab10e00b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology</topic><topic>Bisphosphonates</topic><topic>Bone Density Conservation Agents - adverse effects</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Bone metastases</topic><topic>Bone Neoplasms - drug therapy</topic><topic>Bone Neoplasms - secondary</topic><topic>Carcinoma, Renal Cell - drug therapy</topic><topic>Carcinoma, Renal Cell - secondary</topic><topic>Diphosphonates - adverse effects</topic><topic>Diphosphonates - therapeutic use</topic><topic>Disease-Free Survival</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Humans</topic><topic>Hypocalcemia - chemically induced</topic><topic>Imidazoles - therapeutic use</topic><topic>Indazoles - therapeutic use</topic><topic>Indoles - therapeutic use</topic><topic>Interferon-alpha - therapeutic use</topic><topic>Kidney Neoplasms - drug therapy</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>mTOR inhibitors</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Niacinamide - analogs & derivatives</topic><topic>Niacinamide - therapeutic use</topic><topic>Phenylurea Compounds - therapeutic use</topic><topic>Prognosis</topic><topic>Pyrroles - therapeutic use</topic><topic>Renal cell carcinoma</topic><topic>Renal Insufficiency - chemically induced</topic><topic>Retrospective Studies</topic><topic>Sirolimus - analogs & derivatives</topic><topic>Sirolimus - therapeutic use</topic><topic>Survival Rate</topic><topic>TOR Serine-Threonine Kinases - antagonists & inhibitors</topic><topic>Tumors of striated muscle and skeleton</topic><topic>Tumors of the urinary system</topic><topic>Urology</topic><topic>Vascular Endothelial Growth Factor A - antagonists & inhibitors</topic><topic>VEGF-targeted therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McKay, Rana R</creatorcontrib><creatorcontrib>Lin, Xun</creatorcontrib><creatorcontrib>Perkins, Julia J</creatorcontrib><creatorcontrib>Heng, Daniel Y.C</creatorcontrib><creatorcontrib>Simantov, Ronit</creatorcontrib><creatorcontrib>Choueiri, Toni K</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McKay, Rana R</au><au>Lin, Xun</au><au>Perkins, Julia J</au><au>Heng, Daniel Y.C</au><au>Simantov, Ronit</au><au>Choueiri, Toni K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma</atitle><jtitle>European urology</jtitle><addtitle>Eur Urol</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>66</volume><issue>3</issue><spage>502</spage><epage>509</epage><pages>502-509</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><coden>EUURAV</coden><abstract>Abstract Background Bone metastases (BMs) are frequently present in patients with metastatic renal cell carcinoma (mRCC) and cause significant morbidity. Objective The purpose of this analysis was to assess the impact of BMs and bisphosphonate therapy (BT) on outcomes in mRCC. Design, setting, and participants We conducted a pooled analysis of patients with mRCC treated from 2003 to 2011 in phase 2 and 3 trials. Outcome measurements and statistical analysis Statistical analyses were performed using Cox regression and the Kaplan-Meier method. Results and limitations We identified 2749 patients treated with sunitinib ( n = 1059), sorafenib ( n = 355), axitinib ( n = 359), temsirolimus ( n = 208), temsirolimus plus interferon-α (IFN-α) ( n = 208), or IFN-α ( n = 560), with 28% ( n = 781) having BMs. A total of 285 patients (10.4%) received BT. The presence of BMs in patients was associated with shorter overall survival (OS) when compared with patients without BMs (13.2 vs 20.2 mo, respectively; p < 0.0001) and shorter progression-free survival (PFS) (5.1 vs 6.7 mo, respectively; p < 0.0008). When stratified by risk groups, the presence of BMs was associated with shorter OS in all risk groups. The use of BT in patients with BMs was not associated with improved OS compared with patients who did not receive BT (13.3 vs 13.1 mo, respectively; p = 0.3801) or improved PFS (5.1 vs 4.9 mo, respectively; p = 0.1785). Bisphosphonate users with BMs did not have a decreased rate of skeletal-related events (SREs) compared with nonusers (8.6% vs 5.8%, respectively; p = 0.191). In addition, BT was associated with increased rates of hypocalcemia, renal insufficiency, and osteonecrosis of the jaw ( p < 0.0001). Data were analyzed retrospectively. Conclusions We confirm that the presence of BMs is associated with shorter survival in mRCC. BT did not affect survival or SRE prevention and was associated with increased toxicity. Patient summary In this analysis, we demonstrate that bone metastases are associated with shorter survival in patients with metastatic renal cell carcinoma. In addition, we call into question the utility of bisphosphonate therapy in this population.</abstract><cop>Kidlington</cop><pub>Elsevier B.V</pub><pmid>24613250</pmid><doi>10.1016/j.eururo.2014.02.040</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Antineoplastic Agents - therapeutic use Biological and medical sciences Bisphosphonate-Associated Osteonecrosis of the Jaw - etiology Bisphosphonates Bone Density Conservation Agents - adverse effects Bone Density Conservation Agents - therapeutic use Bone metastases Bone Neoplasms - drug therapy Bone Neoplasms - secondary Carcinoma, Renal Cell - drug therapy Carcinoma, Renal Cell - secondary Diphosphonates - adverse effects Diphosphonates - therapeutic use Disease-Free Survival Diseases of the osteoarticular system Female Humans Hypocalcemia - chemically induced Imidazoles - therapeutic use Indazoles - therapeutic use Indoles - therapeutic use Interferon-alpha - therapeutic use Kidney Neoplasms - drug therapy Kidney Neoplasms - pathology Kidneys Male Medical sciences Middle Aged mTOR inhibitors Nephrology. Urinary tract diseases Niacinamide - analogs & derivatives Niacinamide - therapeutic use Phenylurea Compounds - therapeutic use Prognosis Pyrroles - therapeutic use Renal cell carcinoma Renal Insufficiency - chemically induced Retrospective Studies Sirolimus - analogs & derivatives Sirolimus - therapeutic use Survival Rate TOR Serine-Threonine Kinases - antagonists & inhibitors Tumors of striated muscle and skeleton Tumors of the urinary system Urology Vascular Endothelial Growth Factor A - antagonists & inhibitors VEGF-targeted therapy |
| title | Prognostic Significance of Bone Metastases and Bisphosphonate Therapy in Patients with Renal Cell Carcinoma |
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