News in Brief

■ KW 2021 American Society of Nephrology’s Kidney Week 2021

Long-Term Aspirin Use Associated With Lower CKD Progression Risk

Beneficial effect observed in patients taking the drug for at least 90 days

BY JODY A. CHARNOW LONG-TERM ASPIRIN (ASA) use may be associated with slower deterioration of renal function and decreased risk for death among patients with chronic kidney disease (CKD), according to new study findings.

In a study of 856 US veterans with nondialysis CKD, a team led by Csaba P.Kovesdy, MD, of the University of Tennessee Health Science Center in Memphis, examined the association of long-term ASA use (90 days or more) with mortality and a combined renal endpoint of dialysis initiation or a 40% or greater decline in estimated glomerular filtration rate (eGFR). The study population consisted of 653 patients on long-term ASA therapy and 203 ASA nonusers (controls). The groups had mean ages of 68.1 years and 64.2 years, respectively. Of the 653 ASA patients, 7.8% did not receive low-dose ASA (less than 200 mg per day).

Over a median follow-up period of 4.8 years, 315 patients (36.7%) reached the combined renal endpoint (236 in the ASA group and 79 in the control arm) and 373 patients (43.5%) died (277 in the ASA group and 96 in the control arm).

In a fully adjusted model, patients in the ASA group had a significant 45% lower risk for the renal endpoint and 47% lower risk for death compared with nonusers, Dr Kovesdy and colleagues reported.

The investigators adjusted for demographics, body mass index, smoking status, comorbidities, steroid use, baseline eGFR, proteinuria, medication adherence, and other potential confounders.

“Microinflammation may be a mechanism contributing to adverse outcomes in patients with CKD,” Dr Kovesdy told Renal & Urology News. “Low-dose ASA is usually used as an antiplatelet agent for cardiovascular indications, but may also have beneficial effects by reducing microinflammation. We found an association between longterm ASA and lower risk of a composite renal outcome and mortality in a single center cohort of patients with CKD. These results will have to be replicated in larger and more diverse cohorts and potentially in future clinical trials, before we can recommend ASA for renoprotection.” ■

Long-term aspirin use may have renoprotective effects, a recent study found.

Intensive BP Control May Increase Death Risk

INTENSIVE BLOOD pressure control targeting a systolic blood pressure (SBP) level of less than 120 mm Hg may increase mortality risk among older veterans, investigators reported.

Investigators created a model based on blood pressure readings from 1,959,003 mostly male (96%) veterans who had high rates of chronic diseases, such as diabetes (36%), coronary artery disease (21%), chronic lung disease (15%), sleep apnea (11%), advanced chronic kidney disease (CKD; 7.7%), and atrial fibrillation (7.7%).

Having a mean SBP of less than 120 mm Hg was significantly associated with an adjusted 26% increased risk for all-cause mortality, compared with a mean SBP of 130 mm Hg or more, Diana I. Jalal, MD, Masaaki Yamada, MD, and colleagues from The University of Iowa Roy J and Lucille A Carver College of Medicine in Iowa City reported. Death risk increased with age category and was significantly stronger among veterans aged 70 years and older.

Results from this retrospective study contrast with findings from the landmark SPRINT trial due to the different populations, use of routine office vs standardized blood pressure measurement, and other factors. Among ambulatory adults aged 75 years or older in SPRINT2, treating to an SBP target of less than 120 mm Hg compared with an SBP target of less than 140 mm Hg resulted in significantly lower rates of major cardiovascular events and death from any cause. However, half of treated patients did not attain SBP of less than 120 mm Hg.

In an interview with Renal & Urology News, Dr Yamada explained that findings from their observational study should be interpreted cautiously. “Based on the collective evidence, we believe that the current recommendations by ACC/AHA 2017 are reasonable; that is, to target a SBP of less than 130 mm Hg in elderly community dwellers, while exercising caution in those with lifelimiting conditions,” Dr Yamada said.

The KDIGO 2021 guideline, however, recommends a target of systolic BP less than 120 mm Hg for those with CKD with and without diabetes, Dr Yamada continued. In addition, KDIGO stipulates that it may be harmful to target SBP less than 120 mm Hg based on non-standardized blood pressure measurements. Both guidelines acknowledge that intensive blood pressure management may not be warranted in individuals with life-limiting conditions.

“It is important for clinicians to apply the guidelines with a deep understanding of their own outpatient BP measurement procedures and to individualize treatment goals for each patient based on their patients’ overall health and treatment goals,” Dr Yamada said. ■

AKI Increases Readmission, Mortality Risk

ACUTE KIDNEY injury (AKI) is an independent risk factor for rehospitalization and death both in the short- and long-term, investigators reported.

Ivonne H. Schulman, MD, program director in the Division of Kidney, Urologic, and Hematologic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and colleagues compared 594,509 patients hospitalized with AKI and 594,509 propensity-score matched patients hospitalized for other causes from the 2007-2020 Optum Clinformatics database.

AKI was significantly associated with a 77% adjusted increased rate of any hospital readmission within 90 days of initial discharge compared with no AKI, the investigators reported. AKI was also significantly associated with a 1.6-, 3.1-, 3.2-, and 7.9-fold increased risk for pneumonia, sepsis, heart failure, and end-stage kidney disease, respectively, within 90 days of discharge.

At 1 year, the cumulative incidence of all-cause rehospitalization was significantly higher in the AKI group. In the 2 years before the index admission, twice as many patients with AKI (55.9%) than without (26.5%) had been hospitalized.

All-cause mortality rates in the AKI group were a significant 3.0- and 2.4-fold higher at 90 days and 1 year, respectively, compared with the noAKI group.

In an interview with Renal & Urology News, Dr Schulman pointed out that sepsis, heart failure, and recurrent AKI — which were significantly more common in the AKI group — were the primary causes of rehospitalization within 90 days and 1 year.

“While the best post-AKI clinical management regimen is yet to be determined, these results underscore the immediate need for close posthospitalization monitoring of individuals with AKI,” Dr Schulman said. ■

AVFs Often Require Intervention to Mature

Almost one-third of patients needed interventions to facilitate maturation or treat a complication

INTERVENTION is commonly required to foster maturation of arteriovenous fistulas (AVFs), maintain patency, and treat complications, according to a new study.

“The findings of our study may help optimize clinical care by providing a benchmark for AVFs,” Thomas S. Huber, MD, PhD, of the University of Florida College of Medicine in Gainesville, and colleagues reported in JAMA Surgery.

In the prospective, multicenter Hemodialysis Fistula Maturation cohort study, AVF maturation rates among 380 patients with kidney failure were 29%, 67%, and 76% at 3, 6, and 12 months, respectively. Among 535 patients with nondialysis chronic kidney disease (CKD), AVF maturation rates were expectedly lower at 10%, 38%, and 58% at the respective time points. Median time to maturation was 105 days for the kidney failure group and 170 days for the CKD group. Sixty-four percent of all AVFs were created in the upper arm, most commonly using the brachial/ulnar/ radial-cephalic configuration.

In the kidney failure and CKD groups, 37.7% and 34.6%, respectively, required interventions to foster maturation or manage complications before maturation, according to the investigators. AVF stenosis was the most common reason for intervention in both the kidney failure (26.3%) and CKD (22.5%) groups. The kidney failure group required a tunneled dialysis catheter for a mean 2.9 months before access ascertainment. Approximately one-third of patients required hospitalization before AVF was usable: 37.7% of the kidney failure group and 33.5% of the CKD group.

The functional patency for all of the AVFs that matured at 1 year was 87% and at 2 years, 75%, Dr Huber’s team reported. Patency rates were not affected by intervention.

The investigators found that 47.5% of the AVFs that matured required further intervention to maintain patency or treat complications. The top reasons for intervention were AVF stenosis (38.6%), central vein stenosis (14.6%), and thrombosis (13.4%). More than half of patients in both groups required hospitalization. Overall survival rates for the kidney failure and CKD groups were 92% vs 84% at 12 months, 74% vs 97% at 24 months, and 85% vs 76% at 36 months, respectively.

“The AVF functional patency following maturation was reasonable, with a 2-year rate of 75%, but almost half of the study participants underwent some type of intervention to maintain use,” Dr Huber’s team concluded. “The associated participant morbidity in terms of [tunneled dialysis catheter] use, inpatient hospitalizations, and mortality was substantial.”

The authors acknowledged study limitations. They pointed out, for example, that the study’s primary objective “was to identify predictors of AVF maturation, and accordingly, the participants were all deemed to be reasonable candidates for AVF creation. It is conceivable that the criteria for enrollment were liberalized and participants with a low likelihood of successful maturation were enrolled.” ■

AVF stenosis was the top reason for intervention, recent study finds.

PCa Possibly Delays Kidney Transplants

PROSTATE CANCER (PCa) reduces the likelihood of kidney transplantation and increases the risk for death among men with end-stage kidney disease (ESKD) receiving dialysis, according to a recent study.

Among 588,478 men aged 40-79 years on dialysis who were identified using 1999-2015 data in the US Renal Data System (USRDS), prostate cancer developed in 18,162 (3.1%). Investigators

propensity score matched 15,554 patients with PCa with 15,554 control patients without prostate cancer at the time of their counterparts’ diagnosis.

Survival rates were 76%, 48%, and 30% at 1, 3, and 5 years in the PCa group, respectively, compared with 80%, 51%, and 33% in the control group. Men in the PCa group had a significant 11% higher risk for death and 22% decreased likelihood of kidney transplantation compared with controls, Nagaraju Sarabu, MD, MPH, of University Hospitals Cleveland Medical Center in Ohio, and colleagues reported in Kidney Medicine.

Kidney transplantation lowered the risk for premature death by a significant 80% in both patients with and without PCa.

The 5-year relative survival of 91% for patients on dialysis with vs without PCa is lower than a previously reported rate of 98% for the general population with vs without PCa, the investigators noted. They discussed several possible contributors to the higher mortality rate: Advanced PCa is more common among the men with ESKD compared with general population. Comorbidities characteristic of patients with ESKD may result in less aggressive PCa treatment. Complications of PCa treatments might be worse with ESKD. Finally, a delay in kidney transplantation due to PCa may increase the chances of death. The USRDS database lacked details on individual PCa cases, precluding analysis.

“Future studies should investigate the underpinnings of increased mortality and impact of delay in transplant in balancing risks of increased mortality associated with remaining on dialysis and benefits of avoiding progression of the cancer due to immunosuppression,” the investigators wrote. ■

Study finds a 22% decreased likelihood of receiving a kidney transplant.

Neoadjuvant Chemotherapy Benefits BCG Progressors

PATIENTS WHO PROGRESS on bacillus Calmette-Guérin (BCG) therapy to muscle-invasive bladder cancer (MIBC) have worse outcomes than patients with de novo MIBC and warrant neoadjuvant chemotherapy (NAC), according to investigators.

In a review of 801 patients who underwent radical cystectomy (RC) for cT2-3 N0M0 disease, 20.3% had progressive MIBC and 79.7% had de novo MIBC. Among patients with low-risk disease who did not receive NAC, progressive MIBC was significantly associated with greater pathologic upstaging (64.9% vs 42.7%) and worse overall survival (median 51.5 vs 95.1 months), cancerspecific survival (median not reached), and recurrence/metastasis-free survival (median 49.3 vs 87.9 months), compared with de novo MIBC.

NAC treatment significantly decreased the odds of pathologic upstaging by 81% and 74% in the progressive and de novo MIBC groups, respectively, Ashish M. Kamat, MD, of The University of Texas, MD Anderson Cancer Center in Houston, and colleagues reported in The Journal of Urology. Further, NAC treatment increased the odds of complete pathologic response 4.5- and 4.3-fold, respectively. The NAC regimen varied.

According to the investigators, the data suggest a comparable “window of cure” exists for patients with progressive MIBC and justify their inclusion in risk-stratified approaches to NAC patient selection.

“Our data suggest that, until underlying molecular rationale — and validated molecular markers — allow for personalized therapy (as is being studied in various prospective trials), NAC should be offered to patients who have progressed to MIBC after BCG therapy.”

In an accompanying editorial, LaMont J.Barlow, MD, and Gary D. Steinberg, MD, of NYU Langone Health in New York, New York, commented: “The present study adds to a growing body of literature attempting to elucidate the biological and clinical differences between patients initially diagnosed with MIBC and patients experiencing progression from nonmuscle-invasive disease.” ■

Video Informs Men About PCa Genetic Testing

MEN PONDERING prostate cancer genetic testing may find a pretest educational video preferable to genetic counseling (GC), according to a recent study published in JCO Precision Oncology.

Thousands of men are eligible for prostate cancer genetic testing to inform precision therapy, screening, and hereditary cancer risk, but a shortage of trained genetic counselors is a barrier to testing. Counseling patients with an educational video could address this issue.

“This is the first study with real-world data to publish on a pretest video in a male population in the context of prostate cancer germline testing,” said lead investigator Veda N. Giri, MD, a medical oncologist at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, Pennsylvania, where she is director of Cancer Risk Assessment and Clinical Cancer Genetics. “Results are supportive of practice change for alternate delivery of pretest information for men to make an informed decision for genetic testing.”

The findings are from the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER) Study, which included 127 men asked to choose between pretest video-based genetic education (VBGE) or GC. Of these, 90.6% had prostate cancer and 85.7% had a family history of cancer.

A higher proportion of patients chose VBGE over GC (71% vs 29%). The VBGE group had a higher proportion of patients who intended to share genetic testing results (96.4% vs 86.4%). Both the VBGE and GC groups had high rates of genetic testing (94.4% and 92.0%). Cancer genetics 3 knowledge improved to a similar extent in both groups.

Major reasons for choosing the video included greater convenience (62.2%), less time commitment (37.8%), and absence of waiting time to view the video (20.2%). Individuals in the GC arm received personalized counseling by telehealth or telephone. Major reasons for choosing GC included ability to ask questions of a genetics provider (62.2%) and preference or ability to do the visit from home.

The 11-minute video addressed cancer inheritance, purpose of testing, risks and benefits of testing, multigene panel options, and types of potential results. It also included implications of results for treatment, screening, and cancer management, implications of hereditary cancer risk for blood relatives, genetic discrimination laws, and possible reproductive implications. A link to the video was sent to men who chose it. The men had an opportunity to ask questions of a study investigator before proceeding with genetic testing.

“Urology practice is now a critical doorway into hereditary cancer information for men and their families, and genetic testing is essential to consider for men due to the impact on precision medicine, emerging impact on active surveillance, and prostate cancer screening,” Dr Giri said. ■Renal & Urology News

Educational video could address a shortage of trained genetic counselors.

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RT for RCC

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American (3%). The median age was 65 years, and 24 were men.

Good Tolerability All patients were treated with SBRT, but if such high doses were deemed not safe, they received hypofractionated intensity-modulated radiation therapy, Dr Tang said. Further rounds of radiotherapy were permitted for treating subsequent sites of progression. Serial SBRT as monotherapy demonstrated antitumor activity and achieved a median PFS of 22.7 months. Tolerability was good, with all patients completing at least 1 round of radiation therapy without requiring dose reduction or discontinuation due to toxicities. Only 6 patients (20%) experienced a grade 2 or less adverse event, 2 patients experienced a grade 3 event (pain and muscle weakness), and 1 patient experienced a grade 4 event (hyperglycemia).

Biopsy samples collected 3 months after treatment confirmed that radiation therapy was effective in eliminating viable tumor cells. The team conducted computed tomography-guided biopsies on 14 patients at first follow-up and found that 6 patients (43%) tested negative for viable malignancy. A meaningful reduction in tumor cell proliferation occurred in the remaining patients, dropping from 15% before radiation therapy to 6% after treatment. Upon final analysis, 23 patients (77%) remained off systemic therapy.

The trial has been extended and is enrolling 100 patients. The findings from the phase 2 trial, however, suggest this strategy could be used for treatment de-escalation to delay, avoid, or hold systemic therapy in patients with oligometastatic RCC. Contemporary retrospective studies suggest this approach can produce local control rates exceeding 90% in patients with RCC; similar rates were identified in the current study (97% local control at the data cutoff date).

Jason Hearn, MD, a clinical associate professor of radiation oncology at the University of Michigan Medical School in Ann Arbor, said this is a reasonable strategy that may produce a host of benefits. “It is possible that this approach might be associated with fewer side effects than systemic therapy, especially in some patients, though this study does not directly provide such a comparison,” Dr Hearn said. “A randomized trial comparing this approach to systemic therapy would be informative as to comparative toxicity and efficacy. A cost effectiveness analysis comparing common systemic therapies to radiotherapy would also be useful.”

John T. Barrett, MD, PhD, interim chair of the department of radiation oncology at the Medical College of Georgia at Augusta University, said the latest study joins other important series demonstrating the efficacy of aggressive radiotherapy for oligometastases in RCC and other relatively radioresistant tumors. Systemic therapy for metastatic RCC with tyrosine kinase inhibitors can be poorly tolerated and significantly impact quality of life for a majority of patients, Dr Barrett noted.

He noted these findings are consistent with the results of the National Cancer Institute’s phase 1 NRG-BR001 trial, which showed that SBRT in standard doses is safe for patients with a median of 3 metastases. “In the NCI trial, there were no dose-limiting toxicities and over 50% of trial participants were alive at 2 years following treatment,” Dr Barrett said.

Possible Improved Quality of Life Joseph Salama, MD, a professor in the department of radiation oncology at Duke University School of Medicine in Durham, North Carolina, said the latest findings are important for patients as it is a way to treat their cancer directly, safely, and without unpleasant side effects. “It will allow patients to hopefully have improved quality of life with their cancer controlled with less time on therapy, saving effective therapies when they are truly needed,” Dr Salama said.

The patients in the current study were carefully selected and had good performance status and normal baseline laboratory tests, but often it is the patients with poor performance status and abnormal laboratory tests who are not able to tolerate systemic therapies. These are the patients for whom this approach of metastasis-directed therapy may be most useful, Dr Salama said, adding that he would like to see serial radiation therapy validated in this patient population. ■

ICPi-AKI predictors

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to 1.5 times the baseline value within 90 days following ICPi-AKI, occurred in 276 (64.3%) patients. Treatment with corticosteroids was significantly associated with 2.6-fold increased odds of renal recovery, Dr Gupta reported. Among patients treated with corticosteroids, treatment within 3 days of ICPiAKI was significantly associated with 2-fold higher odds of renal recovery compared with later treatment.

She noted that 28% of patients were rechallenged with an ICPi after an episode of ICI-related AKI. Of these, recurrent ICPi-AKI developed in only 16.5% of them, “which shows that rechallenge should be considered in these patients,” she said.

Although the study is the largest investigation of ICPi-AKI to date, Dr Gupta and colleagues acknowledged limitations. They noted that not all patients underwent a kidney biopsy to confirm the diagnosis. They also did not collect data on tumor response to ICPi therapy. Further, patients in their study were disproportionately treated at US sites, which may affect the generalizability of the findings.

The latest study adds to a growing medical literature on the association between ICPi therapy and AKI. A study of 138 patients with ICPi-AKI and 276 control patients who received ICPi therapy but did not experience AKI also demonstrated that lower baseline eGFR and PPI use were independently associated with an increased risk for ICPi-AKI, Frank B. Cortazar, MD, of Massachusetts General Hospital in Boston, and colleagues reported in the Journal of the American Society of Nephrology. The median time from ICPi initiation to AKI was 14 weeks. Complete and partial recovery after ICPi-AKI occurred in 40% and 45% of cases, respectively. Recurrent ICPi-AKI occurred in 23% of patients who were rechallenged with an ICPi.

In a study of 676 patients treated with ICPi therapy, AKI developed in 96 patients (14.2%). Of these, 32 patients (33.3%) had ICPi-AKI, which occurred at a median of 15 weeks after ICPi initiation and was mostly low-grade, Marije S. Koks, MD, of University Medical Center Utrecht in the Netherlands, and colleagues reported in PLOS One in June. Although patients with all-cause AKI had a 2-fold increased risk of death, ICPiAKI was not associated with increased mortality, according to investigators. ■

Steroid treatment increased the odds of renal recovery 2.6-fold, data show.

DFS predicts OS

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database to assess the association between DFS and OS in patients with newly diagnosed, completely resected, intermediate-high (pT2N0 Grade4/pT3N0) or high-risk (pT4N0/pTanyN1) RCC post-nephrectomy. They also compared mean monthly all-cause medical and pharmacy costs per patient between the recurrence and non-recurrence cohorts.

Overall, 643 post-nephrectomy RCC patients, 269 with recurrence and 374 without recurrence, were included in the study. Patient demographics and disease characteristics were well balanced across the cohorts. In both cohorts, the mean age was approximately 75 years, and most patients were White (each 86%).

Among patients with and without recurrence, 96.3% and 98.9% had intermediate-high risk RCC and 3.7% and 1.0% had high-risk RCC, respectively. Among patients with recurrence, 10.8% had locoregional recurrence and 89.2% had distant metastatic recurrence.

In landmark analyses, patients with recurrence by each landmark point had shorter subsequent OS compared with those who did not have recurrence. The median OS at 1, 3, and 5 years was 2.4, 4.5, and 5.7 years, respectively, for the recurrence group and 9.7 years, not reached, and not reached, respectively, for the group without recurrence. Patients without recurrence at 1, 3, and 5 years after initial nephrectomy had a significant 3.5-, 3.0-, and 2.7-fold greater likelihood of survival compared with patients who had recurrence at those landmark points.

Further, OS at year 5 since the landmark points favored the group without recurrence. For patients who had recurrence at 1, 3, and 5 years following initial nephrectomy, the OS rates 5 years later were 37%, 42.3%, and 53.2%, respectively. For patients without recurrence at those landmark points, the OS rates 5 years later were 70.1%, 72.8%, and 78.6%, respectively.

Patients with recurrence had significantly higher inflation-adjusted all-cause medical and pharmacy costs per patient per month compared with patients without recurrence, on average $4924 and $1387 higher, respectively, Dr Haas’ team reported.

This approach using landmark analysis can also be applied to other datasets to hone the populations most at risk for limited DFS and OS, according to the investigators. ■

Study included intermediate-high risk and high-risk RCC patients.

News in Brief

Please visit us at www.renalandurologynews.com for the latest news updates from the fields of urology and nephrology

Short Takes

Chronic Hypertension Tied to Preterm Delivery

Preterm delivery is associated with an increased risk for chronic hypertension, researchers reported in JAMA Cardiology.

The finding is from a national cohort study of 2,195,989 women in Sweden who had singleton deliveries. Preterm delivery (gestational age less than 37 weeks) and extremely preterm delivery (gestational age 22-27 weeks) were significantly associated with a 1.7and 2.2-fold increased risk of hypertension within 10 years after delivery, in adjusted analyses, compared with full-term deliveries, Casey Crump, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York, New York, and colleagues reported.

MACE Linked to Chronic, Transient Hyperkalemia

Both transient and chronic hyperkalemia in patients with nondialysis-dependent chronic kidney disease (CKD) are associated with major adverse cardiovascular events (MACE) and death, recent findings suggest.

Compared with normal potassium levels, transient and chronic hyperkalemia were significantly associated with 36% and 16% increased odds of MACE, respectively, Marco Trevisan, PhD candidate at Karolinska Institutet in Stockholm, Sweden, and colleagues reported in the Clinical Kidney Journal.

The study included 36,511 adults with stage 3 to 5 CKD.

Moderate Physical Activity May Decrease UI Risk

Moderate physical activity may decrease the risk of urinary incontinence (UI) in women, according to study findings published in Urology.

The study, by Michelle M. Kim, MD, PhD, Massachusetts General Hospital in Boston, and colleagues, included 30,213 women who participated in the 2008-2018 National Health and Nutrition Examination Survey cycles. Of these, 23.1%, 23.2%, and 8.4% reported having stress, urge, and mixed UI, respectively. Women who reported moderate recreational activity had significant 21% and 34% decreased odds of stress and urge UI, respectively. Women who reported moderate work-related activity had significant 16%, 16%, and 34% decreased odds of stress, urge, and mixed UI, respectively.

BCG Therapy and OAB Symptoms

The prevalence of overactive bladder (OAB) symptoms requiring medical treatment increases along with the duration of intravesical bacillus Calmette-Guérin (BCG) immunotherapy for nonmuscle-invasive bladder cancer, a study found.

6 weeks: 13.1%

12 months or less: 30.4%

More than 12 months 52.2%

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Effect of Post-RP Botulinum Toxin Varies by OAB Type

Intravesical botulinum toxin treatment for overactive bladder (OAB) following radical prostatectomy (RP) appears most effective for patients with pure detrusor overactivity, according to preliminary data presented at the 2021 International Continence Society annual meeting.

Among 24 patients with post-RP incontinence who received intravesical botulinum toxin treatment, 10 had pure detrusor overactivity, 1 had pure stress urinary incontinence with OAB symptoms, and 13 had mixed urinary incontinence.

Significant clinical improvement was found only in the group with pure detrusor overactivity, Nataniel Tan, MD, of St George’s Hospital in London, UK, reported. In this group, mean total 24-hour pad use significantly declined from 2.9 pads per day before treatment to 1.6 pads per day at 3 months. Based on the ICIQ-OAB questionnaire responses, symptom severity scores significantly decreased 41% from 10.1 to 5.7 and bother scores decreased 26% from 26.9 to 19.9.

Prior Nephrectomy Does Not Affect ICI Efficacy in mRCC

Prior nephrectomy does not affect the efficacy of first-line immune checkpoint inhibitor (ICI)-based therapy for metastatic renal cell carcinoma (mRCC) relative to sunitinib, according to a recent systematic review and meta-analysis published online ahead of print in Urologic Oncology.

Raj Satkunasivam, MD, MS, of Houston Methodist Hospital in Houston, Texas, and colleagues analyzed data from 6 randomized phase 3 trials involving 5121 patients, of whom 3968 (77%) had a prior nephrectomy. Compared with sunitinib, ICI-based therapy was significantly associated with a 25% and 26% decreased risk for death among patients who had prior nephrectomy and those who had not, respectively. Similar results were found for progression-free survival.

Cabozantinib May Be Effective for RCC Brain Metastases

Cabozantinib may be an effective treatment for patients with brain metastases from renal cell carcinoma, according to a recent retrospective study.

The study included 88 cabozantinib-treated patients divided into 2 cohorts. Cohort A included 33 patients with progressing brain metastases without concomitant brain-directed local therapy, and cohort B included 55 patients with stable or progressing brain metastases treated concomitantly with brain-directed local therapy. The median follow-up was 17 months. The intracranial radiologic response rate, the study’s primary outcome, was 55% in cohort A compared with 47% in cohort B, Laure Hirsch, MD, of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute in Boston, Massachusetts, and colleagues reported in JAMA Oncology. Cabozantinib was well tolerated, with no unexpected toxic effects or neurologic adverse events and no treatment-related deaths reported.

“These findings show considerable intracranial activity and an acceptable safety profile of cabozantinib in patients with renal cell carcinoma and brain metastases,” the authors concluded.