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Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: closed (15 September 2023) | Viewed by 22984

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Dr. Anja Rabien

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Department of Urology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
Interests: renal cancer; bladder cancer; prostate cancer; targeted therapies; biomarkers; metastasis; invasion; signaling pathways

Special Issue Information

Dear Colleagues,

The fate of most cancer patients is determined not by the primary tumor itself, which is often resectable, but by metastases following the dysplasia. Despite advances in the therapy of metastatic renal cell carcinoma, early diagnosis and substantial therapeutic effects still are a long way off. Conventional diagnostic tools cannot detect beginning invasion and metastasis, characterized by single cells and clumps of cells leaving their microenvironment and forming micrometastases. Therefore, a deeper insight into metastatic processes at the molecular level should reveal diagnostic possibilities, particularly considering the fact that no biomarker has found its way into clinical use until now. The same problem concerns the prognostic point of view, which is strongly associated with drug resistance, a common feature of many kidney cancers. Precision medicine for metastatic renal cell carcinomas and a comprehensive understanding of underlying signaling networks up to forming a metastatic niche could forward the efforts to avoid or control metastasis.

Although therapies of metastatic kidney cancers, the majority of which are clear cell renal cell carcinomas, could be improved using checkpoint inhibitors, success often remains very limited. The problem of resistance still requires advances in immune therapies and targeted therapies. As animal models poorly resemble the situation in humans, new 3D culture systems could be a suitable approach for drug testing to develop tailor-made treatments for patients.

The present Special Issue of Cancers is asking for recent original articles and reviews to collect and enable progress in state-of-the-art research for metastatic kidney cancer.

Dr. Anja Rabien
Guest Editor

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Keywords

renal cancer
metastasis
invasion
biomarkers
diagnosis
prognosis
precision medicine
signaling
metastatic niche
targeted therapy
immune therapy
resistance
3D culture

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Published Papers (8 papers)

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Research

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15 pages, 8229 KiB

Open AccessArticle

Digital Spatial Profiling Identifies the Tumor Periphery as a Highly Active Biological Niche in Clear Cell Renal Cell Carcinoma

by Felix Schneider, Adam Kaczorowski, Christina Jurcic, Martina Kirchner, Constantin Schwab, Viktoria Schütz, Magdalena Görtz, Stefanie Zschäbitz, Dirk Jäger, Albrecht Stenzinger, Markus Hohenfellner, Stefan Duensing and Anette Duensing

Cancers 2023, 15(20), 5050; https://doi.org/10.3390/cancers15205050 - 19 Oct 2023

Cited by 4 | Viewed by 1824

Abstract

Clear cell renal cell carcinoma (ccRCC) is characterized by a high degree of intratumoral heterogeneity (ITH). Besides genomic ITH, there is considerable functional ITH, which encompasses spatial niches with distinct proliferative and signaling activities. The full extent of functional spatial heterogeneity in ccRCC is incompletely understood. In the present study, a total of 17 ccRCC tissue specimens from different sites (primary tumor, n = 11; local recurrence, n = 1; distant metastasis, n = 5) were analyzed using digital spatial profiling (DSP) of protein expression. A total of 128 regions of interest from the tumor periphery and tumor center were analyzed for the expression of 46 proteins, comprising three major signaling pathways as well as immune cell markers. Results were correlated to clinico-pathological variables. The differential expression of granzyme B was validated using conventional immunohistochemistry and was correlated to the cancer-specific patient survival. We found that a total of 37 proteins were differentially expressed between the tumor periphery and tumor center. Thirty-five of the proteins were upregulated in the tumor periphery compared to the center. These included proteins involved in cell proliferation, MAPK and PI3K/AKT signaling, apoptosis regulation, epithelial-to-mesenchymal transition, as well as immune cell markers. Among the most significantly upregulated proteins in the tumor periphery was granzyme B. Granzyme B upregulation in the tumor periphery correlated with a significantly reduced cancer-specific patient survival. In conclusion, this study highlights the unique cellular contexture of the tumor periphery in ccRCC. The correlation between granzyme B upregulation in the tumor periphery and patient survival suggests local selection pressure for aggressive tumor growth and disease progression. Our results underscore the potential of spatial biology for biomarker discovery in ccRCC and cancer in general. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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14 pages, 2341 KiB

Open AccessArticle

Critical Evaluation of a microRNA-Based Risk Classifier Predicting Cancer-Specific Survival in Renal Cell Carcinoma with Tumor Thrombus of the Inferior Vena Cava

by Mischa J. Kotlyar, Markus Krebs, Antonio Giovanni Solimando, André Marquardt, Maximilian Burger, Hubert Kübler, Ralf Bargou, Susanne Kneitz, Wolfgang Otto, Johannes Breyer, Daniel C. Vergho, Burkhard Kneitz and Charis Kalogirou

Cancers 2023, 15(7), 1981; https://doi.org/10.3390/cancers15071981 - 26 Mar 2023

Cited by 3 | Viewed by 2156

Abstract

(1) Background: Clear cell renal cell carcinoma extending into the inferior vena cava (ccRCC^IVC) represents a clinical high-risk setting. However, there is substantial heterogeneity within this patient subgroup regarding survival outcomes. Previously, members of our group developed a microRNA(miR)-based risk classifier—containing miR-21-5p, miR-126-3p and miR-221-3p expression—which significantly predicted the cancer-specific survival (CSS) of ccRCC^IVC patients. (2) Methods: Examining a single-center cohort of tumor tissue from n = 56 patients with ccRCC^IVC, we measured the expression levels of miR-21, miR-126, and miR-221 using qRT-PCR. The prognostic impact of clinicopathological parameters and miR expression were investigated via single-variable and multivariable Cox regression. Referring to the previously established risk classifier, we performed Kaplan–Meier analyses for single miR expression levels and the combined risk classifier. Cut-off values and weights within the risk classifier were taken from the previous study. (3) Results: miR-21 and miR-126 expression were significantly associated with lymphonodal status at the time of surgery, the development of metastasis during follow-up, and cancer-related death. In Kaplan–Meier analyses, miR-21 and miR-126 significantly impacted CSS in our cohort. Moreover, applying the miR-based risk classifier significantly stratified ccRCC^IVC according to CSS. (4) Conclusions: In our retrospective analysis, we successfully validated the miR-based risk classifier within an independent ccRCC^IVC cohort. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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11 pages, 2168 KiB

Open AccessArticle

Concomitant Use of Sulforaphane Enhances Antitumor Efficacy of Sunitinib in Renal Cell Carcinoma In Vitro

by Igor Tsaur, Anita Thomas, Emine Taskiran, Jochen Rutz, Felix K.-H. Chun, Axel Haferkamp, Eva Juengel and Roman A. Blaheta

Cancers 2022, 14(19), 4643; https://doi.org/10.3390/cancers14194643 - 24 Sep 2022

Cited by 6 | Viewed by 1682

Abstract

Chronic treatment of renal cell carcinoma (RCC) with the tyrosine kinase inhibitor sunitinib (ST) inevitably induces resistance and tumor re-activation. This study investigated whether adding the natural compound sulforaphane (SFN) with its anti-cancer properties could improve ST efficacy in vitro. The RCC cell lines A498, Caki1, KTCTL26, and 786O were exposed to ST, SFN, or both (dual therapy, DT) before (short-term exposure) and during ST-resistance buildup (long-term 8-week exposure). Tumor growth, proliferation, and clone formation were evaluated, as was cell cycle progression and cell cycle regulating proteins. In nonresistant cells (short-term), DT induced a higher reduction in cell viability in three cell lines as compared to monotherapy with either ST or SFN. Long-term SFN or DT significantly reduced tumor growth and proliferation, whereas ST alone had no effect or even elevated proliferation in three cell lines. SFN or DT (but not ST alone) also blocked clonogenic growth. Both long-term SFN and DT enhanced the number of cells in the S- and/or G2/M-phase. Protein analysis in 786O cells revealed a down-regulation of cyclin dependent kinase (CDK) 1 and 2. CDK2 or Cyclin A knockdown caused reduced 786O growth activity. SFN therefore inhibits or delays resistance to chronic ST treatment. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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25 pages, 3463 KiB

Open AccessArticle

Shikonin Inhibits Cell Growth of Sunitinib-Resistant Renal Cell Carcinoma by Activating the Necrosome Complex and Inhibiting the AKT/mTOR Signaling Pathway

by Sascha D. Markowitsch, Olesya Vakhrusheva, Patricia Schupp, Yasminn Akele, Jovana Kitanovic, Kimberly S. Slade, Thomas Efferth, Anita Thomas, Igor Tsaur, René Mager, Axel Haferkamp and Eva Juengel

Cancers 2022, 14(5), 1114; https://doi.org/10.3390/cancers14051114 - 22 Feb 2022

Cited by 12 | Viewed by 4002

Abstract

Therapy resistance remains a major challenge in treating advanced renal cell carcinoma (RCC), making more effective treatment strategies crucial. Shikonin (SHI) from traditional Chinese medicine has exhibited antitumor properties in several tumor entities. We, therefore, currently investigated SHI’s impact on progressive growth and metastatic behavior in therapy-sensitive (parental) and therapy-resistant Caki-1, 786-O, KTCTL-26, and A498 RCC cells. Tumor cell growth, proliferation, clonogenic capacity, cell cycle phase distribution, induction of cell death (apoptosis and necroptosis), and the expression and activity of regulating and signaling proteins were evaluated. Moreover, the adhesion and chemotactic activity of the RCC cells after exposure to SHI were investigated. SHI significantly inhibited the growth, proliferation, and clone formation in parental and sunitinib-resistant RCC cells by G2/M phase arrest through down-regulation of cell cycle activating proteins. Furthermore, SHI induced apoptosis and necroptosis by activating necrosome complex proteins. Concomitantly, SHI impaired the AKT/mTOR pathway. Adhesion and motility were cell line specifically affected by SHI. Thus, SHI may hold promise as an additive option in treating patients with advanced and therapy-resistant RCC. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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16 pages, 16298 KiB

Open AccessArticle

DNA Methylation in INA, NHLH2, and THBS4 Is Associated with Metastatic Disease in Renal Cell Carcinoma

by Olga Katzendorn, Inga Peters, Natalia Dubrowinskaja, Joana M. Moog, Christel Reese, Hossein Tezval, Pouriya Faraj Tabrizi, Jörg Hennenlotter, Marcel Lafos, Markus A. Kuczyk and Jürgen Serth

Cancers 2022, 14(1), 39; https://doi.org/10.3390/cancers14010039 - 22 Dec 2021

Cited by 3 | Viewed by 2951

Abstract

The detection of DNA methylation in primary tumor tissues could be relevant for early stratification of aggressive renal cell carcinomas (RCCs) as a basis for future personalized adjuvant therapy. Methylated TCGA KIRC based candidate CpG loci in INA, NHLH2, and THBS4 that are possibly associated with RCC metastasis were evaluated by pyrosequencing in 154 paired normal adjacent and primary tumor tissues, as well as in 202 metastatic tissues. Statistical analysis was carried out by bivariate logistic regression for group comparisons, log rank survival analysis, and unsupervised and supervised analysis for the classification of tumors. Increased methylation of INA, NHLH2, and THBS4 loci were significantly associated with distant metastasis in primary tumors (p < 0.05), tissue-specific hypermethylation in metastatic (p = 7.88 × 10⁻⁸, 5.57 × 10⁻¹⁰, 2.06 × 10⁻⁷) and tumor tissues (p = 3.72 × 10⁻²⁴, 3.17 × 10⁻¹³, 1.58 × 10⁻¹⁹), and shortened progression free survival in patients (p = 0.03). Combined use of CpG site-specific methylation permits the discrimination of tissues with metastatic disease and reveals a significant contribution of CpG sites in all genes to the statistical classification model. Thus, metastasis in RCC is significantly associated with methylation alterations in INA, NHLH2, and THBS4 loci, providing independent information for the potential early detection of aggressive renal cancers as a rationale for stratifying patients to adjuvant therapies. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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13 pages, 2568 KiB

Open AccessArticle

Characterization of Genetic Heterogeneity in Recurrent Metastases of Renal Cell Carcinoma

by Carolin Sauter-Meyerhoff, Regina Bohnert, Pascale Mazzola, Viktoria Stühler, Siarhei Kandabarau, Florian A. Büttner, Stefan Winter, Lisa Herrmann, Steffen Rausch, Jörg Hennenlotter, Falko Fend, Marcus Scharpf, Arnulf Stenzl, Stephan Ossowski, Jens Bedke, Matthias Schwab and Elke Schaeffeler

Cancers 2021, 13(24), 6221; https://doi.org/10.3390/cancers13246221 - 10 Dec 2021

Cited by 1 | Viewed by 2797

Abstract

Metastatic renal cell carcinoma (RCC) exhibits poor prognosis. Better knowledge of distant metastases is crucial to foster personalized treatment strategies. Here, we aimed to investigate the genetic landscape of metastases, including synchronous and/or recurrent metastases to elucidate potential drug target genes and clinically relevant mutations in a real-world setting of patients. We assessed 81 metastases from 56 RCC patients, including synchronous and/or recurrent metastases of 19 patients. Samples were analysed through next-generation sequencing with a high coverage (~1000× mean coverage). We therefore established a novel sequencing panel comprising 32 genes with impact on RCC development. We observed a high frequency of mutations in known RCC driver genes (e.g., >40% carriers of VHL and PBRM1 mutations) in metastases irrespective of the metastatic site. The somatic mutational composition was significantly associated with cancer-specific survival (p(logrank) = 0.03). Moreover, we identified in 34 patients at least one drug target gene as well as clinically relevant mutations listed in the VICC Meta-Knowledgebase in 7%. In addition to significantly higher mutational burden in recurrent metastases compared to earlier ones, synchronous and/or recurrent metastases of individual patients, even after a time-period >2 yrs, shared a high proportion of somatic events. Our data demonstrate the importance of somatic profiling in metastases for precision medicine in RCC. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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15 pages, 6273 KiB

Open AccessArticle

Thrombospondin-2 and LDH Are Putative Predictive Biomarkers for Treatment with Everolimus in Second-Line Metastatic Clear Cell Renal Cell Carcinoma (MARC-2 Study)

by Philip Zeuschner, Sebastian Hölters, Michael Stöckle, Barbara Seliger, Anja Mueller, Hagen S. Bachmann, Viktor Grünwald, Daniel C. Christoph, Arnulf Stenzl, Marc-Oliver Grimm, Fabian Brüning, Peter J. Goebell, Marinela Augustin, Frederik Roos, Johanna Harde, Iris Benz-Rüd, Michael Staehler and Kerstin Junker

Cancers 2021, 13(11), 2594; https://doi.org/10.3390/cancers13112594 - 25 May 2021

Cited by 3 | Viewed by 3079

Abstract

There is an unmet need for predictive biomarkers in metastatic renal cell carcinoma (mRCC) therapy. The phase IV MARC-2 trial searched for predictive blood biomarkers in patients with predominant clear cell mRCC who benefit from second-line treatment with everolimus. In an exploratory approach, potential biomarkers were assessed employing proteomics, ELISA, and polymorphism analyses. Lower levels of angiogenesis-related protein thrombospondin-2 (TSP-2) at baseline (≤665 parts per billion, ppb) identified therapy responders with longer median progression-free survival (PFS; ≤665 ppb at baseline: 6.9 months vs. 1.8, p = 0.005). Responders had higher lactate dehydrogenase (LDH) levels in serum two weeks after therapy initiation (>27.14 nmol/L), associated with a longer median PFS (3.8 months vs. 2.2, p = 0.013) and improved overall survival (OS; 31.0 months vs. 14.0 months, p < 0.001). Baseline TSP-2 levels had a stronger relation to PFS (HR 0.36, p = 0.008) than baseline patient parameters, including IMDC score. Increased serum LDH levels two weeks after therapy initiation were the best predictor for OS (HR 0.21, p < 0.001). mTOR polymorphisms appeared to be associated with therapy response but were not significant. Hence, we identified TSP-2 and LDH as promising predictive biomarkers for therapy response on everolimus after failure of one VEGF-targeted therapy in patients with clear cell mRCC. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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Review

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21 pages, 689 KiB

Open AccessReview

Tyrosine Kinase Inhibitors in the Treatment of Metastasised Renal Cell Carcinoma—Future or the Past?

by Jakob Michaelis, Markus Grabbert, August Sigle, Mehmet Yilmaz, Daniel Schlager, Christian Gratzke, Arkadiusz Miernik and Dominik Stefan Schoeb

Cancers 2022, 14(15), 3777; https://doi.org/10.3390/cancers14153777 - 3 Aug 2022

Cited by 10 | Viewed by 2794

Abstract

Background: To review and discuss the literature on applying tyrosine kinase inhibitors (TKIs) in the treatment of metastasised renal cell carcinoma (mRCC). Materials and Methods: Medline, PubMed, the Cochrane database, and Embase were screened for randomised controlled trials, clinical trials, and reviews on treating renal cell carcinoma, and the role of TKI. Each substance’s results were summarised descriptively. Results: While TKI monotherapy is not currently recommended as a first-line treatment for metastasized renal cell carcinoma, TKIs are regularly applied to treat treatment-naïve patients in combination with immunotherapy. TKIs depict the first-choice alternative therapy if immunotherapy is not tolerated or inapplicable. Currently, seven different TKIs are available to treat mRCC. Conclusions: The importance of TKIs in a monotherapeutic approach has declined in the past few years. The current trend toward combination therapy for mRCC, however, includes TKIs as one significant component of treatment regimens. We found that to remain applicable to ongoing studies, both when including new substances and when testing novel combinations of established drugs. TKIs are of major importance for the treatment of renal cancer now, as well as for the foreseeable future. Full article

(This article belongs to the Special Issue Metastatic Renal Cell Carcinoma—From Diagnosis to Therapy)

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