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Background In Hungary, the mortality rate for testicular germ cell cancer (TGCC) is 0,9/100000 which is significantly higher than the EU average. We prospectively evaluated the effect of socioeconomic position on patient delay and therapy outcomes. Methods Questionnaires on subjective social status (MacArthur Subjective Status Scale), objective socioeconomic position (wealth, education, and housing data), and on patient’s delay were completed by newly diagnosed TGCC patients. Results Patients belonged to a relatively high socioeconomic class, a university degree was double the Hungarian average, Cancer-specific mortality in the highest social quartile was 1.56% while in the lowest social quartile 13.09% ( p  = 0.02). In terms of patient delay, 57.2% of deceased patients waited more than a year before seeking help, while this number for the surviving patients was 8.0% ( p  = 0.0000). Longer patient delay was associated with a more advanced stage in non-seminoma but not in seminoma, the correlation coefficient for non-seminoma was 0.321 ( p  < 0.001). For patient delay, the most important variables were the mother’s and patient’s education levels (r = − 0.21, p  = 0.0003, and r = − 0.20, p  = 0.0005), respectively. Since the patient delay was correlated with the social quartile and resulted in a more advanced stage in non-seminoma, the lower social quartile resulted in higher mortality in non-seminoma patients ( p  = 0.005) but not in seminoma patients ( p  = 0.36) where the patient delay was not associated with a more advanced stage. Conclusions Based on our result, we conclude that to improve survival, we should promote testicular cancer awareness, especially among the most deprived populations, and their health care providers.

In practice it is still not clear whether a drug holiday in sunitinib (Su) treatment can be safety, without impairing the overall outcome of patients with metastatic renal cell carcinoma (mRCC). The aim was to retrospectively evaluate the outcome in patients who restarted Su after an interruption of ≥3 months and a combined analysis of case studies from literature. From 556 patients treated between January 2006 and March 2016 a group of 38 patients were selected whose treatment was interrupted for other reasons than disease progression. During interruption Su was restarted in case of RECIST-defined progression. The primary objective was the objective response (OR) and progression free survival (PFS) of baseline and restarted therapy. The secondary objective was the overall survival (OS) calculated from the start of baseline treatment. Multivariate survival analysis was also applied. The major causes of interruption were toxicity (39%) and patient’ choice (24%). Median duration of interruption was 7 (range 3–41) months. The OR of baseline and restarted treatment was 63% and 39%, respectively. After a median follow-up of 76 (95% CI 65–79) months the median PFS of baseline and restarted treatment was 21 (18–27) and 14 (10–18) months, respectively. The median OS was 61 (56–80) months. In multivariate analysis the lack of OR of restated treatment was an independent predictor of shorter PFS of restarted Su. According to our findings and also on combined case studies from literature restarted Su can be effective in selected cases of patients who progressed during treatment holiday.

Célkitűzések:1. Összefüggést kerestünk a mellékhatások és a sunitinib kezelés hatékonysága között.2. Kiértékeltük a betegség kimenetelét az újrakezdett sunitinib esetében, miután a sunitinib kezelést ≥3 hónapig megszakították. Az irodalmi esettanulmányokat összevontan elemeztük.3. Vizsgáltuk a harmadik vagy további vonalban újraadott sunitinib hatékonyságát.Eredmények:1. A 274 sunitinib-kezelt beteg esetében, a 32 hónap medián követési idő alatt, ha magas vérnyomás, hasmenés, kéz-láb szindróma (HFS), bőrjelenség vagy leukopénia jelentkezett, hosszabb volt a progressziómentes (PFS) és teljes túlélés (OS). A mellékhatások a túlélést szinergista módon befolyásolták. A több mellékhatás markere a hosszabb PFS-nek és OS-nek.2. A vizsgált 38 beteg esetében, ha progrediáltak, a sunitinibet újrakezdték (restart). Az alap és az újrakezdett kezelés esetén az objektív válasz (OR) 63% és 39%, valamint a medián PFS 21 és 14 hónap. A medián OS pedig 61 hónap. Az újrakezdésnél az OR hosszabb PFS-t jelent.3. Összesen 21 esetben újraadták (rechallenge) a sunitinibet. A betegek az első sunitinib után más TKI vagy/és mTOR gátlót, majd újra sunitinibet kaptak. Az első és az újraadott sunitinib kezelésnél a PFS 22 ill.14 hónap. A mellékhatás profil hasonló. Az OS (medián 67 hónap) független markerei a fiatalabb kor (<57 év) és a hosszabb (>2 év) első sunitinib kezelés.Következtetések:1. A sunitinib hatékonysága szinergista módon javult, ha több mellékhatás jelentkezett.2. Az újrakezdett sunitinib hatásos lehet azoknál, akik progrediálnak a kezelési szünet alatt.3. Eredményeink és irodalmi kombinált adatok alapján is a sunitinib újraadása biztonságosan alkalmazható. A hosszabb első sunitinib kezelés után, függetlenül a további kezelések típusától, hosszabb OS-t tapasztaltunk.

Background Sunitinib is still one of the standard therapies in metastatic renal cell carcinoma (mRCC). Despite the benefit of sunitinib resistance will develop in the majority of patients. Most of them receive multiple sequential therapies during the course of disease. Objectives To retrospectively investigate the efficacy and safety of rechallenged sunitinib in third or later line settings. Patients and Methods Twenty-one mRCC patients were identified who received rechallenged sunitinib between March 2010 and April 2018. Patients received sunitinib in first or second line, then other tyrosine kinase and/or mTOR inhibitors were applied, then sunitinib was rechallenged. Patients’ characteristics, tolerability, treatment modalities, and treatment outcomes were recorded. The primary end-point was progression-free survival (PFS) of rechallenged sunitinib. Results Median age of patients was 62 years at the start of sunitinib rechallenge. Sixty-seven percent of patients were male. All patients had prior nephrectomy. Upon rechallenge 4 patients achieved partial response and 12 stable disease. The median PFS of first sunitinib treatment was 22 (95% CI 17–26) months and for rechallenged sunitinib 14 (95% CI 6–20) months. No increased severity of prior toxicity or new adverse events was reported during rechallenged sunitinib. The median overall survival (OS) from the start of first sunitinib was 67 (95% CI 46–76) months. Multivariate Cox regression analysis revealed that younger age (< 57 years) at start of first sunitinib (HR = 0.24; 95% CI 0.07–0.79; p  = 0.019) and longer (> 2 years) first sunitinib treatment (HR = 0.28; 95% CI 0.09–0.93; p  = 0.038) were independent markers of longer OS. Conclusion Sunitinib rechallenge is a feasible and tolerable option with clinical benefit in selected mRCC patients.