2024
Barriers to Clinical Trial Implementation Among Community Care Centers
Ebrahimi H, Megally S, Plotkin E, Shivakumar L, Salgia N, Zengin Z, Meza L, Chawla N, Castro D, Dizman N, Bhagat R, Liv S, Li X, Rock A, Liu S, Tripathi A, Dorff T, Oyer R, Boehmer L, Pal S, Chehrazi-Raffle A. Barriers to Clinical Trial Implementation Among Community Care Centers. JAMA Network Open 2024, 7: e248739. PMID: 38683608, PMCID: PMC11059033, DOI: 10.1001/jamanetworkopen.2024.8739.Peer-Reviewed Original ResearchConceptsClinical trial implementationClinical trial enrollmentTrial enrollmentUnmet needsCancer clinical trial enrollmentHealth care practicesPatients seeking careTrial implementationCommunity care centersCommunity oncology settingNational survey studyRural practiceClinical research opportunitiesCare practicesCare settingsCancer clinicOncology settingLimited staffingPractice changeRural settingsOncology clinicMain OutcomesHispanic residentsReferral practicesTrial participants
2023
Characterization of papillary and clear cell renal cell carcinoma through imaging mass cytometry reveals distinct immunologic profiles
Govindarajan A, Salgia N, Li H, Castro D, Mirzapoiazova T, Armstrong B, Zhao D, Mercier B, Dizman N, Chawla N, Zengin Z, Meza L, Tripathi N, Sayegh N, Chehrazi-Raffle A, Tripathi A, Pal S. Characterization of papillary and clear cell renal cell carcinoma through imaging mass cytometry reveals distinct immunologic profiles. Frontiers In Immunology 2023, 14: 1182581. PMID: 37638025, PMCID: PMC10457014, DOI: 10.3389/fimmu.2023.1182581.Peer-Reviewed Original ResearchConceptsClear cell renal cell carcinomaPapillary renal cell carcinomaRenal cell carcinomaCell renal cell carcinomaCell carcinomaT cellsTumor microenvironmentPRCC cohortCcRCC cohortCcRCC patientsMain immune cell typesDistinct immunologic profileRCC histological subtypesMedian overall survivalProportion of CD4Baseline tumor tissueImmune cell populationsSubtypes of RCCImmune cell typesMass cytometry analysisCross-validate findingsSignificant differencesFFPE samplesMacrophage compositionTME compartmentsReal-World Outcomes of Latinx Versus Non-Latinx Patients Treated With First-Line Immunotherapy for Metastatic Renal-Cell Carcinoma
Chehrazi-Raffle A, Leong S, Ali S, Kim T, Melamed S, Li X, Zengin Z, Meza L, Chawla N, Govindarajan A, Castro D, Mercier B, Ebrahimi H, Dizman N, Tripathi N, Sayegh N, Rock A, Yeh J, Pal S, Onyshchenko M. Real-World Outcomes of Latinx Versus Non-Latinx Patients Treated With First-Line Immunotherapy for Metastatic Renal-Cell Carcinoma. The Oncologist 2023, 28: 1079-1084. PMID: 37432304, PMCID: PMC10712704, DOI: 10.1093/oncolo/oyad190.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaProgression-free survivalComprehensive cancer centerNivolumab/ipilimumabShorter progression-free survivalOverall survivalRenal cell carcinomaLatinx patientsMultivariate Cox proportional hazards regressionCox proportional hazards regressionSafety-net healthcare systemHope Comprehensive Cancer CenterFirst-line immunotherapyTertiary oncology centerImmune checkpoint inhibitorsLos Angeles County DepartmentMedian overall survivalKaplan-Meier methodProportional hazards regressionDifferent healthcare settingsReal-world outcomesCheckpoint inhibitorsData cutoffClinical outcomesHazards regressionAssociation Between Time-of-Day of Immune Checkpoint Blockade Administration and Outcomes in Metastatic Renal Cell Carcinoma
Dizman N, Govindarajan A, Zengin Z, Meza L, Tripathi N, Sayegh N, Castro D, Chan E, Lee K, Prajapati S, Feng M, Loo V, Pace M, O'Brien S, Bailey E, Barragan-Carrillo R, Chehrazi-Raffle A, Hsu J, Li X, Agarwal N, Pal S. Association Between Time-of-Day of Immune Checkpoint Blockade Administration and Outcomes in Metastatic Renal Cell Carcinoma. Clinical Genitourinary Cancer 2023, 21: 530-536. PMID: 37495481, DOI: 10.1016/j.clgc.2023.06.004.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaObjective response rateTreatment failureRenal cell carcinomaHazard ratioOverall survivalCell carcinomaMultivariate analysisHigh Cut-OffNivolumab/ipilimumabProspective Randomized StudyBaseline characteristicsRandomized studyClinical outcomesMedian timePreclinical evidenceUnivariate analysisPatientsResponse rateImmune systemInfusion timeStatistical significanceOutcomesCarcinomaInfusionChanges in Perception of Cure Among Patients With Genitourinary Cancers Initiating Immune Checkpoint Inhibitors: A Longitudinal Study
Bergerot C, Philip E, Govindarajan A, Castro D, Malhotra J, Bergerot P, Salgia S, Salgia M, Salgia N, Hsu J, Meza L, Zengin Z, Liu S, Chehrazi-Raffle A, Tripathi A, Dorff T, Pal S. Changes in Perception of Cure Among Patients With Genitourinary Cancers Initiating Immune Checkpoint Inhibitors: A Longitudinal Study. Clinical Genitourinary Cancer 2023, 21: 626-630.e3. PMID: 37391301, PMCID: PMC11225089, DOI: 10.1016/j.clgc.2023.05.018.Peer-Reviewed Original ResearchConceptsPerception of cureExpectation of cureGenitourinary cancersImmune checkpoint inhibitor therapyCheckpoint inhibitor therapyImmune checkpoint inhibitorsProportion of patientsSevere side effectsLongitudinal studyChi-square testICI therapyCheckpoint inhibitorsInhibitor therapyECOG scoreGeneral linear modelingPatients' perceptionsMetastatic cancerPatientsSide effectsDecreased anxietyTherapyCancerCureLower ratesAnxiety ScaleExamining Exclusion Criteria in Advanced Prostate Cancer Clinical Trials: An Assessment of recommendations From the American Society Of Clinical Oncology and Friends of Cancer Research
Ebrahimi H, Castro D, Feng M, Prajapati S, Lee K, Chan E, Paul T, Sehgal I, Patel J, Li X, Zengin Z, Meza L, Mercier B, Hsu J, Govindarajan A, Chawla N, Dizman N, Bergerot C, Rock A, Liu S, Tripathi A, Dorff T, Pal S, Chehrazi-Raffle A. Examining Exclusion Criteria in Advanced Prostate Cancer Clinical Trials: An Assessment of recommendations From the American Society Of Clinical Oncology and Friends of Cancer Research. Clinical Genitourinary Cancer 2023, 21: e467-e473. PMID: 37301665, DOI: 10.1016/j.clgc.2023.05.013.Peer-Reviewed Original ResearchConceptsProstate cancer clinical trialsHBV/HCV infectionCancer clinical trialsHepatitis B virusClinical trialsConcurrent malignancyBrain metastasesEligibility criteriaHCV infectionHIV infectionExclusion criteriaClinical OncologyEastern Cooperative Oncology Group scaleAssessment of recommendationsECOG PS 0C virus infectionRestrictive eligibility criteriaAmerican SocietyCancer researchHCV positivityPS 0HIV positivityImmunotherapy trialsB virusVirus infectionUltrasensitive Circulating Tumor DNA Pilot Study Distinguishes Complete Response and Partial Response With Immunotherapy in Patients With Metastatic Renal Cell Carcinoma
Chehrazi-Raffle A, Muddasani R, Dizman N, Hsu J, Meza L, Zengin Z, Malhotra J, Chawla N, Dorff T, Contente-Cuomo T, Dinwiddie D, McDonald B, McDaniel T, Trent J, Baehner F, Murtaza M, Pal S. Ultrasensitive Circulating Tumor DNA Pilot Study Distinguishes Complete Response and Partial Response With Immunotherapy in Patients With Metastatic Renal Cell Carcinoma. JCO Precision Oncology 2023, 7: e2200543. PMID: 37027813, PMCID: PMC10309555, DOI: 10.1200/po.22.00543.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaPartial responseComplete responseVariant allele fractionRenal cell carcinomaCell carcinomaCtDNA analysisImmune checkpoint inhibitor therapyCheckpoint inhibitor therapyDiscontinuation of immunotherapyDepth of responseICI therapyNivolumab monotherapyEligible patientsRadiographic progressionInhibitor therapyPeripheral bloodDisease progressionCtDNA assessmentSubsequent progressionPatientsMultiple indicationsSingle time pointPatient-specific mutationsSecondary objectiveTwelve-Month Follow-up of the Immune Response After COVID-19 Vaccination in Patients with Genitourinary Cancers: A Prospective Cohort Analysis
Meza L, Zengin Z, Salgia S, Malhotra J, Karczewska E, Dorff T, Tripathi A, Ely J, Kelley E, Mead H, Hsu J, Dizman N, Salgia N, Chawla N, Chehrazi-Raffle A, Muddasani R, Govindarajan A, Rock A, Liu S, Salgia R, Trent J, Altin J, Pal S. Twelve-Month Follow-up of the Immune Response After COVID-19 Vaccination in Patients with Genitourinary Cancers: A Prospective Cohort Analysis. The Oncologist 2023, 28: e748-e755. PMID: 36971500, PMCID: PMC10485287, DOI: 10.1093/oncolo/oyad067.Peer-Reviewed Original ResearchConceptsCOVID-19 vaccinationGenitourinary cancersRenal cell carcinomaBooster doseCell carcinomaImmune responseBlood samplesSevere acute respiratory syndrome coronavirus 2Acute respiratory syndrome coronavirus 2T-cell receptor sequencingRespiratory syndrome coronavirus 2Baseline blood samplesMajority of patientsMinority of patientsProspective cohort analysisSyndrome coronavirus 2Twelve-month followAntibody titer analysisCOVID-19 vaccineSeroconversion ratesMedian ageUrothelial cancerCoronavirus 2Prostate cancerCohort analysisOutcomes for International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Groups in Contemporary First-line Combination Therapies for Metastatic Renal Cell Carcinoma
Ernst M, Navani V, Wells J, Donskov F, Basappa N, Labaki C, Pal S, Meza L, Wood L, Ernst D, Szabados B, McKay R, Parnis F, Suarez C, Yuasa T, Lalani A, Alva A, Bjarnason G, Choueiri T, Heng D. Outcomes for International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Groups in Contemporary First-line Combination Therapies for Metastatic Renal Cell Carcinoma. European Urology 2023, 84: 109-116. PMID: 36707357, DOI: 10.1016/j.eururo.2023.01.001.Peer-Reviewed Original ResearchConceptsInternational mRCC Database ConsortiumMetastatic renal cell carcinomaInternational mRCC Database Consortium risk groupIO combination therapyIpi-nivoOverall survivalRenal cell carcinomaCombination therapyTreatment durationRisk groupsCell carcinomaImmuno-oncologyTreatment cohortsInternational Metastatic Renal Cell Carcinoma Database Consortium modelStandard of care first-line treatmentVascular endothelial growth factor-targeted therapyFirst-line combination therapyMedian follow-up timePoor-risk groupEndpoint of OSFirst-line treatmentKaplan-Meier methodLog-rank testModel stratified patientsShort follow-upGenomic and Transcriptomic Predictors of Response from Stereotactic Body Radiation Therapy in Patients with Oligoprogressive Renal Cell Carcinoma
Zengin Z, Govindarajan A, Salgia N, Sayegh N, Tripathi N, Muddasani R, Chehrazi-Raffle A, Feng M, Mercier B, Ladbury C, Hao C, Salgia S, Chawla N, Meza L, Malhotra J, Dizman N, Hsu J, Castro D, Barragan-Carrillo R, Ebrahimi H, Philip E, Chang M, Zhang J, Byron S, Lyou Y, Dorff T, Pal S, Dandapani S. Genomic and Transcriptomic Predictors of Response from Stereotactic Body Radiation Therapy in Patients with Oligoprogressive Renal Cell Carcinoma. European Urology Oncology 2023, 6: 447-450. PMID: 36609061, DOI: 10.1016/j.euo.2022.11.006.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaStereotactic body radiation therapyRenal cell carcinomaBody radiation therapyCell carcinomaRadiation therapyClear cell renal cell carcinomaFirst-line treatmentCell renal cell carcinomaStereotactic body radiotherapyKidney cancer patientsOligoprogressive diseaseSystemic treatmentReactive oxygen species pathwayBody radiotherapyCancer patientsTreatment selectionPatientsTreatment changesOxygen species pathwayRadiation treatmentCarcinomaCell proliferationPotential roleRadiotherapyPerceptions of COVID-19 Vaccination in Patients with Genitourinary Cancers: A Survey Study
Castro D, Zengin Z, Malhotra J, Bergerot C, Meza L, Dizman N, Govindarajan A, Hsu J, Chehrazi-Raffle A, Chawla N, Mercier B, Chen S, Feng M, Prajapati S, Lee K, Philip E, Dorff T, Lyou Y, Pal S. Perceptions of COVID-19 Vaccination in Patients with Genitourinary Cancers: A Survey Study. Cancer Investigation 2023, 41: 70-76. PMID: 36239609, DOI: 10.1080/07357907.2022.2136683.Peer-Reviewed Original Research
2022
Tivozanib in Patients with Advanced Renal Cell Carcinoma Previously Treated With Axitinib: Subgroup Analysis from TIVO-3
Meza L, McDermott D, Escudier B, Hutson T, Porta C, Verzoni E, Atkins M, Kasturi V, Pal S, Rini B. Tivozanib in Patients with Advanced Renal Cell Carcinoma Previously Treated With Axitinib: Subgroup Analysis from TIVO-3. The Oncologist 2022, 28: e167-e170. PMID: 36576430, PMCID: PMC10020797, DOI: 10.1093/oncolo/oyac255.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaProgression-free survivalRenal cell carcinomaTIVO-3Cell carcinomaResponse rateEvaluate PFSAdvanced renal cell carcinomaTreated with axitinibTreatment of patientsClinical efficacyIdentified patientsSubgroup analysisTivozanibAxitinibPatientsCarcinomaSorafenibTreatmentMonthsSubgroupsTrialsTherapySurvivalDrugCharacterization of Patients With Metastatic Renal Cell Carcinoma Experiencing Complete Response to First-line Therapies: Results From the International Metastatic Renal Cell Carcinoma Database Consortium
Takemura K, Navani V, Ernst M, Wells J, Meza L, Pal S, Lee J, Li H, Agarwal N, Alva A, Hansen A, Basappa N, Szabados B, Powles T, Tran B, Hocking C, Beuselinck B, Yuasa T, Choueiri T, Heng D. Characterization of Patients With Metastatic Renal Cell Carcinoma Experiencing Complete Response to First-line Therapies: Results From the International Metastatic Renal Cell Carcinoma Database Consortium. Journal Of Urology 2022, 209: 701-709. PMID: 36573926, DOI: 10.1097/ju.0000000000003132.Peer-Reviewed Original ResearchConceptsTKI cohortInternational Metastatic Renal Cell Carcinoma Database ConsortiumComplete responseFirst-line therapyOverall survivalCombination therapyTKI armsTyrosine kinase inhibitor therapyMetastatic renal cell carcinomaNon-clear cell histologyMultiple sites of metastasesTyrosine kinase inhibitor monotherapyBaseline characteristics of patientsResponse rateComplete response rateKinase inhibitor therapyOverall survival benefitSite of metastasisFavorable overall survivalRenal cell carcinomaAdverse clinicopathological featuresCharacterization of patientsReal-world patientsCharacteristics of patientsClinical trial populationsGenomic and Clinical Prognostic Factors in Patients With Advanced Urothelial Carcinoma Receiving Immune Checkpoint Inhibitors
Chawla N, Sayegh N, Tripathi N, Govindarajan A, Zengin Z, Phillip E, Dizman N, Meza L, Muddasani R, Chehrazi-Raffle A, Malhotra J, Hsu J, Agarwal N, Pal S, Tripathi A. Genomic and Clinical Prognostic Factors in Patients With Advanced Urothelial Carcinoma Receiving Immune Checkpoint Inhibitors. Clinical Genitourinary Cancer 2022, 21: 69-75. PMID: 36509613, DOI: 10.1016/j.clgc.2022.11.007.Peer-Reviewed Original ResearchConceptsProgression-free survivalOverall response rateTumor mutational burdenOverall survivalWorse OSPrimary diseaseMultivariate analysisMedian progression-free survivalImmune checkpoint inhibitor therapyInferior progression-free survivalPromoter mutationsWorse progression-free survivalCheckpoint inhibitor therapyMedian overall survivalImmune checkpoint inhibitorsTertiary cancer centerClinical prognostic factorsPrimary tumor siteTERT promoter mutationsCheckpoint inhibitorsInhibitor therapyLaboratory parametersPrognostic factorsCancer CenterFemale sexCabozantinib Safety With Different Anticoagulants in Patients With Renal Cell Carcinoma
Shayeb A, McManus H, Urman D, Jani C, Zhang T, Dizman N, Meza L, Sivakumar A, Gan C, Barata P, Bilen M, Gao X, Heng D, Pal S, Narra R, Kilari D, Kaymakcalan M, McGregor B, Choueiri T, McKay R. Cabozantinib Safety With Different Anticoagulants in Patients With Renal Cell Carcinoma. Clinical Genitourinary Cancer 2022, 21: 55-62. PMID: 36411184, DOI: 10.1016/j.clgc.2022.10.013.Peer-Reviewed Original ResearchConceptsLow molecular weight heparinRenal cell carcinomaMajor bleeding eventsBleeding eventsRecurrent VTECell carcinomaDirect oral anticoagulant useAdvanced renal cell carcinomaDifferent anticoagulantsPrimary safety endpointSafety of cabozantinibOral anticoagulant usePrimary efficacy endpointClear cell histologyReal-world cohortRetrospective multicenter studyRisk-benefit discussionsLimited safety dataVenous thromboembolism managementMolecular weight heparinAnticoagulant groupConcurrent anticoagulationDOAC groupThrombosis complicationsEfficacy endpointReal-world Practice Patterns and Safety of Concurrent Radiotherapy and Cabozantinib in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium
Loo Gan C, Huang J, Pan E, Xie W, Schmidt A, Labaki C, Meza L, Bouchard G, Li H, Jackson-Spence F, Sánchez-Ruiz C, Powles T, Kumar S, Weise N, Hall W, Rose B, Beuselinck B, Suarez C, Pal S, Choueiri T, Heng D, McKay R. Real-world Practice Patterns and Safety of Concurrent Radiotherapy and Cabozantinib in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. European Urology Oncology 2022, 6: 204-211. PMID: 36328934, DOI: 10.1016/j.euo.2022.10.004.Peer-Reviewed Original ResearchConceptsMetastatic renal cell carcinomaMRCC treated with cabozantinibRenal cell carcinomaAdverse eventsRisk-benefit assessmentCell carcinomaReceiving radiotherapyInternational Metastatic Renal Cell Carcinoma Database ConsortiumPatients treated with stereotactic ablative body radiotherapyInternational multicenter retrospective studyStereotactic ablative body radiotherapyPractice patternsConventional palliative radiotherapyGrade 5 eventsIntermediate-risk diseaseReceipt of radiotherapyMultiple brain metastasesMetastatic kidney cancerRadiotherapy-related toxicityCourse of radiotherapyEfficacy of cabozantinibMulticenter retrospective studyStudy of patientsOptimize treatment outcomesAssessment of patientsLive bacterial supplementation for improving treatment response in metastatic renal cell carcinoma
Meza L, Govindarajan A, Feng M, Pal S. Live bacterial supplementation for improving treatment response in metastatic renal cell carcinoma. Clinical And Translational Medicine 2022, 12: e948. PMID: 35899808, PMCID: PMC9332118, DOI: 10.1002/ctm2.948.Peer-Reviewed Original ResearchCABOSEQ: The Effectiveness of Cabozantinib in Patients With Treatment Refractory Advanced Renal Cell Carcinoma: Results From the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC)
Navani V, Wells J, Boyne D, Cheung W, Brenner D, McGregor B, Labaki C, Schmidt A, McKay R, Meza L, Pal S, Donskov F, Beuselinck B, Otiato M, Ludwig L, Powles T, Szabados B, Choueiri T, Heng D. CABOSEQ: The Effectiveness of Cabozantinib in Patients With Treatment Refractory Advanced Renal Cell Carcinoma: Results From the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). Clinical Genitourinary Cancer 2022, 21: 106.e1-106.e8. PMID: 35945133, DOI: 10.1016/j.clgc.2022.07.008.Peer-Reviewed Original ResearchConceptsInternational Metastatic Renal Cell Carcinoma Database ConsortiumIpilimumab-nivolumabOverall survivalTreatment failureAdvanced renal cell carcinomaActivity of cabozantinibClinically meaningful activityMedian TTFEffects of cabozantinibGrowth factor inhibitorsRenal cell carcinomaMultivariate Cox regressionMedian OSRetrospective observational naturePoor riskCell carcinomaFactor inhibitorsCabozantinibCox regressionResponse ratePatientsOverall populationObservational natureVEGFiMonthsOutcomes of patients with advanced non-clear cell renal cell carcinoma treated with first-line immune checkpoint inhibitor therapy
Graham J, Wells J, Dudani S, Gan C, Donskov F, Lee J, Kollmannsberger C, Meza L, Beuselinck B, Hansen A, North S, Bjarnason G, Sayegh N, Kanesvaran R, Wood L, Hotte S, McKay R, Choueiri T, Heng D. Outcomes of patients with advanced non-clear cell renal cell carcinoma treated with first-line immune checkpoint inhibitor therapy. European Journal Of Cancer 2022, 171: 124-132. PMID: 35717820, DOI: 10.1016/j.ejca.2022.05.002.Peer-Reviewed Original ResearchConceptsInternational Metastatic RCC Database ConsortiumImmune checkpoint inhibitor groupImmune checkpoint inhibitorsVascular endothelial growth factorICI-based therapyObjective response rateVascular endothelial growth factor groupMammalian target of rapamycinClear-cell renal cell carcinomaFirst-line therapyOutcomes of patientsRenal cell carcinomaTreatment failureOverall survivalInhibitor monotherapyCell carcinomaFirst-lineAdvanced non-clear cell renal cell carcinomaInternational Metastatic RCC Database Consortium risk groupMammalian target of rapamycin-targeted therapiesMetastatic clear-cell renal cell carcinomaNon-clear cell renal cell carcinomaNon-clear cell RCCAssociated with improved OSMedian TTFImaging Response to Contemporary Immuno-oncology Combination Therapies in Patients With Metastatic Renal Cell Carcinoma
Navani V, Ernst M, Wells J, Yuasa T, Takemura K, Donskov F, Basappa N, Schmidt A, Pal S, Meza L, Wood L, Ernst D, Szabados B, Powles T, McKay R, Weickhardt A, Suarez C, Kapoor A, Lee J, Choueiri T, Heng D. Imaging Response to Contemporary Immuno-oncology Combination Therapies in Patients With Metastatic Renal Cell Carcinoma. JAMA Network Open 2022, 5: e2216379. PMID: 35687336, PMCID: PMC9187954, DOI: 10.1001/jamanetworkopen.2022.16379.Peer-Reviewed Original ResearchConceptsInternational Metastatic Renal Cell Carcinoma Database ConsortiumMetastatic renal cell carcinomaIO combination therapyInternational Metastatic Renal Cell Carcinoma Database Consortium riskPresence of lung metastasesCombination therapyCytoreductive nephrectomyComplete responseStable diseasePartial responseOverall survivalLung metastasesProgressive diseaseImmuno-oncologyImaging responseDiagnosis of metastatic renal cell carcinomaVascular endothelial growth factor inhibitorsIncreased likelihood of responseMedian overall survivalResponse Evaluation CriteriaGrowth factor inhibitorsMulticenter international cohort studyRenal cell carcinomaLikelihood of responseInternational cohort study