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In this presentation we will bring to your attention the case of a patient with clear cell renal carcinoma and the disease extended by multiple pulmonary, lymphatic, bone and liver metastases, classified according to the prognostic criteria in the intermediate risk group. The patient benefited from right nephrectomy with right partial adrenalectomy followed by four consecutive targeted therapies for metastatic disease: two lines of tyrosine kinase inhibitors (sunitinib in the first line and sorafenib in the second line), followed by two lines of mTOR inhibitors (temsirolimus and everolimus). The monitoring of disease progression was performed periodically through clinical and paraclinical examinations, computed tomography, bone scan and MRI examinations. The therapeutic line was changed every time the disease progressed. We experienced a spectacular patient survival under four treatment lines of 45 months in metastatic disease, compared to a statistically estimated median survival period of 22.5 months for patients with metastatic renal cancer in the intermediate risk group. We basically observed that for this patient the survival was double. [ABSTRACT FROM AUTHOR]

At the moment, genetic tests have become an important and necessary part of the diagnosis and treatment algorithm of cancer. Genetic testing becomes mandatory in many cancers for the correct orientation of treatment. Genetic tests have a prognostic and predictive role, depending on the outcome of the treatment and the prognosis group in which the patient is framed. Therefore, we can speak at this moment about custom therapies tailored to each individual patient, depending on the molecular biology of the tumor, prognostic factors and predictive factors. Targeted therapies are selected according to the mutations identified at the tumor level, which offer a major advantage in terms of response rate, time to disease progression and median survival. Also, the benefit of adjuvant therapies or certain types of cytotoxic agents may be estimated by preliminary genetic testing, thereby avoiding additional toxicity in patients with good prognosis at low risk of recurrence. Also, genetic tests can be used to determinate the risk of developing cancer. Several types of cancer display a familial predisposition and specific gene mutations confer a high-lifetime risk to develop the disease. During the last decades, the basis for such genetic predisposition has been clarified for several cancer syndromes and the high-risk genes mutated in familial cases are currently subjected to genetic diagnostic screening programs. Mutation testing in these genes has a major impact in genetic counseling, helps increase the chance of survival, defines the prognosis of carriers, and identifies the most appropriate and prophylactic measures. [ABSTRACT FROM AUTHOR]

Bladder cancer is the seventh cause of cancer death in men and the tenth in women. In metastatic disease, the prognosis remains poor, with a median survival of 15 months. Chemotherapy has remained standard systemic therapy over the past 15 years for patients with recurrent or metastatic disease. The therapeutic regimens recommended by guides in metastatic disease, as the first treatment line, are the combination of gemcitabine and platinum salts or the MVAC combination. Currently, there is no second-line standard systemic therapy for patients with tumor relapse after first-line chemotherapy. Therefore, the treatment of advanced and metastatic urothelial tumors remains a challenge for oncologists. Following radical cystectomy, more than half of patients with invasive urothelial carcinoma will develop recurrent disease. The excellent results obtained in the treatment of other solid tumors using targeted therapies such as tyrosine kinase inhibitors or CTLA-4 anti-CTL-4 or PD1 inhibitor immunotherapy have led to the idea that these therapies could be used with promising results in the treatment of metastatic bladder cancer. The acquisition of mutations in the PI3K/AKT/mTOR intracellular signal transduction pathway has been demonstrated in over 40% of bladder cancers, suggesting that blocking the mTOR pathway would be a promising target therapy in this pathology. Starting from this idea, there are currently several phase I and II studies of mTOR inhibitors like temsirolimus or sirolimus, the preliminary results being encouraging. In terms of immunotherapy in metastatic bladder cancer, there are currently several phase I or phase II studies testing anti-CTLA-4 therapy (ipilimumab) or PD1 inhibitors (nivolumab). Besides these molecules, there are studies that test new molecules such as MPDL3280A, MEDI4736 and MK3475 (lambrolizumab). All preliminary data show the efficacy of these new therapies in metastatic urothelial carcinoma. Our paper aims to review these new therapies by presenting the undergoing studies for recurrent and metastatic urothelial carcinoma with the preliminary results and safety profile of these new agents. In the future, we will have a new standard in the systemic treatment of advanced and metastatic urothelial carcinomas. [ABSTRACT FROM AUTHOR]

Ocular melanoma is a distinct entity with an increasing incidence in recent years. The incidence of ocular melanomas in the USA, according to Surveillance, Epidemiology and End Results (SEER), is 0.69/100,000 people per year in men and 0.54/100,000 people per year in women. Ocular melanoma has a particular prognosis and treatment. It represents 5% of all melanomas. Among ocular malignancies, melanomas are the most common. 13% of the deaths due to melanoma are caused by ocular melanoma because of the increased metastatic rate and poor response to treatment. Metastases occur in 31% of patients at 5 years, 45% at 15 years and 50% at 25 years, according to Collaborative Ocular Melanoma Study Group (COMS). Metastases in the liver are the most common - 89% of patients with metastasis. The death rate from metastasis is 80% at 1 year and 92% at 2 years. In recent years, the mutations that occur in ocular melanoma and treatment options have been extensively researched. The results obtained with various systemic therapies are disappointing. In this paper we intend to present prognostic factors and treatment modalities. [ABSTRACT FROM AUTHOR]