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1143 Treatment of patients with metastatic papillary-type II and clear-cell renal cell carcinoma – comparison of the survival with tyrosine kinase inhibitors
1143
Treatment of patients with metastatic papillary-type II and clear-cell renal cell carcinoma comparison of the survival with tyrosine kinase inhibitors Eur Urol Suppl 2014;13;e1143
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Casuscelli J., Szabados B., Buchner A., Stief C.G., Staehler M. University-Hospital Munich Grosshadern, Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: To-date the sequential use of tyrosine kinase inhibitors (TKI) has shown efficacy and prolongation of the survival in patients with metastatic clear-cell renal cell carcinoma (ccRCC). However the treatment of patients with non-clear-cell RCC has not yet been established and the data on TKI therapy of rare renal cell cancer histologies is scarce. In our study we focus on papillary type II renal cell carcinoma (papIIRCC) and assess the outcome of our patients with metastatic disease on systemic treatment. The outcomes are compared with our patients with clear cell histology. MATERIAL & METHODS: Patients with metastases of papillary type II renal cell carcinoma or clear cell renal cell carcinoma with follow up of ≥2 years were identified from an institutional database. First-line treatment in all patients consisted in single agent sunitinib or sorafenib. We assessed progression free survival (PFS) and overall survival (OS). Subgroup analyses were conducted to determine the influence of primary tumor stage and tumor differentiation on PFS and OS. Survival analyses generated Kaplan-Meier curves. RESULTS: 18 patients with papIIRCC received sunitinib (16) or sorafenib (2) while 166 patients with ccRCC were treated with sunitinib (78%) or sorafenib (22%). Median PFS for papIIRCC is 7 mos, for ccRCC it is 11 mos (p=0,026). OS for papIIRCC is 13 mos, while ccRCC show an OS of 32 mos (p<0,001). The same tendency for longer PFS and OS is seen in ccRCC patients with low primary tumor stage or highly differentiated carcinomas, whereas large tumors and low differentiation determine a similar poor prognosis in both groups. CONCLUSIONS: Patients with papIIRCC have on average a poorer outcome and shorter PFS than ccRCC patients on the same therapy. PapIIRCC patients benefit from TKI therapy. However, OS is significantly lower compared with ccRCC patients, in particular when initial tumor stage and differentiation suggest a more favourable prognosis. This difference may be due to the aggressive behaviour of the papillary type II histology, but our assumption is that the administered therapy is not conceived for this type of RCC. Future studies with larger groups are required to determine the optimal treatment for papillary type II renal cell cancer.
Treatment of patients with metastatic papillary-type II and clear-cell renal cell carcinoma comparison of the survival with tyrosine kinase inhibitors Eur Urol Suppl 2014;13;e1143
Print! Print!
Casuscelli J., Szabados B., Buchner A., Stief C.G., Staehler M. University-Hospital Munich Grosshadern, Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: To-date the sequential use of tyrosine kinase inhibitors (TKI) has shown efficacy and prolongation of the survival in patients with metastatic clear-cell renal cell carcinoma (ccRCC). However the treatment of patients with non-clear-cell RCC has not yet been established and the data on TKI therapy of rare renal cell cancer histologies is scarce. In our study we focus on papillary type II renal cell carcinoma (papIIRCC) and assess the outcome of our patients with metastatic disease on systemic treatment. The outcomes are compared with our patients with clear cell histology. MATERIAL & METHODS: Patients with metastases of papillary type II renal cell carcinoma or clear cell renal cell carcinoma with follow up of ≥2 years were identified from an institutional database. First-line treatment in all patients consisted in single agent sunitinib or sorafenib. We assessed progression free survival (PFS) and overall survival (OS). Subgroup analyses were conducted to determine the influence of primary tumor stage and tumor differentiation on PFS and OS. Survival analyses generated Kaplan-Meier curves. RESULTS: 18 patients with papIIRCC received sunitinib (16) or sorafenib (2) while 166 patients with ccRCC were treated with sunitinib (78%) or sorafenib (22%). Median PFS for papIIRCC is 7 mos, for ccRCC it is 11 mos (p=0,026). OS for papIIRCC is 13 mos, while ccRCC show an OS of 32 mos (p<0,001). The same tendency for longer PFS and OS is seen in ccRCC patients with low primary tumor stage or highly differentiated carcinomas, whereas large tumors and low differentiation determine a similar poor prognosis in both groups. CONCLUSIONS: Patients with papIIRCC have on average a poorer outcome and shorter PFS than ccRCC patients on the same therapy. PapIIRCC patients benefit from TKI therapy. However, OS is significantly lower compared with ccRCC patients, in particular when initial tumor stage and differentiation suggest a more favourable prognosis. This difference may be due to the aggressive behaviour of the papillary type II histology, but our assumption is that the administered therapy is not conceived for this type of RCC. Future studies with larger groups are required to determine the optimal treatment for papillary type II renal cell cancer.