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Meta-analysis of upfront VEGF targeted therapy prior to nephrectomy in metastatic clear cell renal cancer
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
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Meta-analysis of upfront VEGF targeted therapy prior to nephrectomy in metastatic clear cell renal cancer Eur Urol Suppl 2017; 16(3);e1604
Szabados B.1, Gomez De Liano Lista A.1, Wimalasingham A.1, De Bruijn R.2, Haanen J.3, Blank C.3, Hall P.4, Staehler M.6, Chowdhury S.5, Hopkins T.4, Powles T.4, Bex A.2 1
Barts Health Nhs Trust St Bartholomew's Hospital, Dept. of Oncology, London, United Kingdom, 2The Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands, 3The Netherlands Cancer Institute, Dept. of Oncology, Amsterdam, The Netherlands, 4Barts Health NHS Trust St Bartholomew's Hospital, Dept. of Oncology, London, United Kingdom, 5Guy's, King's and St Thomas' Hospitals, Dept. of Oncology, London, United Kingdom, 6University Hospital Munich-Grosshadern, Dept. of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: The safety and efficacy of upfront VEGF targeted therapy before nephrectomy in metastatic clear cell renal cancer (mCCRC) has not been robustly evaluated. MATERIAL & METHODS: In this study we performed a meta-analysis of 3 studies (NCT01512186, NCT01024205, EudraCT 2006-006491-38) with an almost identical design and included a single institution experience (which adopted this approach as a standard). Patients with newly diagnosed mCCRC had 12-18 weeks of sunitinib or pazopanib prior to planned cytoreductive nephrectomy (CN). RESULTS: 224 patients were included in this analysis (54% had sunitinib and 46% pazopanib). Overall 73% had MSKCC intermediate risk and 23% poor risk disease. 20% of patients had an ECOG performance status of 0.84% of patients obtained stable disease or a response to therapy (by RECIST 1.1) before surgery. The median reduction of size of the primary tumour was 14%. 59% of patients had CN. The commonest reason for not performing CN was progression of disease (52%). Progression free survival (PFS) and overall survival (OS) was 7.4 (95% CI 5.7-9.2) and 19.3 months (95% CI: 14.7-24.0) respectively. Patients with poor risk MSKCC disease (n=55) had a poor outcome irrespective of CN (OS = 8.0 months 95% CI 6.4-9.6). Patients with intermediate MSKCC risk having received CN (n=101) had a median OS of 35.16 months (95% CI 30.46-39.86) compared to 8.25 months (95% CI 0.73-15.77) in patients with intermediate risk who did not proceed to surgery (p<0.01). CONCLUSIONS: Outcomes with this approach are in line with expected survival for this population.This approach is attractive for patients with MSKCC intermediate risk disease as it may identify long-term survivors in combination with CN.
Eur Urol Suppl 2017; 16(3);e1604 Powered by TCPDF (www.tcpdf.org)
921
Meta-analysis of upfront VEGF targeted therapy prior to nephrectomy in metastatic clear cell renal cancer Eur Urol Suppl 2017; 16(3);e1604
Szabados B.1, Gomez De Liano Lista A.1, Wimalasingham A.1, De Bruijn R.2, Haanen J.3, Blank C.3, Hall P.4, Staehler M.6, Chowdhury S.5, Hopkins T.4, Powles T.4, Bex A.2 1
Barts Health Nhs Trust St Bartholomew's Hospital, Dept. of Oncology, London, United Kingdom, 2The Netherlands Cancer Institute, Dept. of Urology, Amsterdam, The Netherlands, 3The Netherlands Cancer Institute, Dept. of Oncology, Amsterdam, The Netherlands, 4Barts Health NHS Trust St Bartholomew's Hospital, Dept. of Oncology, London, United Kingdom, 5Guy's, King's and St Thomas' Hospitals, Dept. of Oncology, London, United Kingdom, 6University Hospital Munich-Grosshadern, Dept. of Urology, Munich, Germany INTRODUCTION & OBJECTIVES: The safety and efficacy of upfront VEGF targeted therapy before nephrectomy in metastatic clear cell renal cancer (mCCRC) has not been robustly evaluated. MATERIAL & METHODS: In this study we performed a meta-analysis of 3 studies (NCT01512186, NCT01024205, EudraCT 2006-006491-38) with an almost identical design and included a single institution experience (which adopted this approach as a standard). Patients with newly diagnosed mCCRC had 12-18 weeks of sunitinib or pazopanib prior to planned cytoreductive nephrectomy (CN). RESULTS: 224 patients were included in this analysis (54% had sunitinib and 46% pazopanib). Overall 73% had MSKCC intermediate risk and 23% poor risk disease. 20% of patients had an ECOG performance status of 0.84% of patients obtained stable disease or a response to therapy (by RECIST 1.1) before surgery. The median reduction of size of the primary tumour was 14%. 59% of patients had CN. The commonest reason for not performing CN was progression of disease (52%). Progression free survival (PFS) and overall survival (OS) was 7.4 (95% CI 5.7-9.2) and 19.3 months (95% CI: 14.7-24.0) respectively. Patients with poor risk MSKCC disease (n=55) had a poor outcome irrespective of CN (OS = 8.0 months 95% CI 6.4-9.6). Patients with intermediate MSKCC risk having received CN (n=101) had a median OS of 35.16 months (95% CI 30.46-39.86) compared to 8.25 months (95% CI 0.73-15.77) in patients with intermediate risk who did not proceed to surgery (p<0.01). CONCLUSIONS: Outcomes with this approach are in line with expected survival for this population.This approach is attractive for patients with MSKCC intermediate risk disease as it may identify long-term survivors in combination with CN.
Eur Urol Suppl 2017; 16(3);e1604 Powered by TCPDF (www.tcpdf.org)