826P - Contribution of tumor burden and body composition parameters as prognostic factors of metastatic renal cell carcinoma (mRCC) treated by targeted th...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Renal Cell Cancer
Presenter Emilie Lanoy
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors E. Lanoy1, S. Antoun2, R. Iacovelli3, Y. Loriot4, M. Merad5, C. Massard4, K. Fizazi4, M. Dipalma5, B. Escudier4
  • 1Biostatistic And Epidemiology Unit, Gustave Roussy, 94805 - villejuif/FR
  • 2Ambulatory Care, Gustave-Roussy, 94805 - Villejuif/FR
  • 3Medical Oncology, Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 4Medical Oncology, Gustave-Roussy, 94805 - Villejuif/FR
  • 5Ambulatory Care, Gustave Roussy Institute, 94805 - Villejuif/FR

Abstract

Aim

We previously showed that tumor burden (TB) and skeletal muscle density (SMD) at baseline are independent prognostic factors for overall survival (OS) in mRCC. We aimed to analyze the respective roles of baseline TB and Heng score, baseline and 12 week- body mass index (BMI) (weight /height2) and body composition (BC) on OS in mRCC included in trials evaluating targeted therapy.

Methods

Baseline and 12 weeks- TB, BMI, adipose tissue (AT), muscular muscle (MM) and SMD were assessed using previously reported techniques. To withdraw causes of early death, OS was estimated from 12 weeks after therapy initiation, using Kaplan-Meier method and compared across strata using log-rank test. To identify prognostic factors, impact of baseline and 12 week- body components were assessed in a multivariable Cox proportional hazards models adjusted for Heng risk groups.

Results

116 pts, treated with sorafenib (n = 35), sunitinib (n = 33) or everolimus (n = 18) or placebo (n = 30) with full data for TB, BMI and BC, have been analyzed. BMI was low (< 18.5), normal (18.5 – 25) and high (> 25 kg2/m2) in 3 (3%), 47 (41%) and 66 (56%) pts respectively. Median OS was 18 months, 95% Confidence Interval (CI) = [16;21]. Median estimates and hazard ratios derivated from the multivariable Cox model were:

Median OS (weeks) Hazard Ratio (95%CI) p-value
Heng risk
High 6 1 - 0.0002
Intermediate 45 0.2 0.1 – 0.6
Favorable 112 0.1 0.0 – 0.3
TB
>= 19 cm 76 1 - 0.0002
9.5-19 cm 85 1.2 0.7 – 2.1
<9.5 cm 161 0.4 0.2 – 0.7
BMI
Normal 112 1 - 0.007
Low 154 0.8 0.2-3.2
High 66 1.9 1.2 – 3.1

SMD and BC were not independently associated with OS.

Conclusions

High/intermediate risk Heng score, large TB and high BMI are independent predictors of shorter survival in pts alive after 12 weeks of treatment. Mechanisms underlying the surprising deleterious effect of high BMI could not be determined from body composition impact analysis. After adjustment on TB, high muscle density is not protective any more.

Disclosure

Y. Loriot: Advisory board Bayer; B. Escudier: Advisory board Bayer, Pfizer, Novartis Honoraria from Bayer, Roche, Pfizer, Genentech, Novartis, AVEO, GSK. All other authors have declared no conflicts of interest.