837P - Poor risk metastatic renal cell carcinoma (mRCC) patients are not a homogeneous group: A new stratificating model in the era of targeted therapy

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Renal Cell Cancer
Translational Research
Presenter Francesco Guida
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors F.M. Guida1, M. Santoni2, U. De Giorgi3, M. De Tursi4, G. Procopio5, S. Pignata6, L. Galli7, G. Di Lorenzo8, G. Badalamenti9, A. Felici10, P. Marchetti11, R. Iacovelli12, F. Longo13, M. Maruzzo14, F. Massari15, C. Suarez16, M. Aieta17, S. Cascinu2, M. Milella18, D. Santini19
  • 1Medical Oncology, university campus bio-medico, 00128 - rome/IT
  • 2Medical Oncology, AOU Ospedali Riuniti Ancona Università Politecnica delle Marche, 60126 - Ancona/IT
  • 3Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, 47014 - Meldola (FC)/IT
  • 4Medical Oncology, Ospedale SS. Annunziata, Chieti/IT
  • 5Oncologia Medica, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 6Dipartimento Di Oncologia Uroginecologica, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G Pascale, IRCCS, Napoli/IT
  • 7Azienda Ospedaliero-universitaria Pisana, Istituto Toscano Tumori, Division of Medical Oncology, 55100 - Pisa/IT
  • 8Genitourinary Cancer Section And Rare-cancer Center, University Federico II, 80131 - Napoli/IT
  • 9Oncologia Medica, Azienda Ospedaliera Universitaria Policlinico 'Paolo Giaccone', Palermo/IT
  • 10Divisione Di Oncologia Medica A, Istituto Nazionale Tumori Regina Elena, 00144 - Roma/IT
  • 11Oncologia Medica, Azienda Ospedaliera St. Andrea - Roma, IT-00189 - Roma/IT
  • 12Medical Oncology, Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 13Dipartimento Medicina Sperimentale E Patologia, Policlinico Umberto I, IT-00161 - Roma/IT
  • 14Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, IT-35128 - Padova/IT
  • 15Oncologia Medica, Azienda Ospedaliera Universitaria Integrata Verona-"Borgo Roma", 37134 - Verona/IT
  • 16Oncology, Hospital Vall d'Hebron, Barcelona/ES
  • 17Medical Oncology, Department of Medical Oncology, National Institute of Cancer, Rionero in Vulture (PZ)., 70122 - Rionero (PZ)/IT
  • 18Divisione Di Oncologia Medica A, Istituto Regina Elena, 00144 - Roma/IT
  • 19Medical Oncology, Campus Bio-Medico di Roma, 00128 - Roma/IT

Abstract

Aim

The prognostic stratification of poor risk mRCC patients in the era of targeted therapy represents an unmet medical need. We analyzed, individually, each prognostic factor included in modified Memorial Sloan-Kettering Cancer Center (MSKCC) and Heng criteria to investigate their prognostic relevance in poor risk mRCC patients and proposed a model to stratify poor risk patients into 3 separate subgroups.

Methods

Data were collected from 20 Italian and 2 Spanish centers. Overall survival (OS) was estimated using Kaplan-Meier method. Hemoglobin, Performance Status, Thrombocytosis, Neutrophilia, Number of metastatic sites, Time from diagnosis to treatment, LDH and Hypercalcemia, according to modified MSKCC and Heng criteria, were included in the Cox analysis.

Results

239 (151 males; 205 clear cell) poor risk mRCC pts were enrolled according to, at least, three of MSKCC, or modified MSKCC or Heng criteria. 233 pts were treated with a first line therapy (56 pts with temsirolimus, 163 pts with tyrosine kinase inhibitors (TKI), 14 pts with other agents); 101 pts with a second line (50 everolimus, 49 TKI, 2 other agents) and 31 pts with a third line ( 4 everolimus; 20 TKI, 7 other agents). Only Hemoglobin (13 vs 8 months; p = 0.005), Performance Status (14 vs 7 months; p = 0.002), and Time from diagnosis to treatment (22 vs. 8 months; p < 0.001) were predictors of short survival, independently from the presence/absence of the other prognostic factors. We identified three risk categories: the favorable-poor risk group (0-1 of previous confirmed three prognostic factors; 45 pts) in which median OS (mOS) was 20 months; the intermediate-poor risk group (2 prognostic factors; 111 pts) in which mOS was 11 months and the poor-poor risk group (3 prognostic factors; 81 pts) in which mOS was 5 months (p < 0.001).

Conclusions

This is the first study that identifies three different prognostic subgroups among poor risk RCC patients. Kaplan Meier survival curves of each subgroup will be presented during the meeting.

Disclosure

All authors have declared no conflicts of interest.