836P - Prognostic factors and validation of prognostic nomograms in patients (pts) treated with 3 targeted therapies (TTs) for metastatic renal cell carcin...

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Renal Cell Cancer
Presenter Roberto Iacovelli
Authors R. Iacovelli1, M. Rizzo2, V. Lorusso3, F. Atzori4, P.A. Zucali5, C. Sacco6, F. Boccardo7, F. Valduga8, F. Massari9, G. Procopio10
  • 1Dipartimento Di Scienze Radiologiche, Oncologiche Ed Anatomo-patologiche, Sapienza University of Rome, 00161 - Rome/IT
  • 2Medical Oncology, Azienda Ospedaliera Antonio Cardarelli, Naples/IT
  • 3Medical Oncology Unit, Ospedale Vito Fazzi, IT-73100 - Lecce/IT
  • 4Azienda Ospedaliero Universitaria Cagliari, IT-09042 - Monserrato/IT
  • 5Department Of Oncology, Humanitas Cancer Center IRCCS, Rozzano/IT
  • 6Medical Oncology, University Hospital, Udine/IT
  • 7Dept. Of Medical Oncology B, IRCCS AOU San Martino - IST-Istituto Nazionale per la Ricerca sul Cancro, 16132 - Genova/IT
  • 8Medical Oncology, St Chiara Hospital, Trento/IT
  • 9Oncologia Medica, Azienda Ospedaliera Universitaria Integrata Verona-"Borgo Roma", 37134 - Verona/IT
  • 10Oncologia Medica, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT



Outcomes of pts treated with three TTs for mRCC have not been well characterized. Survival data as well as existing prognostic criteria in this population were evaluated.

Table: 836P

P Group Cleveland Clinic French Heng MSKCC
Pts (%) PFS (mos) p Pts (%) PFS (mos) p Pts (%) PFS (mos) P Pts (%) PFS (mos) p
Good 20 NR <0.001 6 NR 0.008 32 17.5 <0.001 21 NR <0.001
Intermediate 37 15.3 81 14.3 62 15.2 65 15.2
Poor 43 10.2 13 9.1 6 5.5 19 6.4


Pts with clear-cell mRCC who received 3 TTs were included. A questionnaire was send to main Italian centers involved in the treatment of mRCC. Demographic data, history of RCC, type and length of first, second and third lines were collected. Values of serum Hb, PLT, neutrophils, LDH and Ca, ECOG-PS, previous RT and number of metastatic sites >2 before the start of third line were evaluated. Cleveland Clinic, French, Heng, and MSKCC scores and relative survival were calculated.


Following the screening of 1905 pts, 252 (13%) with 3 TTs were identified. The median age was 60 yrs (range 52-68), 73% were male, 96% had nephrectomy and 38% were metastatic at diagnosis. At 1st line, the Motzer class was good, intermediate, and poor in 48%, 47% and 5% of pts, respectively. The median OS from the start of 3rd line was 14.3 mos (95%CI, 10.1 – 18.6). Rate and survival by prognostic group according to each classification are reported in table below. When prognostic factors were considered separately, at the univariate analysis ECOG-PS ≥ 2, Hb < LLN, LDH > 1.5ULN, Ca > ULN; PLT > ULN; Neu > ULN, and sites of disease >2 had negative prognostic role. Multivariate analysis shows an independent prognostic role only for ECOG-PS ≥ 2 (HR: 1.8; 95%CI: 1.1–2.8), Hb < LLN (HR: 1.8; 95%CI: 1.2–2.6) and neu > ULN (HR: 2.1; 95%CI: 1.2–3.8). Pts were stratified in 3 groups according to the presence of none, 1 or ≥2 prognostic factors. The median OS was 20.3, 13.6 and 7.8 months, respectively (p < 0.0001)


Current nomograms are able to predict survival in patients with mRCC before the 3rd line with TT. Neutrophils, platelets and ECOG-PS were the most important prognostic factors.


All authors have declared no conflicts of interest.