837P - Second line treatment in metastatic papillary renal cell carcinoma: retrospective analysis of a 48 patients cohort

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anticancer agents
Renal Cell Cancer
Therapy
Biological therapy
Presenter Laurence Albiges
Authors L. Albiges1, F. Riet2, C. Massard3, S. Le Moulec4, Y. Loriot2, A. Levy2, B. Escudier5
  • 1Department Of Medical Oncology, Institut Gustave Roussy, 94805 - Villejuif/FR
  • 2Department Of Medical Oncology, Institut Gustave Roussy, Villejuif/FR
  • 3Sitep, Institut Gustave Roussy, Villejuif/FR
  • 4Oncologie Medicale, Hôpital d'instruction des armées du Val-de-Grâce, Paris/FR
  • 5Institut Gustave Roussy, Villejuif/FR

Abstract

Background

Papillary renal cell carcinoma (pRCC) accounts for 10-15% of mRCC. Although standard VEGF/mTOR inhibitors were retrospectively assessed in this setting, there is no specific recommendation for this subtype. First line prospective dedicated studies are to be released shortly. No second line data have been reported so far.

Material and methods

All pts with metastatic pRCC treated in first line from May 2006 to Nov 2011 at Institut Gustave Roussy, were retrospectively analysed. Clinical data, prognosis classifications and treatments were assessed; PFS after first and second line treatments and OS were calculated.

Results

Forty-eight pts with metastatic pRCC were identified. Median age at diagnosis was 62, sex ratio 41M / 7F. Histological subtypes were type 2 (67%), type I (10%), and unclassified (23%). Nephrectomy had been performed in 38 pts (78%). Most pts presented with synchronous metastatic disease (68%). Metastatic sites were respectively: lung (52%), retroperitoneal LN (44%), mediastinal LN (46%), bone (25%), liver (23%). Prognostic classification by MSKCC was good in 14, intermediate in 27 and poor in 4 pts. Median OS was 16.2 months [1-70], 21/48 pts are still alive with a median follow up of 24 months. A majority of pts (77%) was enrolled in prospective phase II and III clinical trials as first or second line treatment, others were treated according to guidelines. As first line treatment, pts received: sunitinib (25), everolimus (19), sorafenib (2), bevacizumab based regimen (2). Median first line PFS is 8.0 months [1-43]. Thirty-two (73 %) pts received a second line treatment after first line failure. Second line treatment included VEGFR-TKI (19) including sunitinib (11), sorafenib (6) and pazopanib (2) or mTOR inhibitor (12). Median second line PFS is 3.3 months [1-34]. Median PFS is 3.0 months after TKI and 3.7 months after mTOR inhibitors. Noteworthy fourteen patients (29%) received a third line treatment.

Conclusions

This is the first report of second line data in pRCC. Median second line PFS is 3.3 months, similar for mTOR inhibitors and VEGFR-TKI agents. Nevertheless PFS post-second line treatment in pRCC is lower than that observed in clear cell RCC, pointing out their poorer prognosis and the need for biology-driven dedicated targeted therapy development.

Disclosure

L. Albiges: Laurence Albiges declares Novartis (compensated) and pfizer (uncompensated) consultant role and honoraria from novartis for other topic. No funding or honoraria related to the submitted abstract.

K. Fizazi: Participation to advisory boards and/or speaker for: – Amgen – Astrazeneca – Novartis – Sanofi–Aventis – Keocyt – Ipsen – Janssen – Astellas – BMS – Bayer.

B. Escudier: Consultant: Bayer, Pfizer, Roche, GSK, Aveo Honorario: Bayer, Roche, Pfizer, Genentech, Novartis, aveo.

All other authors have declared no conflicts of interest.