Because renal cell carcinoma (RCC) is diagnosed 75-80% with clear cell histology, there is little data on treatment and outcome of patients (pts) with non-clear RCC. They are reported to have a poorer prognosis and are often excluded from clinical trials. Here, we present data on papillary RCC, the most common non-clear cell subtype (10-15% of RCC).
The prospective German RCC-Registry includes pts with advanced or metastatic RCC at start of systemic first-line therapy. Data on patient and tumour characteristics, all systemic therapies and outcome are collected. More than 300 medical and uro oncologists are recruiting pts since 2007.
Median age for pts with papillary RCC (n = 92) at start of first-line therapy was 66 years. According to MSKCC risk category, pts were classified into 30% low, 55% intermediate and 2% high risk (12% unknown). From 2007 to May 2016 (data cut) treatment changed. First-line, the use of sunitinib declined and the use of temsirolimus and pazopanib increased. Since 2011 (n = 46), first-line treatments included 33% (n = 15) temsirolimus, 30% (n = 14) sunitinib and 22% (n = 10) pazopanib. The most frequently used second-line treatments since 2011 (n = 28) are sunitinib (36%, n = 10), everolimus and pazopanib (18%, n = 5 each), temsirolimus (11%, n = 3) followed by axitinib and sorafenib (7%, n = 2, each). The most frequently used first -> second-line strategies (first-line since 2011, n = 23) are mTor inhibitors (temsirolimus) -> TKI (35%, n = 8) and TKI -> TKI (26%, n = 6) (TKI: sunitinib, axitinib, pazopanib or sorafenib). Updated data (data cut May 2017) including nivolumab will be presented. Median progression-free survival (PFS) for the first-line was 6.1 months (95% CI 4.0 - 9.9) for pts with papillary RCC versus (vs) 8.6 (7.7 - 9.7) for pts with clear cell RCC (ccRCC, n = 772). For the second-line, median PFS was 3.7 (2.3 – 4.9) vs 4.8 (4.2 – 5.8) (papillary vs ccRCC). Median overall survival (OS) was 12.7 (8.5 – 23.8) vs 20.8 (19.1 – 23.8) (papillary vs ccRCC).
We show first- and second-line treatment of pts with advanced papillary RCC. Our data indicate that prognosis for pts with papillary RCC might be inferior to that of pts with clear cell RCC.
Clinical trial identification
Legal entity responsible for the study
Bayer Vital GmbH, GlaxoSmithKline GmbH & Co. KG, Novatis Pharma GmbH, Pfizer Pharma GmbH, Pfizer Pharma GmbH, Roche Pharma AG
M. Staehler: Consultant, Honoraria, Research Funding: Pfizer, GlaxoSmithKline, Novartis, Bayer, AVEO, Ipsen, Exelixis EISAI Consultant, Honoraria: EUSAPharm, Astellas, Pelloton Consultant, Research Funding: Roche/Genetech Research Funding: Immatics, Wilex. P.J. Goebell: Honoraria for paticipation in expert rounds and honoraria/support as a speaker from Astellas, AstraZeneca, Bayer, Bristol-Myers Squib, Eisai, Ipsen, Janssen, Novartis, Pfizer, Sanofi. N. Marschner: Employed by iOMEDICO, conducting the RCC-Registry as a CRO Member of advisory boards regarding RCC treatment: Novartis, Pfizer, Roche, GSK, Bayer Travel grants: Roche, Novartis, Pfizer, Bayer, GSK Corporate sponsored research: Novartis, Pfizer Roche. All other authors have declared no conflicts of interest.