Introduction:
The treatment of metastatic renal cell carcinoma has evolved with advances in systemic therapy. In the CARMENA trial, patients benefited from upfront systemic therapy, and 17% underwent deferred cytoreductive nephrectomy, with most experiencing near-complete responses to metastatic sites. Prior studies showed that tumor shrinkage of ≥10% with presurgical targeted molecular therapy (TMT) was associated with improved overall survival (OS). Current guidelines recommend a wide variety of systemic therapy options ranging from targeted molecular therapy to immune checkpoint inhibitors. We characterized primary and metastatic tumor diameter response and OS in patients with metastatic clear cell RCC who received preoperative with TMT, immunotherapy (IO), or IO+TMT followed by deferred cytoreductive nephrectomy (dCN).
Methods:
We retrospectively reviewed our institutional database and identified 211 patients with metastatic clear cell RCC (ccRCC) who received preoperative TMT, IO, or IO+TMT followed by dCN between 2005 and 2019. Primary and metastatic tumor longest diameters were calculated from cross-sectional images obtained at initial diagnosis and before dCN with validated RECIST 1.1. Patient characteristics were summarized by using descriptive statistics. OS was calculated using the Kaplan-Meier method. Cox proportional hazards models were applied to assess the association between patient characteristics and OS.
Results:
A total of 41.4 % of patients had primary tumor shrinkage (PTS) of ≥10%, and 64.1% had metastatic tumor shrinkage (MTS) of ≥10%. Median OS, PTS of ≥10%, and MTS of ≥10% were similar between the 3 groups (p=0.14; p=0.18; p=0.44). For patients with MTS of ≥10%, the median OS was 47.5 months compared with 22.5 months in the group with MTS of <10% (p<0.001). On univariable analysis, PTS and MTS of ≥10% were associated with better OS (HR 0.6, CI 0.4-0.9, p=0.01; HR 0.5, CI 0.3- 0.7, p<0.001). On multivariable analysis, MTS of ≥10% was associated with improved OS (HR 0.5, CI 0.4-0.8, p=0.003).
Conclusion:
In patients with metastatic ccRCC, MTS of ≥10% was associated with better OS in patients who underwent dCN, independent of the type of preoperative systemic therapy.
Funding: N/A
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Metastatic Tumor Diameter Response in patients Clear Cell Renal Cell Carcinoma Is Associated with Overall Survival
Category
Kidney Cancer > Clinical
Description
Poster #102
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Presented By: Alberto C. Pieretti
Authors:
Alberto C Pieretti
Daniel D. Shapiro
Westerman Mary E.
Hyunsoo Hwang
Xuemei Wang
Luis A. Segarra
Matthew T. Campbell
Nizar M. Tannir
Eric Jonash
Christopher G. Wood
Jose A. Karam