ASCO GU 2018: Outcomes of Metastatic Chromophobe Renal Cell Carcinoma with Sarcomatoid Features

San Francisco, CA ( Dr. Yasser Ged from Memorial Sloan Kettering Cancer Center (MSKCC) discussed their institution’s experience with metastatic chromophobe renal cell carcinoma with sarcomatoid features. Chromophobe RCC makes up 5-10% of RCC subtypes and is generally thought to confer favorable prognosis. However, presence of sarcomatoid features on histologic review can occur in any RCC subtype and is considered a hallmark of aggressive disease. The objective of this study was to assess outcomes in a cohort of patients with metastatic chromophobe RCC with sarcomatoid features.

The authors queried the MSKCC institutional database between 2002-2017 to identify 27 patients diagnosed with metastatic chromophobe RCC with sarcomatoid features. Overall survival (OS) was calculated for all patients, and time to treatment failure (TTF) for those who received first-line therapy at MSKCC. Next generation sequencing with MSK-IMPACT was also performed in a subset of patients.

Among these 27 patients with newly diagnosed metastatic chromophobe RCC with sarcomatoid features the clinical features are summarized: 

chromophobe rcc 1

Two patients never received first line therapy based on poor performance status, and 16 were treated at MSKCC and received a median of two lines of systemic therapy. First line agents included sunitinib (n = 6), pazopanib (n = 2), temsirolimus (n = 2), everolimus + bevacizumab (n = 2), sunitinib + gemcitabine (n = 2) and interferon alpha (n = 2) with a median TTF of 2.1 months (0.9-14.5). Across the entire cohort, the median OS was 7.9 months (95% CI 4.2-11.2) with an estimated 1 year OS rate of 25%. Interestingly, by comparison, a cohort of 67 patients with metastatic chromophobe RCC lacking sarcomatoid features also treated at MSKCC 2002-17 achieved median OS of 38.1 months, (HR 4.6, 95% CI 2.6-8.3). In the six chromophobe RCC with sarcomatoid feature patients with next generation sequencing analysis, TP53 (n = 4), PTEN (n = 2) and CHEK2 (n = 2) were the most frequently altered genes.

In summary, outcomes for patients with metastatic chromophobe RCC with sarcomatoid features was poor in contrast to patients with chromophobe RCC lacking sarcomatoid features. The lack of benefit observed across various classes of systemic agents warrants study of underlying biology and novel agents.

Presented by: Yasser Ged, MBBS, MRCP, Memorial Sloan Kettering Cancer Center, New York, NY

Co-Authors: Andrea Knezevic, Yingbei Chen, Almedina Redzematovic, Maria Isabel Carlo, Chung-Han Lee, Darren R. Feldman, Sujata Patil, Robert J. Motzer, Martin Henner Voss; Memorial Sloan Kettering Cancer Center, New York, NY

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA