ASCO GU 2018: Renal Cell Carcinoma Primary Tumor Shrinkage on Vascular Endothelial Growth Factor Targeted Therapy - A Pooled Analysis
Methods:
The authors conducted a pooled analysis of 12 Pfizer-sponsored trials in patients with metastatic RCC treated with sunitinib, sorafenib, axitinib, bevacizumab, termsirolimus or interferon-α. Primary endpoint was the primary tumor objective response rate (ORR) by RECIST in patients who have not undergone prior nephrectomy. Kaplan-Meier method was used to estimate median overall survival (OS) of responders (partial or complete) vs. non-responders. Cox regression adjusting for demographics, histology type, prior therapy, metastasis sites, IMDC risk factors and neutrophil-to-lymphocyte ratio was used to compare OS between pts with and without primary tumor ORR.
Results:
565/4736 patients (12%) included in this study had their primary tumors intact, of which 360 (8%) received VEGF-TT. In patients with primary tumor intact, 87% had clear-cell RCC and IMDC risk group were 4% favorable, 33% intermediate, 39% poor, 24% unknown. 35% had bone metastasis and 32% had liver metastases. 65% had ECOG performance status ≥1. Compared to patients with prior nephrectomy, primary tumor intact patients were more likely to have bone or liver metastases or to be IMDC poor risk. Primary tumor ORR was 17% (95% exact CI, 14, 20) in all patients, 19% (95% CI. 16, 23) in first line treated patients and 23% (95% Exact CI, 19, 28) in patients treated with VEGF-TT (any line). Primary tumor ORR was 20% (95% CI. 15, 26) in IMDC intermediate risk pts and 9% (95% exact CI. 5 – 13) in the poor risk. Median OS was 33.98 months in patients with primary tumor ORR and 9.8 months in patients without ORR, adjusted HR 0.42 [95%CI, 0.28, 0.6; p < 0.0001].
Conclusions:
VEGF-TT lead to primary tumor shrinkage in 23% of patients with IMDC intermediate and poor risk advanced RCC, who have not undergone CRN. VEGF-TT may potentially facilitate future CRN in select patients.
Presented by: Dominick Bosse, MD Boston, MA, USA
Co Authors: Xun Lin, Ronit Simantov, Aly-Khan A. Lalani, Ithaar Derweesh, Steven Lee Chang, Toni K. Choueiri, Rana R. McKay; Dana-Farber Cancer Institute, Boston, MA; Pfizer Oncology Inc., San Diego, CA; Pfizer Oncology Inc., New York, NY; University of California San Diego, San Diego, CA; Brigham and Women's Hospital, Boston, MA; Dana-Farber Cancer Institute/ Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA