Peritoneal metastases (PM) have been reported in approximately 1% of patients with metastatic Renal Cell Carcinoma (mRCC). Outcome data are limited due to the rarity of this metastatic site. Therefore, the aim of our study is to describe renal cell carcinoma (RCC) patients with PM treated as per clinical practice.
Baseline characteristics and outcome data of patients with PM from RCC were retrospectively collected from 18 Italian oncological referral centers adhering to the Meet-Uro group, from January 2016 to January 2023.
We collect 81 RCC patients with PM. 78/81 received systemic treatment, 3/81 only best supportive care. First line treatment included tyrosine-kinase inhibitors (TKI) (46/78), ImmuneOncology (IO)-TKI (26/78) and IO-IO (6/78), with different Objective Response Rate (ORR) (43.4% in TKI monotherapy group vs 50% in IO-TKI group, respectively) and Disease Control Rate (DCR) (60.8% in TKI treated patients vs. 76.9% in IO-TKI treated patients). Median PFS was 6.4 months (95%CI 4.18-14.8) in patients treated with TKI monotherapy vs 23.7 months (95%CI 11.1-NR) in patients treated with IO-TKI (p < 0.015). The median OS (mOS) was 22.7 months (95%CI 13.32 - 64.7) in the TKI monotherapy group vs 34.5 mo (95%CI NR-NR) in the IO-TKI group with 53.8% of patients alive at 1 years in the latter group, (p < 0.16). Primary refractory patients were 36.9% for TKI and 15.3% for IO-TKI. According to International Metastatic renal cell carcinoma Database Consortium (IMDC) score, mPFS and mOS were consistent among risk categories. Median PFS was 36.6 months (95%CI 10.9-NR) for good risk patients compared to 10 months (95%CI 7.5-29.8) for intermediate risk and 2.96 months (95%CI 2.43-11.28) for poor risk population (p < 0.0005) whereas mOS was NR (95%CI 28.65-NR) for good risk patients compared to 35.3 months (95%CI 24.6-NA) and 12.4 months (95%CI 3.52-NR) for intermediate and poor risk population, respectively, (p < 0.0002). Only 34/78 (43.5%) received a second line treatment that was TKI (ORR 8.3% and DCR 41.6%) or IO (ORR 18.1% and DCR 40.9%).
We report one of the largest case series regarding PM from RCC. Characteristics of patients suggest a more aggressive behavior of PM from mRCC. Outcome data suggest that TKI-IO as first line treatment, and TKI as second line, confirm their activity for these patients with dismal prognosis.
Clinical genitourinary cancer. 2024 Mar 19 [Epub ahead of print]
Marco Stellato, Sebastiano Buti, Marco Maruzzo, Maria Bassanelli, Melissa Bersanelli, Marilena Di Napoli, Michele Dionese, Martina Fanelli, Roberto Filippi, Giuseppe Fotia, Luca Galli, Francesco Grillone, Michele Maffezzoli, Brigida Anna Maiorano, Cecilia Nasso, Sara Elena Rebuzzi, Luca Lalli, Giandomenico Roviello, Mariella Sorarù, Bruno Vincenzi, Giuseppe Procopio, Elena Verzoni
Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy. Electronic address: ., Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy., Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Department of Oncology, Fondazione IRCCS Istituto Nazionale Tumori "G. Pascale", Napoli, Italy., Department of Oncology, University Hospital of Udine, Udine, Italy., Department of Oncology, University of Turin, Torino, Italy., Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy., SOC Oncologia Azienda Ospedaliera Renato Dulbecco, Catanzaro, Italy., Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy., Medical Oncology, Ospedale Santa Corona, Pietra Ligure, Italy., Medical Oncology Unit, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy., Unit of Translational Immunology, IRCCS Foundation National Cancer Institute, Milan, Italy., Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy., Oncology Unit, Camposampiero General Hospital, Padova, Italy., Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.