TY - JOUR
T1 - Early primary tumor size reduction is an independent predictor of improved overall survival in metastatic renal cell carcinoma patients treated with sunitinib
AU - Abel, E. Jason
AU - Culp, Stephen H.
AU - Tannir, Nizar M.
AU - Tamboli, Pheroze
AU - Matin, Surena F.
AU - Wood, Christopher G.
N1 - Funding Information:
Funding/Support and role of the sponsor: This research is supported in part by the National Institutes of Health through M.D. Anderson Cancer Center Support Grant CA016672. This study was presented at the Society of Urologic Oncology annual winter meeting, American Society of Clinical Oncology Genitourinary Cancer Symposium, and the American Urological Association annual meeting.
PY - 2011/12
Y1 - 2011/12
N2 - Background: In metastatic renal cell carcinoma (mRCC) patients treated with targeted agents and their primary tumor (PT) in situ, early PT decrease in size correlates with improved overall PT response, but the effect on overall survival (OS) is unknown. Objective: To evaluate whether early PT size reduction is associated with improved OS in patients with mRCC undergoing treatment with sunitinib. Design, setting, and participants: We reviewed the clinical and radiographic data of all mRCC patients seen at our institution between January 2004 and December 2009 without prior systemic treatment who received sunitinib with their PT in situ. Measurements: Two independent reviewers measured the diameter of the PT and metastatic disease at baseline and subsequent scans to assess response. Early minor response was defined as ≥10% decrease within 60 d of treatment initiation. Univariate and multivariate analyses were used to calculate a hazard ratio (HR) corresponding to the risk of death based on clinical and pathologic factors as well as PT response. Results and limitations: We identified 75 consecutive patients with a median follow-up of 15 mo. All patients were intermediate or poor risk by common risk stratification systems. Median initial PT diameter was 9.7 cm. Median maximum PT size reduction was -10.2% overall and -36.4% in patients who had early minor PT response. Median OS for patients without minor PT response, with minor PT response after 60 d, and with early minor PT response was 10.3, 16.5, and 30.2 mo, respectively. On multivariate analysis, early minor response was an independent predictor of improved OS (HR: 0.26; p = 0.031). Other significant predictors included venous thrombus, multiple bone metastases, lactate dehydrogenase above the upper limit of normal, symptoms at presentation, and more than two metastatic sites. Conclusions: Early minor PT response is associated with improved OS. Future studies should evaluate this prognostic factor to identify patients with prolonged OS.
AB - Background: In metastatic renal cell carcinoma (mRCC) patients treated with targeted agents and their primary tumor (PT) in situ, early PT decrease in size correlates with improved overall PT response, but the effect on overall survival (OS) is unknown. Objective: To evaluate whether early PT size reduction is associated with improved OS in patients with mRCC undergoing treatment with sunitinib. Design, setting, and participants: We reviewed the clinical and radiographic data of all mRCC patients seen at our institution between January 2004 and December 2009 without prior systemic treatment who received sunitinib with their PT in situ. Measurements: Two independent reviewers measured the diameter of the PT and metastatic disease at baseline and subsequent scans to assess response. Early minor response was defined as ≥10% decrease within 60 d of treatment initiation. Univariate and multivariate analyses were used to calculate a hazard ratio (HR) corresponding to the risk of death based on clinical and pathologic factors as well as PT response. Results and limitations: We identified 75 consecutive patients with a median follow-up of 15 mo. All patients were intermediate or poor risk by common risk stratification systems. Median initial PT diameter was 9.7 cm. Median maximum PT size reduction was -10.2% overall and -36.4% in patients who had early minor PT response. Median OS for patients without minor PT response, with minor PT response after 60 d, and with early minor PT response was 10.3, 16.5, and 30.2 mo, respectively. On multivariate analysis, early minor response was an independent predictor of improved OS (HR: 0.26; p = 0.031). Other significant predictors included venous thrombus, multiple bone metastases, lactate dehydrogenase above the upper limit of normal, symptoms at presentation, and more than two metastatic sites. Conclusions: Early minor PT response is associated with improved OS. Future studies should evaluate this prognostic factor to identify patients with prolonged OS.
KW - Metastatic
KW - Overall survival
KW - Primary tumor response
KW - Renal cell carcinoma
KW - Sunitinib
KW - Targeted therapy
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U2 - 10.1016/j.eururo.2011.07.008
DO - 10.1016/j.eururo.2011.07.008
M3 - Article
C2 - 21784574
AN - SCOPUS:80255124782
SN - 0302-2838
VL - 60
SP - 1273
EP - 1279
JO - European urology
JF - European urology
IS - 6
ER -