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A Syngeneic Mouse Model of Metastatic Renal Cell Carcinoma for Quantitative and Longitudinal Assessment of Preclinical Therapies
Published on: April 12, 2017
Clinical outcome in patients receiving systemic therapy for metastatic sarcomatoid renal cell carcinoma: a
Sumanta K Pal1, Jeremy O Jones, Courtney Carmichael
1Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
Objectives:
Sarcomatoid metastatic renal cell carcinoma (mRCC) represents an aggressive subset of disease, and a definitive therapeutic strategy is lacking. We seek to define outcomes associated with systemic therapy (including immunotherapy, cytotoxic therapy, and targeted agents) for sarcomatoid mRCC, with attention to novel prognostic schema.
Materials And Methods:
From an institutional database including 270 patients with mRCC, we identified 34 patients with documented sarcomatoid features. Within this cohort, we assessed 21 patients who received systemic therapy. Survival was assessed in the overall cohort and in subgroups divided by clinicopathologic characteristics, including the extent of sarcomatoid features, Memorial Sloan-Kettering Cancer Center (MSKCC) risk criteria, Heng criteria, and the nature of systemic therapy rendered.
Results:
Of the 21 patients assessed, 2 patients received chemotherapy, 7 patients received immunotherapy, and 12 patients received targeted agents as their first line treatment. Median overall survival (OS) in the overall cohort was 18.0 months (95% CI 6.9-22.0). By MSKCC criteria, patients with poor-risk disease had a median OS of 4.7 months, compared with 20.1 months for patients with intermediate-risk disease [hazard ratio (HR) 0.02, 95%CI 0.003-0.15; P = 0.0001]. A similar difference in median OS was seen poor- and intermediate-risk groups when stratifying by Heng criteria (HR 0.17, 95%CI 0.001-0.12). There was no significant difference in survival in patients with sarcomatoid predominant disease vs. nonpredominant disease (HR 0.62, 95%CI 0.23-1.65; P = 0.34), nor was there a difference amongst patients who received targeted therapies vs. nontargeted therapies (HR 1.0, 95%CI 0.61-1.40; P = 0.36).
Conclusions:
Compared with previous series and prospective trials assessing patients with sarcomatoid mRCC, the observed survival was prolonged. Although both Heng and MSKCC risk scores may be useful in determining prognosis, further studies are needed to identify relevant biomarkers and define the optimal therapeutic strategy for this disease.
Insights
Systemic therapy for sarcomatoid metastatic renal cell carcinoma (mRCC) showed prolonged survival, with risk scores aiding prognosis. Further research is needed for optimal treatment strategies in this aggressive cancer.
Area of Science:
- Oncology
- Medical Research
Background:
- Sarcomatoid metastatic renal cell carcinoma (mRCC) is an aggressive cancer subtype with limited treatment options.
- Understanding prognostic factors and treatment outcomes is crucial for improving patient survival.
Purpose of the Study:
- To evaluate the outcomes of systemic therapies, including immunotherapy, chemotherapy, and targeted agents, in patients with sarcomatoid mRCC.
- To assess the utility of established risk criteria (MSKCC and Heng) in predicting survival for this patient group.
Main Methods:
- Retrospective analysis of 21 patients with sarcomatoid mRCC who received systemic therapy.
- Survival analysis based on clinicopathologic features, extent of sarcomatoid features, and risk stratification using MSKCC and Heng criteria.
Main Results:
- Median overall survival (OS) in the cohort was 18.0 months.
- Poor-risk patients by MSKCC and Heng criteria had significantly shorter OS compared to intermediate-risk patients.
- No significant survival difference was observed based on the extent of sarcomatoid features or type of targeted therapy received.
Conclusions:
- Systemic therapy in this cohort of sarcomatoid mRCC patients demonstrated prolonged survival compared to historical data.
- MSKCC and Heng risk scores appear valuable for prognostication in sarcomatoid mRCC.
- Further investigation into biomarkers and optimal therapeutic strategies is warranted.
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