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Risk of recurrence and conditional survival in complete responders treated with TKIs plus or less locoregional therapies for metastatic renal cell carcinoma

2016; Impact Journals LLC; Volume: 7; Issue: 22 Linguagem: Italiano

10.18632/oncotarget.8302

1949-2553

Daniele Santini, Matteo Santoni, Alessandro Conti, Giuseppe Procopio, Elena Verzoni, Luca Galli, Giuseppe Di Lorenzo, Ugo De Giorgi, Delia De Lisi, Maurizio Nicodemo, Marco Maruzzo, Francesco Massari, Sebastiano Buti, Emanuela Altobelli, Elisa Biasco, Riccardo Ricotta, Camillo Porta, Bruno Vincenzi, Rocco Papalia, Paolo Marchetti, Luciano Burattini, Rossana Berardi, Giovanni Muto, Rodolfo Montironi, Stefano Cascinu, Giuseppe Tonini,

Cancer Genomics and Diagnostics

// Daniele Santini 1 , Matteo Santoni 2 , Alessandro Conti 3 , Giuseppe Procopio 4 , Elena Verzoni 4 , Luca Galli 5 , Giuseppe di Lorenzo 6 , Ugo De Giorgi 7 , Delia De Lisi 1 , Maurizio Nicodemo 8 , Marco Maruzzo 9 , Francesco Massari 10 , Sebastiano Buti 11 , Emanuela Altobelli 12 , Elisa Biasco 5 , Riccardo Ricotta 13 , Camillo Porta 14 , Bruno Vincenzi 1 , Rocco Papalia 12 , Paolo Marchetti 15 , Luciano Burattini 2 , Rossana Berardi 2 , Giovanni Muto 12 , Rodolfo Montironi 16 , Stefano Cascinu 2 , Giuseppe Tonini 1 1 Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy 2 Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy 3 Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Ancona, Italy 4 Oncology Unit I, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy 5 Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy 6 Department of Clinical Medicine, Medical Oncology Unit, Federico II University, Naples, Italy 7 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy 8 Sacro Cuore - Don Calabria Hospital, Negrar, Italy 9 Medical Oncology I, Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy 10 Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy 11 Oncology Unit, University Hospital of Parma, Parma, Italy 12 Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy 13 Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy 14 IRCCS San Matteo University Hospital Foundation, Pavia, Italy 15 Medical Oncology Unit Policlinico Sant’Andrea, Rome, Italy 16 Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy Correspondence to: Daniele Santini, email: d.santini@unicampus.it Keywords: renal cell carcinoma, complete responder patients, tirosin kinase inhibitor, risk of recurrence, conditional survival Received: January 02, 2016     Accepted: February 29, 2016     Published: March 23, 2016 ABSTRACT PURPOSE: We retrospectively analyzed the risk of recurrence and conditional Disease-Free Survival (cDFS) in 63 patients with complete remission during treatment with tirosin kinase inhibitor (TKI), alone or with local treatment in metastatic renal cell carcinoma. RESULTS: 37% patients achieve CR with TKI alone, while 63% with additional loco-regional treatments. 49% patients recurred after CR, with a median Disease free survival of 28.2 months. Patients treated with multimodal approaches present lower rate of recurrence (40% vs 61%) and longer Disease free survival compared to patient treated with TKI alone (16.5 vs 41.9 months, p =0.039).Furthermore the rate of recurrence was higher in patients with brain (88%), pancreatic (71%) and bone metastasis (50%). Patients who continued TKI therapy after complete response had a longer disease free survival than patients who stopped therapy, although the difference was not significant (42.1 vs 25.1 months, p =0.254). 2y-cDFS was better in patients treated with multimodal treatment and who continued TKIs than the other patient arms. CONCLUSIONS: The prognostic value of CR depends on the site where was obtained and how was obtained (with or without locoregional treatment). Cessation of TKI should be carefully considered in complete responder patients.