Clinical Research Papers:
Risk of recurrence and conditional survival in complete responders treated with TKIs plus or less locoregional therapies for metastatic renal cell carcinoma
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Daniele Santini1, Matteo Santoni2, Alessandro Conti3, Giuseppe Procopio4, Elena Verzoni4, Luca Galli5, Giuseppe di Lorenzo6, Ugo De Giorgi7, Delia De Lisi1, Maurizio Nicodemo8, Marco Maruzzo9, Francesco Massari10, Sebastiano Buti11, Emanuela Altobelli12, Elisa Biasco5, Riccardo Ricotta13, Camillo Porta14, Bruno Vincenzi1, Rocco Papalia12, Paolo Marchetti15, Luciano Burattini2, Rossana Berardi2, Giovanni Muto12, Rodolfo Montironi16, Stefano Cascinu2, Giuseppe Tonini1
1Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
2Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
3Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Ancona, Italy
4Oncology Unit I, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
5Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
6Department of Clinical Medicine, Medical Oncology Unit, Federico II University, Naples, Italy
7Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
8Sacro Cuore - Don Calabria Hospital, Negrar, Italy
9Medical Oncology I, Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy
10Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
11Oncology Unit, University Hospital of Parma, Parma, Italy
12Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
13Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
14IRCCS San Matteo University Hospital Foundation, Pavia, Italy
15Medical Oncology Unit Policlinico Sant’Andrea, Rome, Italy
16Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy
Daniele Santini, email: [email protected]
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
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.
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