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

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 and Giuseppe Tonini

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Oncotarget. 2016; 7:33381-33390. https://doi.org/10.18632/oncotarget.8302

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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

Correspondence to:

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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