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 9.7cm. 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. Copyright
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 9.7cm. 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. Copyright
Authors: R C Flanigan; S E Salmon; B A Blumenstein; S I Bearman; V Roy; P C McGrath; J R Caton; N Munshi; E D Crawford Journal: N Engl J Med Date: 2001-12-06 Impact factor: 91.245
Authors: Toni K Choueiri; Wanling Xie; Christian Kollmannsberger; Scott North; Jennifer J Knox; J Geoffrey Lampard; David F McDermott; Brian I Rini; Daniel Y C Heng Journal: J Urol Date: 2010-11-12 Impact factor: 7.450
Authors: Stephen H Culp; Nizar M Tannir; E Jason Abel; Vitaly Margulis; Pheroze Tamboli; Surena F Matin; Christopher G Wood Journal: Cancer Date: 2010-07-15 Impact factor: 6.860
Authors: Katherine M Krajewski; Mengye Guo; Annick D Van den Abbeele; Jeffrey Yap; Nikhil Ramaiya; Jyothi Jagannathan; Daniel Y C Heng; Michael B Atkins; David F McDermott; Fabio A B Schutz; Ivan Pedrosa; Toni K Choueiri Journal: Eur Urol Date: 2011-02-01 Impact factor: 20.096
Authors: Eric Jonasch; Christopher G Wood; Surena F Matin; Shi-Ming Tu; Lance C Pagliaro; Paul G Corn; Ana Aparicio; Pheroze Tamboli; Randall E Millikan; Xuemei Wang; John C Araujo; Wadih Arap; Nizar Tannir Journal: J Clin Oncol Date: 2009-07-27 Impact factor: 44.544
Authors: Anil A Thomas; Brian I Rini; Brian R Lane; Jorge Garcia; Robert Dreicer; Eric A Klein; Andrew C Novick; Steven C Campbell Journal: J Urol Date: 2008-12-18 Impact factor: 7.450
Authors: Daniel Y C Heng; Wanling Xie; Meredith M Regan; Mark A Warren; Ali Reza Golshayan; Chakshu Sahi; Bernhard J Eigl; J Dean Ruether; Tina Cheng; Scott North; Peter Venner; Jennifer J Knox; Kim N Chi; Christian Kollmannsberger; David F McDermott; William K Oh; Michael B Atkins; Ronald M Bukowski; Brian I Rini; Toni K Choueiri Journal: J Clin Oncol Date: 2009-10-13 Impact factor: 44.544
Authors: Nizar M Tannir; Robert A Figlin; Martin E Gore; M Dror Michaelson; Robert J Motzer; Camillo Porta; Brian I Rini; Caroline Hoang; Xun Lin; Bernard Escudier Journal: Clin Genitourin Cancer Date: 2017-06-20 Impact factor: 2.872
Authors: Javier Puente Vázquez; T Alonso Gordoa; J Moreno; L Poma; E Diaz Rubio; A Gomez; J Blazquez; J L Gonzalez Larriba Journal: Curr Treat Options Oncol Date: 2015-03
Authors: P Papavassilis; L M Krabbe; B Thielen; M Bögemann; R Moritz; I Hoffmeister; L Hertle; E Herrmann Journal: Urologe A Date: 2014-04 Impact factor: 0.639