Pancreatic metastases from renal cell carcinoma: Prognostic relevance and outcome in patients treated with targeted agents.

Background: Pancreatic metastases from renal cell carcinoma (PmRCC) are uncommon and their prognostic role in the era of targeted terapies (TTs) is not well defined. We evaluated the outcome of a cohort of PmRCC patients (pts) who were treated with either surgery and TTs Methods: PmRCC pts treated between 1993 and 2014 were identified from the databases of 11 European centers. Clinical records were retrospectively reviewed and clinical outcome was analyzed. Kaplan-Meier methods and log-rank test were used to evaluate progression-free survival (PFS) and overall survival (OS). Cox proportional hazard models were used to analyse covariates associated to OS Results: A total of 276 pts were evaluated. PmRCC were synchronous to the primary in 80 pts (29%). Pts treated with pancreatic local treatment (PLoT), including surgery, were 77 (28%) while pts receiving systemic treatment were 256 (93%). Pts with only PmRCC were 42 (15%) whereas lung (47%), lymph nodes (28%) and liver (23%) were the most common metastatic sites in the remaining pts. Most of pts (95%) received nephrectomy (Nx). Median time from Nx to PmRCC occurrence was 91 months (mo) (IQR 54-142). First-line TTs included: sunitinib (44%), sorafenib (12%), pazopanib (9%), interferon + bevacizumab (6%) and temsirolimus (1%); 37% of pts received cytokines and 53% received subsequent lines of TTs. Best response to first-line TTs were complete response (5%) partial response (40%) and stable disease (39%) with a disease control rate of 84% and a median PFS of 12 mo (IQR 10-14). Median OS (calculated from the time of PmRCC diagnosis to death) was 73 mo (IQR 61-86) with a 5-yr OS of 58%. Median OS for pts treated with PLoT was 106 mo (IQR 78-204) with a 5-yr OS of 75%. At univariate analysis MSKCC/Heng prognostic score (p= .0004), Nx (p= .0002) and PLoT (p= < .0001) were significantly associated with OS.At multivariate analysis these variables confirmed their prognostic role Conclusions: PmRCC are associated with long-term survival, usually occur many years after Nx and lead to an indolent growth thus initial observation might be an option for this pts subgroup. Surgery should be considered in oligometastatic pts while TTs are active in widespread disease

Citation: 

J Clin Oncol 33, 2015 (suppl; abstr 4550)

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