1770 CANCER-SPECIFIC SURVIVAL OUTCOMES OF SUNITINIB TREATMENT IN UISS RISK-STRATIFIED METASTATIC RCC PATIENTS

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20111770 CANCER-SPECIFIC SURVIVAL OUTCOMES OF SUNITINIB TREATMENT IN UISS RISK-STRATIFIED METASTATIC RCC PATIENTS Edward Rampersaud, Tobias Klatte, Frederic Pouliot, David Li, Christine Anterasian, Nazy Zomorodian, Fairooz Kabbinavar, David Miller, Arie Belldegrun, and Allan Pantuck Edward RampersaudEdward Rampersaud Los Angeles, CA More articles by this author , Tobias KlatteTobias Klatte Los Angeles, CA More articles by this author , Frederic PouliotFrederic Pouliot Los Angeles, CA More articles by this author , David LiDavid Li Los Angeles, CA More articles by this author , Christine AnterasianChristine Anterasian Los Angeles, CA More articles by this author , Nazy ZomorodianNazy Zomorodian Los Angeles, CA More articles by this author , Fairooz KabbinavarFairooz Kabbinavar Los Angeles, CA More articles by this author , David MillerDavid Miller Ann Arbor, MI More articles by this author , Arie BelldegrunArie Belldegrun Los Angeles, CA More articles by this author , and Allan PantuckAllan Pantuck Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2098AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior to the advent of targeted therapies, immunotherapy such as interleukin-2 (IL-2) served as the best available therapy for patients with metastatic kidney cancer. In addition to better tolerability, newer “targeted” treatment options should ideally provide similar or better survival benefits as those achieved with aggressive surgical resection and immunotherapy. We therefore sought to determine how patients treated with sunitinib fared compared to immunotherapy using a large mature cohort of patients treated at a single institution as a benchmark. METHODS A prospective database including clinical and pathological variables for 1683 patients with RCC was queried. 305 IL-2 treated patients and 51 sunitinib treated patients with metastatic RCC treated in the first-line setting following cytoreductive nephrectomy were identified and stratified using the UCLA Integrated Staging System (UISS) into low-, moderate-, and high-risk groups, and treatment response and disease specific survival (DSS) were assessed. RESULTS Overall median survival for the entire cohort was 21.5 months in IL-2 treated patients and 19.3 months in sunitinib treated patients (p=0.7693). When stratified by UISS risk group, similar survival outcomes were observed between the two treatment groups: low risk (39.7 months vs. not reached, p=0.2940), intermediate risk (20.9 vs. 17.7 months, p=0.5383), and high risk (10.5 vs. 7.6 months, p=0.2993). Patients treated with IL-2 group demonstrated a 7.3% complete response (CR) rate whereas there were no CRs following treatment with sunitinib (p<0.001). Clinical benefit (CR+ PR + SD) rate was 55% for IL-2 compared to 84% for sunitinib. Survival in those having stable disease following IL-2 was 31.6 months versus 24.8 months after (p=0.007). Excluding non-responders, median survival for IL-2 patients (n=167) was 36 months compared to 26 months for sunitinib patients (n=37) (p=0.06). CONCLUSIONS Targeted agents have proven attractive due to their relative ease of administration. At UCLA, patients treated with sunitinib for metastatic RCC more frequently achieved a clinical benefit than those treated with IL-2, yet overall survival between the two groups was similar. Benefit in treatment response, however, was at the expense of complete responses and required a trade-off of acute for chronic toxicities. Excluding non-responders, IL-2 related survival exceeded that of sunitinib by 10 months. As our ability to select patients likely to respond to IL-2 improves, a substantial number of patients remain good candidates for IL-2 based therapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e710 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edward Rampersaud Los Angeles, CA More articles by this author Tobias Klatte Los Angeles, CA More articles by this author Frederic Pouliot Los Angeles, CA More articles by this author David Li Los Angeles, CA More articles by this author Christine Anterasian Los Angeles, CA More articles by this author Nazy Zomorodian Los Angeles, CA More articles by this author Fairooz Kabbinavar Los Angeles, CA More articles by this author David Miller Ann Arbor, MI More articles by this author Arie Belldegrun Los Angeles, CA More articles by this author Allan Pantuck Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...