Survival outcomes of metastatic renal cell carcinoma (RCC) patients with pancreatic metastases (PM): Pooled analysis from a large clinical trials database.

Abstract

e17072 Background: Pancreatic metastases are a rare site of metastasis for RCC. It has been suggested that patients with metastases to the pancreas have a more indolent disease course, however long term survival outcomes with systemic therapy are not well defined. Methods: We conducted a pooled analysis of metastatic RCC patients treated in phase II/III clinical trials. The primary objective was to evaluate overall survival in patients with PM compared to those without PM. Secondary objectives included progression-free survival (PFS) and objective response rate. Outcome measures were evaluated in the overall cohort and stratified by line and type of therapy and IMDC risk group. Statistical analyses were performed using Cox regression and Kaplan-Meier analysis. Results: We identified 4736 patients treated with either vascular endothelial growth factor (VEGF) targeted (n=3511), mammalian target of rapamycin (mTOR) targeted (n=665), or cytokine therapy (n=560), of which 5.0% (n=235) had PM at initiation of therapy. Median OS (mOS) in patients with PM was significantly prolonged compared to those without PM (Table). In a multivariate Cox regression model, this improvement in mOS remained statistically significant when adjusting for concurrent metastases to the lung, bone, or liver, line and type of therapy, and IMDC risk group. In further subgroup analysis, among patients with PM, superior mOS was noted in patients with favorable or intermediate IMDC risk, treatment naive patients, and treatment with VEGF inhibitors or cytokine therapy (Table). For the overall cohort, PFS was 10.9 vs 6.9 months for patients with and without PM (HR 0.72, 95% CI: 0.60, 0.86). Objective responses were higher in patients with PM vs those without PM (37% vs 24%, p<0.01). Conclusions: The presence of PM in advanced RCC is an independent positive predictor for survival. This effect is pronounced in patients treated with VEGF inhibitors and IMDC favorable and intermediate risk disease. Unraveling the molecular determinates of pancreatic tropism in RCC will be important for personalizing therapy for patients. [Table: see text]