Metastatic Sarcomatoid Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor–Targeted Therapy

Golshayan, Ali Reza; George, Saby; Heng, Daniel Y.C.; Elson, Paul; Wood, Laura S.; Mekhail, Tarek; García, Jorge A.; Aydın, Hakan; Zhou, Ming; Bukowski, Ronald M.; Rini, Brian I.

doi:10.1200/jco.2008.18.0000

Cited by 210 publications

(182 citation statements)

References 37 publications

(16 reference statements)

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“…Metastatic rcc with sarcomatoid differentiation is also associated with poor outcomes after chemotherapy or immunotherapy. In a recent study that included patients who had sarcomatoid rcc, the clinical response to vegf-targeted agents compared favourably with responses to chemotherapy or immunotherapy in earlier studies 23 . The same study also suggested that outcomes with anti-vegf therapy were better in patients with underlying clear cell histology than in those with non-clear cell sarcomatoid metastatic rcc.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors Associated with the Response to Sunitinib in Patients with Metastatic Renal Cell Carcinoma

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors Associated with the Response to Sunitinib in Patients with Metastatic Renal Cell Carcinoma

et al. 2013

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“…29 The overall objective partial response rate was 19%; stable disease was the outcome in 49% of cases and progressive disease was the best response in 33%. In regard to RCC subtype, partial response was only achieved in patients with underlying clear cell RCC.…”

Section: Predictors Of Responsementioning

confidence: 99%

Predictors of Response to Targeted Therapy in Renal Cell Carcinoma

Eisengart

MacVicar²,

Yang³

2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.—The prognosis for patients with metastatic renal cell carcinoma is poor, with an average 5-year survival of approximately 10%. Use of traditional cytokine therapy, specifically high-dose interleukin 2, is limited by significant toxicity. Better understanding of the molecular pathogenesis of renal cell carcinoma has led to the development of targeted therapies to inhibit specific cellular pathways leading to tumorigenesis. These drugs provide improved survival with a more favorable toxicity profile. There is ongoing investigation of markers that predict response of an individual patient to different targeted therapies. Objective.—To explain the molecular basis for vascular endothelial growth factor inhibitor (antiangiogenic) and mammalian target of rapamycin inhibitor therapies for renal cell carcinoma, summarize the clinical trials demonstrating the effectiveness of these drugs, and describe the biomarkers shown to correlate with outcome in patients treated with targeted therapy. Data Sources.—All included sources are from peer-reviewed journals in PubMed (US National Library of Medicine). Conclusion.—Emerging evidence shows promise that biomarkers will be useful for predicting an individual patient's response to targeted therapy, leading to a more personalized approach to treating renal cell carcinoma.

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“…2 Prognostic factors for RCC include clinical stage, time to study entry, laboratory markers (LDH, HgB, Ca), sarcomatoid differentiation and number of sites of metastases. [2][3][4][5] The most common site of distant disease is pulmonary metastases. Due to its aggressive clinical course, sarcomatoid RCC is often treated with nephrectomy and systemic therapy, although there remains no consensus approach to treatment.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous regression of metastatic pulmonary renal cell carcinoma in the setting of sarcomatoid differentiation of the primary tumour

Chan

Booth

Manduch

et al. 2013

CUAJ

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We present a case of spontaneous regression of pulmonary metastases from renal cell carcinoma (RCC) with sarcomatoid differentiation, prior to intervention. The patient presented with conventional type RCC with Furhman Grade 4/4 and sarcomatoid differentiation, complicated by pulmonary metastases. Palliative systemic therapy was planned, but prior to the onset of treatment, serial computed tomography scans demonstrated regression of metastatic disease. Spontaneous regression of metastases is rare, but well-documented in conventional clear cell RCC. To the best of our knowledge, this has not previously been described in the setting of sarcomatoid differentiation of the primary tumour. IntroductionSarcomatoid differentiation is found in 1% to 5% of renal cell carcinoma (RCC) cases and is associated with poor outcomes due to rapid disease progression.1 Sarcomatoid differentiation is thought to represent a transition to higher histological grade and can be observed across all RCC subtypes.2 Prognostic factors for RCC include clinical stage, time to study entry, laboratory markers (LDH, HgB, Ca), sarcomatoid differentiation and number of sites of metastases.2-5 The most common site of distant disease is pulmonary metastases. Due to its aggressive clinical course, sarcomatoid RCC is often treated with nephrectomy and systemic therapy, although there remains no consensus approach to treatment. The role of nephrectomy in the era of targeted therapy has yet to be fully elucidated. Spontaneous regression of metastases is well-documented in the course of conventional RCC, but not previously in the setting of sarcomatoid differentiation. Case reportA 71-year-old male presented with an incidental finding of a large right renal mass on ultrasound during evaluation of the liver for hemochromatotis. Computed tomography (CT) scan (April 2010) revealed a 9.8 × 8.9-cm necrotic, heterogenous mass in the right kidney. Multiple nodules were identified in the lung parenchyma, the largest measuring 2.1 cm (Fig. 1, part A). The patient had been asymptomatic with no flank pain, hematuria, constitutional symptoms, bone pain or focal neurological symptoms. Medical history and physical examination were unremarkable.His presentation was highly suggestive of RCC with metastatic involvement of the lungs. A repeat CT chest (May 2010) found the pulmonary nodules had increased in size, with the largest measuring 3.2 cm (Fig. 1, part B). Renal biopsy confirmed RCC. The patient was offered, but declined, nephrectomy. Based on the Memorial Sloan-Kettering prognostic factors model, 5 the patient was intermediate risk, with one poor prognostic factor, anemia (HgB 136), and palliative sunitinib was planned. CT scans of the head and bone (June 2010) showed no brain or bone metastases, and metastases were limited to the lungs.A repeat CT (July 2010) prior to the start of systemic therapy showed a radiologically stable RCC, and a decrease in size of pulmonary nodules (the largest lesion now 2.0 cm). Given the apparent regression in disease and...

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Metastatic Sarcomatoid Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor–Targeted Therapy

Abstract: Patients who have mRCC and sarcomatoid differentiation can demonstrate objective responses and tumor shrinkage to VEGF-targeted therapy. Patients who have clear-cell histology and a lower percentage of sarcomatoid differentiation may have better outcomes with VEGF-targeted therapy.

Cited by 210 publications

References 37 publications

Prognostic Factors Associated with the Response to Sunitinib in Patients with Metastatic Renal Cell Carcinoma

Prognostic Factors Associated with the Response to Sunitinib in Patients with Metastatic Renal Cell Carcinoma

Predictors of Response to Targeted Therapy in Renal Cell Carcinoma

Spontaneous regression of metastatic pulmonary renal cell carcinoma in the setting of sarcomatoid differentiation of the primary tumour

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