Metastatic renal cell carcinoma to the pancreas and other sites-a multicenter retrospective study.

Background

Metastatic renal cell carcinoma (mRCC) is a heterogenous disease with poor 5-year overall survival (OS) at 14%. Patients with mRCC to endocrine organs historically have prolonged OS. Pancreatic metastases are uncommon overall, with mRCC being the most common etiology of pancreatic metastases. In this study, we report the long-term outcomes of patients with mRCC to the pancreas in two separate cohorts.

Methods

We performed a multicenter, international retrospective cohort study of patients with mRCC to the pancreas at 15 academic centers. Cohort 1 included 91 patients with oligometastatic disease to the pancreas. Cohort 2 included 229 patients with multiples organ sites of metastases including the pancreas. The primary endpoint for Cohorts 1 and 2 was median OS from time of metastatic disease in the pancreas until death or last follow up.

Findings

In Cohort 1, the median OS (mOS) was 121 months with a median follow up time of 42 months. Patients who underwent surgical resection of oligometastatic disease had mOS of 100 months with a median follow-up time of 52.5 months. The mOS for patients treated with systemic therapy was not reached. In Cohort 2, the mOS was 90.77 months. Patients treated with first-line (1L) VEGFR therapy had mOS of 90.77 months; patients treated with IL immunotherapy (IO) had mOS of 92 months; patients on 1L combination VEGFR/IO had mOS of 74.9 months.

Interpretations

This is the largest retrospective cohort of mRCC involving the pancreas. We confirmed the previously reported long-term outcomes in patients with oligometastatic pancreas disease and demonstrated prolonged survival in patients with multiple RCC metastases that included the pancreas. In this retrospective study with heterogeneous population treated over 2 decades, mOS was similar when stratified by first-line therapy. Future research will be needed to determine whether mRCC patients with pancreatic metastases require a different initial treatment strategy.

Funding

Statistical analyses for this study were supported in part by the University of Colorado Cancer Center Support Grant from the NIH/NCI, P30CA046934-30.

Déclaration de conflit d'intérêts

ETL has received institutional research support from Amgen, Inc., Argos Therapeutics, Arrowhead Pharmaceuticals, Inc., Astellas Pharma, Inc., Bristol Myers Squibb, Biosplice Therapeutics, Inc., Calithera Biosciences, Constellation Pharmaceuticals, Inc., Exelixis, Forma Therapeutics, Genentech/F. Hoffmann-La Roche Ltd, Janssen Pharmaceuticals, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., OnQuality Pharmaceuticals LLC, Peloton Therapeutics, Pfizer, Inc., Promontory Therapeutics, Inc (formerly Phosplatin). AM has received relevant institutional research funding from Acerta Pharma, Genentech, Roche, Merck, Novartis, Seattle Genetics, Astellas Pharma, Mirati Therapeutics, Bristol-Myers Squibb, Debiopharm Group. AM has received consulting fees from Debiopharm Group, Seattle Genetics, Pfizer. LH reports grants to prior institution from Bristol-Myers Squib, Merck, and Takeda. As well as current employment (including stock options) at Surface Oncology outside the submitted work. LH reports advisory or consulting services for Genentech, Pfizer, Corvus, Merck, Exelixis, Novartis, Jounce, Bristol-Myers Squibb, EMD Serrano. LH reports honoraria for lectures/presentations for Michael J Hennessy Associates (Healthcare Communications Company and several brands such as OncLive and PER), ASIM CME, and Ology Medical Education. LH receives support from Genentech for travel outside of the submitted work. JB reports relevant institutional research funding from University of Texas Southwestern Medical Center SPORE in Kidney Cancer (NIH P50 CA196516). NA reports consulting fees from Astellas, Astra Zeneca, Aveo, Bayer, Bristol Myers Squibb, Calithera, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Foundation Medicine, Genentech, Gilead, Janssen, Merck, MEI Pharma, Nektar, Novartis, Pfizer, Pharmacyclics, and Seattle Genetics. NA reports institutional research funding from Astellas, Astra Zeneca, Bavarian Nordic, Bayer, Bristol Myers Squibb, Calithera, Celldex, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Genentech, Gilead, Glaxo Smith Kline, Immunomedics, Janssen, Medivation, Merck, Nektar, New Link Genetics, Novartis, Pfizer, Prometheus, Rexahn, Roche, Sanofi, Seattle Genetics, Takeda, and Tracon. RM reports consulting fees from Aveo, AstraZeneca, Bayer, BMS, Calithera, Caris, Dendreon, Exelixis, JNJ, Novartis, Merck, Myovant, Pfizer, Sanofi, Sorrento Therapeutics, Telix, Tempus. VN reports institutional research funding from Pfizer, Merck, Jenssen, Bristol Myers Squibb. BN reports consulting fees from Merck, Janssen, Myovanat Sciences, Exelixis. BN reports honoraria from Pfizer. ND reports consulting fees from Vivreon Gastrosciences Inc. NM reports participation in data safety monitoring board or advisory board for MDS, Ipsen, BMS, and Astellas. TR reports institutional research funding from National Cancer Institute at the National Institutes of Health (grant number 1K08CA248967-01). SG reports institutional research funding from Aravive, Agensys, Aveo Pharmaceuticals, Bayer, BMS, Calithera Biosciences, Corvus Pharmaceuticals, Eisai, Exelixis Inc, Gilead, Merck, Novartis, Pfizer, Seattle Genetics, and Surface Oncology. SG reports consulting fees from Aveo Pharmaceuticals, Bayer, BMS, Corvus Pharmaceuticals, Eisai, EMD Serono, Exelixis Inc, Merck, Immunomedics, Pfizer, QED Therapeutics, Sanofi, and Seattle Genetics; and honoraria from Aptitude Health, Curio Science, and DAVA Oncology. YZ reports advisory board participation with Bristol Myers Squibb, Amgen, Roche Diagnostics, Novartis, Janssen, Eisai, Exelixis, Castle Bioscience, Genzyme Corporation, Astrazeneca, Array, Bayer, Pfizer, Clovis, EMD serono, Myovant. YZ reports data safety monitoring board participation with Janssen Research and Development. All other authors have nothing to declare.