Metastatic Sarcomatoid Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor-Targeted Therapy
Metastatic Sarcomatoid Renal Cell Carcinoma Treated With Vascular Endothelial Growth Factor-Targeted Therapy
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DOI：
10.1200/jco.2008.18.0000
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发表时间：
2009-01-10
影响因子：
45.3
通讯作者：
Rini, Brian I.
中科院分区：
文献类型：
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作者：
Golshayan, Ali Reza;George, Saby;Rini, Brian I.
具有肉瘤样分化的转移性肾细胞癌（mRCC）是一种侵袭性疾病，与化疗或免疫治疗的不良结果相关。血管内皮生长因子（VEGF）靶向治疗在该疾病患者中的应用尚不清楚。患者和方法回顾性分析原发肿瘤具有肉瘤样特征并接受vegf靶向治疗的mRCC患者。检查病理切片以确定肉瘤样分化的百分比。确定客观缓解率、肿瘤负荷缩小百分比、无进展生存期（PFS）和总生存期（OS）。结果发现43例肉瘤样mRCC患者。肉瘤样特征的中位数百分比为14%（范围为3%至90%）。患者接受舒尼替尼（49%）、索拉非尼（28%）、贝伐单抗（19%）或舒尼替尼加贝伐单抗（5%）治疗。8例患者（19%）出现部分缓解；21例（49%）病情稳定；14例（33%）患者的最佳反应是进展性疾病。部分反应仅限于具有潜在的透明细胞组织学和少于20%的肉瘤样成分的患者。肿瘤缩小的中位数为-2%（范围为-85%至127%），53%的患者在治疗中达到了一定程度的肿瘤缩小。中位PFS和OS估计分别为5.3个月和11.8个月。结论mRCC伴肉瘤样分化患者对vegf靶向治疗有客观反应，肿瘤缩小。具有清晰细胞组织学和较低的肉瘤样分化百分比的患者在vegf靶向治疗中可能有更好的结果。
PurposeMetastatic renal cell carcinoma (mRCC) with sarcomatoid differentiation is an aggressive disease that is associated with poor outcomes to chemotherapy or immunotherapy. The utility of vascular endothelial growth factor (VEGF)-targeted therapy in patients with this disease is unknown.Patients and MethodsPatients who had mRCC with sarcomatoid features in the primary tumor and who were treated with VEGF-targeted therapy were retrospectively identified. Pathology slides were reviewed to determine the percentage of sarcomatoid differentiation. Objective response rate, percentage of tumor burden shrinkage, progression-free survival (PFS), and overall survival (OS) were determined.ResultsForty-three patients who had sarcomatoid mRCC were identified. The median percentage of sarcomatoid features was 14% (range, 3% to 90%). Patients were treated with either sunitinib (49%), sorafenib (28%), bevacizumab (19%), or sunitinib plus bevacizumab (5%). Partial responses were observed in eight patients (19%); 21 patients (49%) had stable disease; and 14 patients (33%) had progressive disease as their best response. Partial responses were limited to patients who had underlying clear-cell histology and less than 20% sarcomatoid elements. Median tumor shrinkage was -2% (range, -85% to 127%), and 53% achieved some degree of tumor shrinkage on therapy. Median PFS and OS were estimated to be 5.3 months and 11.8 months, respectively.ConclusionPatients 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.