Introduction: Pancreatic metastases (PM) of renal cell carcinoma (RCC) are diagnosed in about 2% of all metastases in this disease. The recommended treatment for isolated pancreatic lesion is surgery. The effects of antiangiogenic molecules on these hypervascularized lesions have not been evaluated for patients (pts) who are not eligible for surgery. We present the clinical results of treatment by sunitinib on pts with unresectable metastatic RCC with PM.
Materiel and methods: An exhaustive retrospective monocentric review of the medical records of pts with histologically confirmed RCC with PM treated with sunitinib was performed. Evaluation of the tumor response was done according to RECIST criteria by spiral CT scan, after every 6 weeks cycle of sunitinib.
Results: A total of 10 pts (7 men, 3 women), with a median age of 60 years who underwent radical nephrectomy for primary RCC (left-sided tumor for 8 pts, right-sided for 2 pts) has been analyzed. Seven pts had an ECOG performance status (PS) of 0 at the beginning of sunitinib, three had a PS of 1. Median number of metastatic sites was 3 (range 1-5) and the median interval of relapse between initial diagnosis of RCC and PM was 7 years (range 0-12). The pancreatic involvement was limited to one lesion for 1 pt, and was multiple (head, tail and/or body of the pancreas) for 9 pts. One pt had clinical symptoms and one other had biological symptoms of pancreatic insufficiency. Two pts had sunitinib as first line of treatment for metastatic disease, six as a second line and two as a third line.
After a median follow-up of 37 months, 8 pts were still alive and their median survival time was 29.5 months (range 19-84). Five are still under treatment with sunitinib. Best response was complete response (CR) in one pt, partial response (PR) in 3 and stable disease (SD) in 6. A progressive disease was afterward diagnosed in 4 pts. Two pts have shown a CR of their pancreatic metastases
All clinical and biological pancreatic symptoms disappeared when a PR was noted. During treatment with sunitinib, 4 pts presented a grade I toxicity on lipasemia but not on amylasemia.
Response of the PM was similar to the response of other metastatic sites. Best response (SD or PR) was observed for the PM and for the other metastatic sites in the same cycle.
The response on PM appeared early (between C2 and C3) and for 7 pts was at least a stabilization of the lesions. The stabilization of the lesions was long-lasting and confirmed for these seven pts.
Conclusions: Sunitinib was active for PM. Pancreatic metastases of RCC were rarely clinically or biologically symptomatic. Pancreatic metastases had the same pattern of response than the other metastatic sites with a similar delay of response.
- American Association for Cancer Research