Prognostic Role of Circulating Tumor Cells in Metastatic Renal Cell Carcinoma: A Large, Multicenter, Prospective Trial.

Autor: Basso U; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Facchinetti A; Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy.; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy., Rossi E; Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy.; Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy., Maruzzo M; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Conteduca V; Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy., Aieta M; Department of Onco-Hematology, Division of Medical Oncology, Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy., Massari F; Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.; Medical Oncology, IRCCS Azienda Ospedaliera Universitaria, Bologna, Italy., Fraccon AP; Medical Oncology, Ospedale P. Pederzoli, Peschiera Del Garda, Peschiera Del Garda (VR), Italy., Mucciarini C; Medical Oncology Unit, Ramazzini Hospital, Carpi-AUSL Modena, Modena, Italy., Sava T; Medical Oncology, Ospedale Borgo Trento, Verona, Italy., Santoni M; Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy., Pegoraro C; Medical Oncology Ospedale di Montecchio Maggiore, Azienda ULSS 8 Berica, Berica, Italy., Durante E; Department of Medical Oncology, Ospedale di Legnago, Azienda ULSS 9 Scaligera, Scaligera, Italy., Nicodemo M; Department of Medical Oncology, Sacro Cuore - Don Calabria Hospital, Negrar, Italy., Perin A; Medical Oncology, Polo Unico Ospedale Santorso, Santorso, Azienda ULSS 7 Pedemontana, Pedemontana, Italy., Bearz A; Department of Medical Oncology, Centro Riferimento Oncologico CRO IRCCS, Aviano, Italy., Gatti C; Medical Oncology, Ospedale di Chioggia, Azienda ULSS 3 Serenissima, Chioggia, Italy., Fiduccia P; Clinical Research Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Diminutto A; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Barile C; Medical Oncology, Ospedale di Rovigo, Azienda ULSS 5 Polesana, Rovigo, Italy., De Giorgi U; Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy., Zamarchi R; Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Zagonel V; Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy.
Jazyk: angličtina
Zdroj: The oncologist [Oncologist] 2021 Sep; Vol. 26 (9), pp. 740-750. Date of Electronic Publication: 2021 Jun 17.
DOI: 10.1002/onco.13842
Abstrakt: Background: Circulating tumor cells (CTCs) correlate with adverse prognosis in patients with breast, colorectal, lung, and prostate cancer. Little data are available for renal cell carcinoma (RCC).
Materials and Methods: We designed a multicenter prospective observational study to assess the correlation between CTC counts and progression-free survival (PFS) in patients with metastatic RCC treated with an antiangiogenic tyrosine kinase inhibitor as a first-line regimen; overall survival (OS) and response were secondary objectives. CTC counts were enumerated by the CellSearch system at four time points: day 0 of treatment, day 28, day 56 and then at progression, or at 12 months in the absence of progression.
Results: One hundred ninety-five eligible patients with a median age of 69 years were treated with sunitinib (77.5%) or pazopanib (21%). At baseline, 46.7% of patients had one or more CTCs per milliliter (range, 1 to 263). Thirty patients had at least three CTCs, with a median PFS of 5.8 versus 15 months in the remaining patients (p = .002; hazard ratio [HR], 1.99), independently of the International Metastatic RCC Database Consortium score at multivariate analysis (HR, 1.91; 95% confidence interval [CI], 1.16-3.14). Patients with at least three CTCs had a shorter estimated OS of 13.8 months versus 52.8 months in those with fewer than three CTCs (p = .003; HR, 1.99; multivariate analysis HR, 1.67; 95% CI, 0.95-2.93). Baseline CTC counts did not correlate with response; neither did having CTC sequencing counts greater than or equal to one, two, three, four, or five.
Conclusion: We provide prospective evidence that the presence of three or more CTCs at baseline is associated with a significantly shorter PFS and OS in patients with metastatic RCC.
Implications for Practice: This prospective study evaluated whether the presence of circulating tumor cells (CTCs) in the peripheral blood correlates with activity of first-line tyrosine kinase inhibitors in metastatic renal cell carcinoma (RCC). This study demonstrated that almost half of patients with metastatic RCC have at least one CTC in their blood and that those patients with at least three CTCs are at increased risk of early progressive disease and early death due to RCC. Studies incorporating CTC counts in the prognostic algorithms of metastatic RCC are warranted.
(© 2021 AlphaMed Press.)
Databáze: MEDLINE
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