Originally published as JCO Early Release 10.1200/JCO.2008.18.0000 on December 8 2008

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

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

From the Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

Corresponding author: Brian I. Rini, MD, Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Ave, Desk R35, Cleveland, OH 44195; e-mail: rinib2{at}ccf.org

Purpose Metastatic 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 Methods Patients 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.

Results Forty-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.

Conclusion 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.

published online ahead of print at www.jco.org on December 8, 2008

Presented in part at the 6th International Kidney Cancer Association Symposium, Chicago, IL, October 11-13, 2007, and at the 2008 Genitourinary Cancer Symposium, San Francisco, CA, February 14-16, 2008.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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