Association of prior pelvic radiation with long-term oncologic outcomes following radical cystectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 308-308
Author(s):  
Harras B. Zaid ◽  
Matthew K. Tollefson ◽  
Igor Frank ◽  
William P. Parker ◽  
Robert Houston Thompson ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Disease Recurrence ◽  
Oncologic Outcomes ◽  
Rank Test ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
Surgical Complexity

308 Background: Receipt of pelvic radiotherapy (PRT) prior to radical cystectomy (RC) has unclear association on oncologic outcomes. Methods: The Mayo Clinic Cystectomy Registry was queried to review 2139 patients undergoing RC for M0 bladder cancer between 1990 and 2010. We then identified patients receiving PRT prior to RC, and matched these cases to non-radiated controls (~1:2) on the basis of age, sex, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Cancer-specific survival (CSS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: Of 2139 patients undergoing RC, 104 (4.9%) had received PRT prior to surgery. These patients were matched to 191 non-radiated control patients (no PRT). Overall, patients were well-matched on disease and patient characteristics. Median follow-up was 9.6 years (IQR 6.0, 14.8). During this time, 108 patients experienced disease recurrence and 218 died, including 122 who died from bladder cancer. Five-year CSS among patients who did versus did not receive PRT was 55% versus 63% (p=0.10), while the 5-year PFS was 55% versus 61% (p=0.32). Furthermore, the pattern of disease recurrence (abdominal/visceral, urothelial, local/pelvic, thoracic, soft tissue/other) did not differ between the no PRT and PRT groups (all p>0.05). Conclusions: Receipt of PRT prior to RC is not associated with worse oncologic outcomes. While prior PRT may increase surgical complexity, CSS, PFS, and patterns of recurrence are similar to patients who have not received PRT.

Association of perioperative venous thromboembolism with long-term oncologic outcomes following radical cystectomy.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 364-364
Author(s):  
Harras B. Zaid ◽  
Matthew K. Tollefson ◽  
Igor Frank ◽  
William P. Parker ◽  
Robert Houston Thompson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Radical Cystectomy ◽  
Disease Recurrence ◽  
Cancer Prognosis ◽  
Oncologic Outcomes ◽  
Rank Test ◽  
Perioperative Morbidity ◽  
Kaplan Meier ◽  
Significant Difference

364 Background: Venous thromboembolism (VTE) has been reported to occur in 2-5% of patients undergoing radical cystectomy (RC). While VTE is an important cause of perioperative morbidity, the association of these events with long-term cancer prognosis has not been established. Herein, we evaluated the association of perioperative VTE with patients’ risk of subsequent disease recurrence and mortality. Methods: We reviewed 2889 patients undergoing RC between 1980−2009 at the Mayo Clinic to identify patients diagnosed with a VTE within 90 days of RC. These cases were then matched in a 1:2 fashion to control patients undergoing RC who did not develop VTE. Matching was performed on the basis of age, BMI, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were estimated utilizing the Kaplan-Meier method and compared with the log-rank test. Results: A total of 132 patients with a VTE within 90 days of RC were identified, accounting for 4.6% of all patients analyzed. These cases were matched to 257 controls per criteria noted above, and were overall well-matched. Of the 389 patients in this study, median follow-up after RC was 9.2 years, during which time 152 (39%) patients experienced recurrence and 306 (78%) died, including 157 (40%) who died of bladder cancer. We found no significant difference in 5-year RFS (59% versus 61%; p = 0.75); CSS (57% versus 64%; p = 0.13); or OS (45% versus 50%; p = 0.15) between patients with versus without perioperative VTE, respectively. Conclusions: We found that VTE within 90 days of RC did not significantly impact long-term cancer outcomes. While these events represent an important cause of perioperative morbidity, no interaction with oncologic control was noted, and patients may be counseled accordingly.

Bone-targeted therapy in patients with renal cell carcinoma bone metastases undergoing palliative surgery.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16572-e16572
Author(s):  
Benjamin Garmezy ◽  
Ava Brozovich ◽  
Lei Feng ◽  
Lorenzo Deveza ◽  
Robert L. Satcher
Keyword(s):  
Targeted Therapy ◽  
Bone Metastases ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Palliative Surgery ◽  
Open Reduction Internal Fixation ◽  
Rank Test ◽  
Cancer Center ◽  
Kaplan Meier ◽  
Md Anderson

e16572 Background: RCC bone metastases (RCCBM) are found in 20-39% of patients and are becoming more prevalent. RCCBM cause significant morbidity and often require surgical intervention. Current bone-targeted therapies include bisphosphonates and denosumab. Previous literature has suggested that bisphosphonates do not improve survival or reduce skeletal related events and little has been published about the effect of denosumab. Here we present experience describing outcomes and therapeutic effect in patients with RCCBM following palliative surgery for bone metastasis. Methods: We performed a retrospective analysis of 226 patients with RCCBM who underwent orthopedic surgery at MD Anderson Cancer Center between 11/2005 – 8/2019. The Kaplan-Meier method and log-rank test were used to estimate and evaluate survival differences. Results: Patient characteristics included: median age 58.2, male 66.4%, clear cell histology 93.5%, metastatic at presentation 57.9%, nephrectomy 79.8% (63.9% prior to orthopedic intervention), received radiation to the surgical site (pre-op: 13.0%, post-op: 41.4%). First orthopedic intervention: resection arthroplasty 37.2%, curettage and intramedullary nailing (IMN) 18.6%, IMN 16.4%, open reduction internal fixation 15.0%, amputation 2.7%, 10.2% other. Pre-op therapy: bisphosphonate 12.4%, denosumab 5.8%, both 2.7%, none 79.2%. Post-op therapy: bisphosphonate 18.1%, denosumab 13.7%, both 0.9%, none 67.2%. With a median follow up of 3.1 years after first orthopedic intervention, median overall survival (OS) was 2.7 yr (95% CI 2.1 – 3.6). Progression free survival (PFS) was calculated from time of first surgery to either first progression or death; median PFS was 5.2 months (95% CI 4.6 – 7.5). Pre-op or post-op bone-targeted therapy was not significantly associated with PFS (yes vs no: Pre-op: median 3.4 vs 6.3 mth, p=0.42; Post-op: median 4.3 vs 5.8 mth, p=0.61) or OS (Pre-op: 2.1 vs 2.9 yr, p=0.45; Post-op: 2.4 vs 3.2 yr, p=0.18). Post-op denosumab compared to bisphosphonate was associated with increased PFS (9.6 vs 3.8 mth, p=0.03) and OS (3.3 vs 1.6 yr, p=0.02). However, post-op denosumab vs no bone-targeted therapy was not significantly associated with increased PFS (9.6 vs 5.8 mth, p=0.42) or OS (3.3 vs 3.2 yr, p=0.85). Of note, post-op bisphosphonate vs no bone-targeted therapy was associated with reduced PFS (3.8 vs 5.8 mth, p=0.04) and OS (1.6 vs 3.2 yr, p=0.01). Conclusion: Addition of bone-targeted therapy did not significantly improve PFS or OS in patients with RCCBM undergoing orthopedic intervention. Post-op denosumab was associated with better PFS and OS compared to bisphosphonates and bisphosphonates were associated with worse PFS and OS compared to no bone-targeted therapy. Patient selection for therapy may be an important source of bias. Prospective research is needed to clarify the role and selection of bone-targeted therapy in RCCBM patients.

Three versus four cycles of neoadjuvant gemcitabine cisplatin for muscle invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16524-e16524
Author(s):  
Catherine Kendall Major ◽  
Michael Brandon Williams ◽  
Mark T. Fleming
Keyword(s):  
Radical Cystectomy ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Intention To Treat ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Muscle Invasive ◽  
Dose Dense

e16524 Background: The standard of care for MIBC is neoadjuvant (NAC) cisplatin-based chemotherapy with either 3-4 cycles of dose dense MVAC or 4 cycles of gemcitabine/cisplatin (GC) followed by radical cystectomy. However, due to toxicity some patients are unable to complete intention to treat full course chemotherapy. We aim to identify any variation in overall survival (OS) and progression-free survival (PFS) with 3 vs 4 cycles of neoadjuvant GC in the setting of miUCB. We hypothesize that there will be a statistically significant difference in OS and PFS with three vs four cycles of neoadjuvant GC. Methods: A consecutive retrospective chart review of patients with MIBC treated with three or four cycles of neoadjuvant cisplatin-based chemotherapy from 2009-2020 was performed. R Studio was used to generate Kaplan-Meier curves representing OS and PFS with p-values. Results: One hundred and twenty-one patients were identified. Patient characteristics are described in the table below. Eighty-six patients received 4 cycles of GC and thirty-five patients received 3 cycles. Ninety-five patients proceeded to cystectomy: 93 received a radical cystectomy, 1 received a partial cystectomy, and 1 was aborted due to positive lymph nodes. There was a statistically significant difference in OS between those who got 3 or 4 cycles (p=0.03) and PFS (p=0.014). Median OS for those who got 3 cycles and 4 cycles was 52 months and 92 months respectively. Conclusions: Toxicity can preclude patients from receiving four cycles of GC and this study demonstrates a significant difference in overall OS and PFS between those who receive 3 vs 4 cycles of GC.[Table: see text]

Management of cT1 micropapillary bladder cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 308-308
Author(s):  
Daniel Levi Willis ◽  
Mario Fernandez ◽  
Rian J. Dickstein ◽  
Sahil Parikh ◽  
Jay Bakul Shah ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Descriptive Analysis ◽  
Initial Therapy ◽  
Intravesical Therapy ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Bcg Therapy ◽  
Intravesical Bcg

308 Background: We have previously reported that intravesical BCG is ineffective as therapy for micropapillary variant of bladder cancer. Since then, smaller reports have emerged with differing conclusions. Here we report our updated experience and expanded number of patients with micropapillary bladder cancer (MPBC), with emphasis on cT1 MPBC. Methods: An IRB approved institutional review of our bladder cancer database identified 255 patients presenting with MPBC with 72 patients staged as cT1N0M0 at the time of initial diagnosis. Statistical and descriptive analysis was performed using IBM SPSS Statistics version 20 and survival analysis was performed using the Kaplan-Meier estimator and compared using the log-rank test. Results: Of the 72 patients with cT1 MPBC, intravesical BCG was used in 38 patients (53%), while 32 (44%) proceeded directly to radical cystectomy. This included 15 (20%) who received neoadjuvant chemotherapy for lymphovascular invasion (LVI). Kaplan-Meier estimates of overall survival (OS) and disease specific survival (DSS) at 5 and 10 years were 66% and 45%, and 70% and 61%, respectively. Among those receiving BCG, 28 (74%) recurred at a median of 7 mo., and 17 (45%) progressed, including 8 (30%) who developed metastatic disease. Among the 10 post BCG patients who underwent cystectomy after progression, median DSS was 43 mo. (mean=53 mo.) and 5 year DSS was 33%, whereas among those proceeding directly to cystectomy, median DSS was not reached (mean=152 mo.) and the 5 year DSS rate was 92% (p<0.001). For OS, upfront cystectomy conferred a median survival of 170 mo. versus 92 mo. for those receiving BCG as initial therapy (p=0.05). There was no association of OS with the presence of CIS, repeat transurethral resection (TUR), or history of intravesical therapy prior to the diagnosis of MPBC. Interestingly, the extent of micropapillary component in the initial TUR specimen did have prognostic value for those treated with BCG as patients with focal MPBC were 2.3 times less likely to progress (p=0.02). Conclusions: Our updated findings support the use of upfront radical cystectomy prior to progression of disease in patients with cT1 MPBC. BCG therapy should be attempted only in select patients as there is a high risk of disease progression during BCG treatment.

Predicting survival after radical cystectomy: Validation of the SPARC score.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 326-326
Author(s):  
Brian Robin Hu ◽  
Manuel S Eisenberg ◽  
Stephen A. Boorjian ◽  
Igor Frank ◽  
Leo Dalag ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Smoking Status ◽  
Performance Status ◽  
Rank Test ◽  
Survival Prediction ◽  
Kaplan Meier ◽  
Pathologic Features ◽  
Carcinoma Of The Bladder

326 Background: The Survival Prediction After Radical Cystectomy (SPARC) score (Eisenberg et al, J Urol 2013) incorporates clinical and pathologic features to predict cancer specific survival (CSS) for urothelial carcinoma of the bladder. Validation of this model would improve its generalizability. Methods: Using the IRB-approved bladder cancer database at the University of Southern California (USC), we identified patients who underwent radical cystectomy (RC) for urothelial carcinoma of the bladder for curative intent from 1971-2009. Clinical factors (Charlson comorbidity index, ECOG performance status, hydronephrosis, adjuvant chemotherapy, smoking status) and pathologic factors (pathologic T stage, nodal status, multifocality, and lymphovascular invasion) included in the SPARC score were obtained. Patients were excluded if there were missing variables or if they underwent neoadjuvant chemotherapy. Associations between clinicopathologic factors and CSS were evaluated using Cox proportional hazards. Calibration plots were generated comparing actuarial CSS with SPARC predicted CSS by deciles. A c-index was generated to determine accuracy of the prediction. Kaplan Meier curves estimated CSS stratified by SPARC score and were compared with the log rank test. Results: A total of 2,045 patients underwent RC and 1,123 (55%) met inclusion criteria with a median follow-up of 4.7 years (IQR 2.0-8.9 years). Of the 1,123 patients, 332 (30%) died of bladder cancer. All the clinical and pathologic variables used in the SPARC scoring model were associated with CSS except for smoking status and tumor multifocality. Calibration plots demonstrated concordance between the SPARC-predicted and actuarial CSS with a c-index of 0.75. Kaplan Meier curves demonstrated significant differences in CSS based upon SPARC score, p<0.001. Conclusions: The SPARC score represents a valid instrument for predicting bladder CSS after RC. The model can be utilized to better tailor adjuvant therapy and surveillance.

scholarly journals Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Giovanni Cochetti ◽  
Francesco Barillaro ◽  
Andrea Boni ◽  
Ettore Mearini
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Intraoperative Complications ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Tertiary Institution ◽  
Cancer Specific Survival

Objective.To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy.Materials and Methods.In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months.Results.Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months.Conclusions.Immediate surgical management seems feasible, safe, and efficacious.

scholarly journals Comparison of Long-Term Survival Outcomes of T4a and T4b Colorectal Cancer

2022 ◽  
Vol 11 ◽  
Author(s):  
Ji Ha Lim ◽  
Jung Wook Huh ◽  
Woo Yong Lee ◽  
Seong Hyeon Yun ◽  
Hee Cheol Kim ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Stage Ii ◽  
Oncologic Outcomes ◽  
Rank Test ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Kaplan Meier ◽  
T Classification ◽  
Survival Differences

BackgroundAlthough T4b is known to have worse oncologic outcomes, it is unclear whether it truly shows a worse prognosis. This study aims to compare the survival differences between T4a and T4b.MethodsPatients who were pathologically diagnosed with T3 and T4 colorectal adenocarcinoma from 2010 to 2014 were included (T3, n = 1822; T4a, n = 424; T4b, n = 67). Overall survival (OS) and cancer-specific survival (CSS) were compared between T4a and T4b using the Kaplan-Meier method and log-rank test.ResultsIn stage II, T4a had better OS and CSS than T4b (5-year OS, 89.5% vs. 72.6%; 5-year CSS, 94.4% vs. 81.7%, all p &lt; 0.05), however, in stage III, there were no significant differences in survivals between groups (all p &gt; 0.05). In multivariable analysis, T classification was not an independent risk factor for OS (p &gt; 0.05). However, for CSS, when respectively compared to T3, T4b (HR 3.53, p &lt; 0.001) showed a relatively higher hazard ratio than T4a (HR 2.27, p &lt; 0.001).ConclusionsT4a showed more favorable OS and CSS than T4b, especially in stage II. Our findings support the current AJCC guidelines, in which T4b is presented as a more advanced stage than T4a.

Outcome of patients with micropapillary bladder cancer treated with neoadjuvant therapy and radical cystectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 318-318 ◽  
Author(s):  
Daniel Levi Willis ◽  
Mario Fernandez ◽  
Rian J. Dickstein ◽  
Sahil Parikh ◽  
Arlene O. Siefker-Radtke ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Treatment Strategy ◽  
Clinical Stage ◽  
High Risk Group ◽  
Rank Test ◽  
Kaplan Meier ◽  
Significant Survival ◽  
Poor Outcomes

318 Background: Micropapillary bladder cancer (MPBC) is an uncommon and aggressive variant of urothelial carcinoma for which the role of neoadjuvant chemotherapy (NAC) is not well-defined. Here we report a retrospective analysis of patients with MPBC undergoing radical cystectomy (RC) with and without NAC. Methods: An IRB-approved review of our radical cystectomy database demonstrated 159 patients with a preoperative diagnosis of MPBC. Of these, 131 patients presented with surgically resectable (≤cT4aN0M0) disease and form the basis of this report. Disease-specific (DSS) and overall survival (OS) were estimated using the Kaplan-Meier estimator and compared by log-rank test. Results: The clinical stage breakdown was cT1:50; cT2:66; cT3:15; and cT4a:0. NAC was administered to 61 patients (47%) with 78% receiving cisplatin-based regimens. Patients were more likely to receive NAC if they presented with cT3 disease, hydronephrosis, or lymphovascular invasion (LVI) in the transurethral resection (TUR) specimen. After a median follow-up of 44 mo., 50% of patients recurred and 41% died of disease, resulting in a 5-year estimated DSS of 58.4% for all 131 patients. Survival analysis was performed for comparable groups according to our established risk factors. For the low risk patients (i.e. cT1-T2, no hydronephrosis, and no LVI) RC upfront (n=47) resulted in a 73% 5-yr DSS compared to 83% with NAC (n=19) (p=0.47). In the high-risk group (cT3 or cT2 with LVI and/or hydronephrosis), 41 patients were treated initially with NAC and 5-yr DSS was 40%, which was similar (p=0.74) to the 31% 5-yr DSS for those treated with RC upfront (n=20). The most important overall prognostic factor was pathologic downstaging to pT0, pTa, or pTis at cystectomy (seen in 52% after NAC and 19% after TUR alone) which conferred a significant survival advantage (5-yr DSS 93% vs. 40% in those not downstaged; p<0.001). Conclusions: Despite incorporation of a multimodal treatment strategy, patients with MPBC and high risk features (LVI, hydronephrosis and/or cT3 stage) have poor outcomes. Further studies are necessary to define the optimal treatment strategy in this challenging subset of patients with urothelial cancer.

scholarly journals Comparison of Open and Intracorporeal Modified Ureterosigmoidostomy (Mainz Ⅱ) After Laparoscopic Radical Cystectomy with Bladder Cancer

2020 ◽  
Author(s):  
Duo Zheng ◽  
Junyao Liu ◽  
Gongjin Wu ◽  
Shujun Yang ◽  
Chuang Luo ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Operation Time ◽  
Progression Free Survival ◽  
Postoperative Recovery ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Kaplan Meier ◽  
Estimated Blood Loss ◽  
Urinary Control

Abstract Objective: To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC).Patients and Methods: We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019.The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier method. Results: Overall 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24±3.91 d vs. 18.98±7.41 d, P=0.033), similar operation time (498.57±121.44 vs. 462.24±99.71, P=0.175), similar estimated blood loss ［400(200-475) ml vs. 400(200-700) ml, P=0.095］,similar overall complication rate within 30-d (19.05% vs. 25.40%, P=0.848) and 90-d (23.81% vs. 17.46%, P=0.748). Complete urinary control rate of 87.3% (55/63) at OMUUD group. In IMUUD with a complete urinary control rate of 90.5% (19/21).There was no significant in OS (χ2=0.015, P=0.901) and PFS (χ2=0.107, P=0.743) between two groups.Conclusion: IMUUD postoperative recovery is faster, other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

Everolimus (E) versus axitinib (A) as second-line therapy (2L) in metastatic renal cell carcinoma (mRCC): Retrospective experience at Gustave Roussy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 527-527 ◽  
Author(s):  
Annalisa Guida ◽  
Laurence Albiges ◽  
Yohann Loriot ◽  
Christophe Massard ◽  
Karim Fizazi ◽  
...  
Keyword(s):  
Progression Free Survival ◽  
Patient Characteristics ◽  
Outcome Data ◽  
Rank Test ◽  
First Line Therapy ◽  
Line Therapy ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Large Center ◽  
Third Line

527 Background: Currently both E and A are standard treatments for patients (pts) with mRCC after failure of first line therapy (1L)with VEGF-targeted therapy. There is no comparative study reported so far, and this study aims to evaluate these 2 drugs in a large center. Methods: Patient characteristics, safety and outcome data from all mRCC pts who received E or A as 2L at Gustave Roussy from April 2007 to May 2015 have been compared. Progression-free Survival (PFS) and Overall Survival (OS) were assessed by the Kaplan-Meier method and compared with the log-rank test. Results: 81 pts were treated with E and 45 pts with A. The table shows patient characteristics. The 2 groups were similar. The most common 1L was sunitinib (79% in E group and 82.2% in A group). Median follow up was 29 mo (95%CI 26 – 31), 26 mo for A and 33 mo for E (p=0.046). Median OS was 21.5 mo for E and 14.9 mo for A (p = 0.23). Median PFS was 5.3 and 7.7 mo for E and A respectively (p = 0.39). Disease control rate was 69% and 73% (p=0.31) and partial response was achieved in 4% and in 24% of pts (p=0.002), respectively in E and A cohort. At time of analysis E is ongoing in 3 pts (4%) and A in 9 pts (20%) (p=0.008). Third-line therapy (3L) was administrated in 62% of pts after E and in 33% after A (p=0.003). The most common 3L after E is A (48%) and vice versa the most common after A is E (71%). Median PFS of 3L after E is 9.1 mo (12.1 mo for A and 8 mo when 3L is not A (p=0.17)). Median PFS of 3L after A is 7.8 mo (95%CI 4-12). Conclusions: No statistically significant difference for PFS and OS were observed. Nevertheless, A showed more PR than E, while more pts received 3L after E. A remains very active in 3L. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document