TITLE:
Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma
AUTHORS:
Keith Chiu, Abdul Razack, Anthony Maraveyas
KEYWORDS:
Isolated Pancreatic Metastases; Renal Cell Carcinoma; Targeted Therapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.9B,
October
16,
2013
ABSTRACT: Background: The
pancreas is an uncommon but recognizable site for metastases from renal cell
carcinoma (RCC). Isolated pancreatic RCC metastases are still rarer and often
present years after initial nephrectomy. Surgical resection has been the
treatment of choice because of superior patient survival compared with
traditional immunotherapy. In recent years, the advent of targeted therapy has
transformed the outcomes of patients with metastatic RCC although little evidence
is available on its effectiveness on this subset of patients. We report our
experience of 6 patients with pancreatic RCC metastases. Patients and Methods: Between 2007 and 2012, 6 patients (2 men, 4 women; median age 78 years)
were diagnosed to have pancreatic RCC metastases at our institute. The clinical
features, treatment and outcomes were examined. Results: All 6 patients had a primary RCC of clear cell type. The
median interval between initial curative nephrectomy and re-presentation with
pancreatic metastases was 12.5 years. Four patients were asymptomatic at the time of diagnosis,
one presented with obstructive jaundice and another with acute gastrointestinal
bleed. Four patients had extra-pancreatic disease. All were deemed unsuitable
or unfit for surgical metastasectomy. Five patients had a Memorial
Sloan-Kettering Cancer Center (MSKCC)
score of 1 (moderate risk) and the other patient
had a score of 0 (good risk). Two patients were commenced on
Sunitinib, one received Pazopanib and one received Temsirolimus. Two patients
did not undergo further treatment. Of the 4 patients who underwent targeted
therapy, the median follow up was 33 months with a median progression free
survival of 16 months. One achieved complete response but recurred soon after
treatment was stopped. Targetted therapy was recommenced and the disease
remained stable. A second patient had long period of stable disease before
disease progression. A third achieved partial response since started on
targeted therapy and a fourth had disease progression despite treatment. Of the four patients who
underwent systemic therapy, three are still alive at the time of this report. Conclusion: Pancreatic metastasis from RCC is a unique subgroup of disease
which runs an indolent course, and a higher incidence in an elderly population.
Our results demonstrate that targeted therapy can be efficacious in some patients
where surgical resection is not suitable or possible.