RCC With Sarcomatoid Features May Benefit From Immunotherapy

Matthew T. Campbell, MD, assistant professor, Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the results of a retrospective analysis of patients with metastatic renal cell carcinoma (mRCC) with sarcomatoid dedifferentiation.

Sarcomatoid dedifferentiation is associated with poor survival outcomes in patients with mRCC. Campbell and other investigators reviewed the cases of 48 patients who were treated with immune checkpoint inhibitors at MD Anderson Cancer Center, 41 of whom had clear cell RCC and 7 of whom had non-clear cell RCC.

The overall response rate (ORR) among patients in the study was 35.4%, including 8 patients (16.7%) who had a complete response. There was a disease control rate of 52.0%. Only 1 patient with non-clear cell disease had a partial response. For the patients with clear cell RCC, the median progression-free survival (PFS) was 8.9 months and median overall survival (OS) was 30.1 months, though median PFS was only 2.3 months and median OS was 6.7 months for the patients with non-clear cell disease.

Campbell says that patients with sarcomatoid dedifferentiation are seeing improved outcomes with immunotherapy, and he feels that the immunotherapy combination of nivolumab (Opdivo) and ipilimumab (Yervoy) will offer the best efficacy for these patients despite potential toxicity.

TRANSCRIPTION:

0:08 |The response rate for all patients that received immunotherapy with sarcomatoid dedifferentiation was around 35%. The chance of benefit for most patients was much higher, with fewer patients having frank progressive disease as best response. Again, PFS [was] somewhere around 9 to 10 months and OS right around 30 months. [It’s] single institution experience, but I think it again adds value from the fact that we are seeing more and more patients with sarcomatoid dedifferentiation with improved outcomes in this new era of immuno-oncology.

0:46 | I think when I see patients in my clinic that have sarcomatoid dedifferentiation with metastatic disease, my preference is to use nivolumab and ipilimumab as initial therapy. I do this because I again think that these patients are more likely to respond to immunotherapy and tend to be more resistant to targeted therapy. I think these are patients that the risk of potential toxicity with nivolumab and ipilimumab is well warranted given the potential response and benefit.