Poster Presentation COSA 2015 ASM

Patterns of care and outcomes among sarcomatoid renal cell carcinoma patients in South Western Sydney   (#385)

Shamsudheen Padinharakam 1 2 3 , Wei Chua 1 2 3 , Stephanie Lim 1 2 3 , Deme Karikios 4 , Diana Adams 4 , Stephen Della-Fiorentina 4 , Paul Desouza 1 2 3 5 , Eugene Moylan 3 , Michelle Harrison 6 , Joseph Descallar 7 , Bavanthi Balakrishnar 3
  1. Medical Oncology, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
  2. School of Medicine, University of New South Wales, Sydney, NSW, Australia
  3. Medical Oncology, Liverpool Hospital, Sydney, NSW, Australia
  4. Medical Oncology, Campbelltown Hospital, Sydney, NSW, Australia
  5. School of Medicine, University of Western Sydney, Sydney, NSW, Australia
  6. Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
  7. Biostatistics, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia

Background

Sarcomatoid renal cell carcinoma (RCC) is rare and represents a more aggressive subtype with less defined treatment strategies. The aim of this study is to describe the patterns of care in sarcomatoid RCC in South Western Sydney Local Health District (SWSLHD) over a ten-year period.

Methods

RCC patients seen at SWSLHD from 1/1/2005 to 30/6/2015 were identified from electronic medical records and data analyzed using SAS software with institutional ethics obtained.

Results

Of the 178 RCC patients, 8% (n=15) were sarcomatoid RCC (87% sarcomatoid with clear-cell component; 13% pure sarcomatoid). Median age was 67years (range 43-84), with 73% males and 87% Caucasians. At initial presentation, 60% were stage 4, 27% stage 2 and 13% stage 3. All stage 2/3 patients (n=6) underwent radical nephrectomy and 89% (n=8) of stage 4 patients underwent cytoreductive nephrectomy. The median tumour size was 85mm (range 60-160), with 73% Furhman grade 3/4. Of the stage 2/3 patients, 83% developed metastases with median time to development of metastases following radical nephrectomy being 9.8months. . The most common sites of metastases were lung (60%), bone (40%), lymph nodes (33%), brain (20%) and liver (14%). The proportion of patients receiving systemic therapy was 47% with 86% receiving only one line of treatment. First-line therapy comprised of 66% sunitinib, 17% pazopanib and 17% sorafenib; with everolimus used in second-line. At a median follow-up of 16 months, the median overall survival for patients with metastatic disease (n=14) was 10 months (range 1.6 to 89).

Conclusions

Less than half of sarcomatoid RCC patients received systemic therapy in our cohort with the majority receiving no more than one line of treatment and with poor survival outcomes. This is reflective of the rapid and aggressive course of sarcomatoid RCC highlighting the need for more effective therapeutic strategies in this rare patient population.