Adjuvant therapy in patients with sarcomatoid renal cell carcinoma: post hoc analysis from Eastern Cooperative Oncology Group‐American College of Radiology Imaging Network (ECOG‐ACRIN) E2805

• Published in: BJU international Vol. 129; no. 6; pp. 718 - 722
• Main Authors: Karam, Jose A., Puligandla, Maneka, Flaherty, Keith T., Uzzo, Robert G., Matin, Surena F., Pins, Michael R., Wood, Christopher G., Kane, Christopher, Jewett, Michael A. S., Kim, Se Eun, Dutcher, Janice P., DiPaola, Robert S., Haas, Naomi B.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.06.2022
• Subjects: Adjuvant therapy; Carcinoma, Renal Cell - surgery; Chemotherapy, Adjuvant - methods; Clinical trials; Disease-Free Survival; Humans; Kidney cancer; Kidney Neoplasms - surgery; Lymph nodes; Lymphatic system; Metastases; Patients; Placebos; Radiology; Renal cell carcinoma; sarcomatoid; Sorafenib - pharmacology; Sorafenib - therapeutic use; Sunitinib - therapeutic use; kidney cancer; sarcomatoid; adjuvant therapy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.15587

Objectives To study the effects of adjuvant therapy in patients with sarcomatoid renal cell carcinoma (sRCC) enrolled in the randomised phase III clinical trial E2805. Patients and Methods The original trial (E2805) was a randomised, double‐blinded phase III clinical trial comparing outcomes in 1943 patients with RCC accrued between 2006 and 2010 and treated with up to 1 year of adjuvant placebo, sunitinib, or sorafenib. The present study analyses the cohort of patients with sRCC that participated in E2805. Results A total of 171 patients (8.8%) had sarcomatoid features. Of these, 52 patients received sunitinib, 58 received sorafenib, and 61 received placebo. Most patients were pT3–4 (71.1%, 63.7%, and 70.5%, respectively); 17.3%, 19.0%, and 27.9% had pathologically positive lymph nodes; and 59.6%, 62.1%, and 62.3% of the patients were University of California Los Angeles (UCLA) Integrated Staging System (UISS) very‐high risk. In 49% of patients with subsequent development of metastatic disease, recurrence occurred in the lung, followed by 30% in the lymph nodes, and 13% in the liver. There was a high local recurrence rate in the renal bed (16%, 29%, and 18%, respectively). The 5‐year disease‐free survival (DFS) rates were 33.6%, 36.0%, and 27.8%, for sunitinib, sorafenib and placebo, respectively (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.45–1.20 for sunitinib vs placebo, and HR 0.82, 95% CI 0.53–1.28 for sorafenib vs placebo). Conclusions Adjuvant therapy with sunitinib or sorafenib did not show an improvement in DFS or OS in patients with sRCC.