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Annals of Oncology<br />
95% CI and curves were compared with log-rank test. The study had <strong>the</strong> ethical<br />
approval.<br />
Results: 1905 pts were screened and 252 pts (13%) were treated with 3 TTs. The<br />
median age was 60 yrs (range 52–68), 73% were male, 96% underwent nephrectomy<br />
and 38% were metastatic at diagnosis. At 1 st line, <strong>the</strong> Motzer class was good,<br />
intermediate, and poor in 48%, 47% and 5% of pts, respectively. PFS for type and<br />
line of <strong>the</strong>rapy are reported in <strong>the</strong> table below. The TTSF was 36.4 (30.5–42.2) vs.<br />
30.6 (26.5–34.6) mos (p = 0.11), and <strong>the</strong> OS was 52.1 (41.6–62.6) vs. 36.3 (31.2–41.4)<br />
mos (p = 0.01), for TKIàTKIàm-TOR and and TKIàm-TORàTKI, respectively. TTSF<br />
for SU-SO-EV was 36.5 vs. 30.4 mos for SU-EV-SO (p = 0.011). When stratified by<br />
ECOG-PS before 3 rd line or baseline MSKCC, TS maintained its independent<br />
prognostic role (p = 0.002 and p = 0.004, respectively).<br />
Conclusions: Only few patients received 3 lines of TTs. The sequence<br />
sunitinib-sorafenib-everolimus was associated with a better TTSF and OS as<br />
compared to <strong>the</strong> sequence sunitinib-everolimus-sorafenib.<br />
Therapy<br />
1 st line 2 nd line 3 rd line<br />
% PFS % PFS % PFS<br />
Sunitinib 60 10.1 31 11.2 8 14.1<br />
Sorafenib 25 13.1 35 7.7 28 5.2<br />
Pazopanib 2 6.4 0 / 0 /<br />
Bevac. + IFN 11 11.3 0 / 1 4.3<br />
Everolimus 0 / 30 4.7 55 6.9<br />
Temsirolimus 2 5.1 3 5.6 5 2.6<br />
O<strong>the</strong>r 0 / 0 / 3 3.2<br />
TOTAL 100 11.6 100 6.8 100 6.2<br />
Disclosure: All authors have declared no conflicts of interest.<br />
819P IMPLEMENTATION OF TARGETED THERAPY IN DENMARK<br />
FOR PATIENTS WITH METASTATIC RENAL CELL<br />
CARCINOMA: RESULTS FROM THE DANISH RENAL<br />
CANCER GROUP (DARENCA) STUDY-2<br />
A.V. Soerensen 1 , F. Donskov 2 , G.G. Hermann 3 , N.V. Jensen 4 , H. Spliid 5 ,<br />
E.Q. Bergan 6 , K. Fode 2 , P.F. Geertsen 1<br />
1 Department of Oncology, University Hospital of Copenhagen Herlev, Herlev,<br />
DENMARK, 2 Department of Oncology, Aarhus University Hospital, Aarhus,<br />
DENMARK, 3 Department of Urology, University Hospital of Copenhagen<br />
Rigshospitalet, Copenhagen, DENMARK, 4 Department of Oncology, Odense<br />
University Hospital, Odense, DENMARK, 5 Section for Statistics, Informatics and<br />
Ma<strong>the</strong>matical Modelling, Technical University of Denmark, Kongens Lyngby,<br />
DENMARK, 6 Denmark, Pfizer, Ballerup, DENMARK<br />
Background: Treatment options for metastatic renal cell carcinoma (mRCC) have<br />
expanded since <strong>the</strong> introduction of targeted <strong>the</strong>rapies. The impact of <strong>the</strong>se new<br />
treatment options on overall survival in a complete national cohort of patients is<br />
unclear.<br />
Objective: To analyze Overall Survival (OS), Progression Free Survival (PFS) and<br />
Time to Treatment Failure (TTF) in a complete national cohort of patients.<br />
Design, setting and participants: All Danish patients with mRCC starting first line<br />
treatment with immuno<strong>the</strong>rapy, TKIs or mTOR-inhibitors between 2006 and 2010<br />
were included. Baseline and outcome data were collected retrospectively. Untreated<br />
patients referred for treatment were also assessed.<br />
Outcome measurements and statistical analysis: OS, PFS and TTF was calculated<br />
using <strong>the</strong> Kaplan-Meier method. Differences between OS and treatment year were<br />
assessed using <strong>the</strong> log rank test. Differences in distributions were tested with <strong>the</strong><br />
Chi-square test.<br />
Results and limitations: Between 2006 and 2010, a total of 1073 patients were<br />
referred. Of <strong>the</strong>se, 759 patients received first line treatment and 314 received no<br />
systemic treatment. The proportion of treated patients increased from 64% in 2006 to<br />
75% in 2010 (p = 0.02). In 2006 22% received targeted <strong>the</strong>rapy and this increased to<br />
75% in 2010 (p < 0.00001). In 2006 21% of first line patients received second line<br />
treatment compared to 41% in 2010 (p = 0.01). From 2006 to 2010 we observed an<br />
improved median OS from 11.5 to 15.7 months (p = 0.03), improved median PFS<br />
from 4.1 to 5.5 months (p = 0.001) and an improved median TTF from 3.1 to 4.9<br />
months (p = 0.006) for first line treatment. The untreated population of 314 patients<br />
had a median OS of 3.1 months from date of metastatic disease with no significant<br />
change from 2006 to 2010.<br />
Conclusions: In a complete national cohort of patients, implementation of targeted<br />
<strong>the</strong>rapy has resulted in improved treatment options and outcome for patients with<br />
mRCC.<br />
Disclosure: A.V. Soerensen: has received a research grant/funding from Pfizer. F.<br />
Donskov: has received a research grant from Novartis. E.Q. Bergan: Employee of<br />
Pfizer Denmark Aps. All o<strong>the</strong>r authors have declared no conflicts of interest.<br />
820P SUNITINIB GLOBAL EXPANDED-ACCESS TRIAL IN<br />
METASTATIC RENAL CELL CARCINOMA (MRCC) – FINAL<br />
RESULTS<br />
M.E. Gore 1 , C. Porta 2 , S. Bracarda 3 , G.A. Bjarnason 4 , S. Oudard 5 , S. Lee 6 ,<br />
L. Crino 7 , T.M. Kim 8 , K. Fly 9 , C. Szczylik 10<br />
1 Department of Medicine, Royal Marsden Hospital NHS Foundation Trust,<br />
London, UNITED KINGDOM, 2 Medical Oncology, IRCCS San Matteo University<br />
Hospital Foundation, Pavia, ITALY, 3 Ospedale San Donato, Medical Oncology<br />
Arezzo, Arezzo, ITALY, 4 Division of Medical Oncology, Sunnybrook Odette<br />
Cancer Centre, Toronto, ON, CANADA, 5 Medical Oncology, Georges Pompidou<br />
Hospital and Rene Descartes University, Paris, FRANCE, 6 Oncology, Seoul<br />
National University Hospital, Seoul, KOREA, 7 Medical Oncology, S. Maria della<br />
Misericordia Hospital, Perugia, ITALY, 8 Medical Oncology, Seoul National<br />
University Hospital, Seoul, KOREA, 9 Oncology, Pfizer Inc., Groton, CT, UNITED<br />
STATES OF AMERICA, 10 Oncology, Military Medical Institute, Warsaw, POLAND<br />
Background: Sunitinib had a manageable safety profile and encouraging efficacy in a<br />
global expanded-access mRCC study (ClinicalTrials.gov, NCT00130897; Pfizer)<br />
initiated prior to regulatory approval, in patients (pts) ineligible for o<strong>the</strong>r trials (Gore<br />
et al, 2009). Here we report final results.<br />
Methods: Pts aged ≥18 yrs with treatment-naïve or previously treated mRCC<br />
received oral sunitinib on <strong>the</strong> approved 50 mg/day 4-wk-on/2-wk-off schedule. Safety<br />
was assessed regularly and tumor measurements were done as per local standard<br />
practice using RECIST-defined response. Analyses included all pts who received ≥1<br />
dose of sunitinib.<br />
Results: 4,577 pts were enrolled. From July 2005 to November 2011, 4,543 pts<br />
received treatment, including poor prognosis pts with brain metastases (7%), Eastern<br />
Cooperative Oncology Group performance status (ECOG PS) ≥2 (14%), non-clear<br />
cell RCC (12%) and age ≥65 yrs (33%). Median treatment duration was 7.5 mths<br />
and median follow-up was 13.6 mths. 4,298 pts (95%) discontinued; reasons included<br />
lack of efficacy (37%), death (20%) and adverse events (AEs; 15%). The most<br />
common treatment-related AEs of any grade were diarrhea (47%), fatigue (40%),<br />
nausea (36%), decreased appetite (31%), mucosal inflammation (29%), stomatitis and<br />
vomiting (both 28%), hand–foot syndrome (HFS; 27%), dysgeusia (25%),<br />
hypertension (24%), thrombocytopenia (23%) and as<strong>the</strong>nia (22%). The most<br />
common treatment-related grade 3/4 AEs were fatigue (9%), thrombocytopenia (8%),<br />
HFS and as<strong>the</strong>nia (both 7%), hypertension and neutropenia (both 6%) and diarrhea<br />
(5%). In 4,219 evaluable pts, <strong>the</strong> objective response rate (ORR) was 16% (n = 660)<br />
with subgroup ORR as follows: baseline brain metastases (30/324 [9%]), ECOG PS<br />
≥2 (32/587 [5%]), non-clear cell RCC (42/505 [8%]), and age ≥65 yrs (195/1,386<br />
[14%]). Overall median progression-free survival was 9.4 mths (95% CI: 8.8, 10.0)<br />
and overall survival was 18.7 mths (95% CI: 17.5, 19.5).<br />
Conclusions: Results from this global expanded-access mRCC trial confirm <strong>the</strong><br />
safety and efficacy of sunitinib in >4,500 pts with wide-ranging disease states in a<br />
real-world setting. The sunitinib AE profile in this broad population was manageable<br />
and consistent with prior trial results.<br />
Disclosure: M.E. Gore: Advisory relationships with Roche, Pfizer, Bristol Myers,<br />
Novartis, GSK, Aveo\\Astellas, Bayer. Honoraria to disclose from Roche, Pfizer,<br />
Bristol Myers, Novartis.C. Porta: Advisory relationship Pfizer Bayer-Schering<br />
Hoffman La Roche GSK Novartis Astellas Boehringer Recordati. Honoraria: Pfizer<br />
Bayer-Schering Hoffman La Roche GSK Novartis Astellas Boehringer Recordati<br />
Research funding Bayer-Schering Novartis. S. Bracarda: Advisory relationship with<br />
Novartis Bayer Schering Pfizer GSK Aveo/Astellas Boheringer-Ingelheim. Honoraria<br />
to disclose from Novartis and Pfizer. G.A. Bjarnason: Advisory relationship with<br />
Pfizer. Honoraria to disclose from Pfizer. Research funding to disclose from Pfizer..<br />
S. Oudard: Advisory relationships: Pfizer, Bayer-Schering, Hoffman La Roche, Glaxo<br />
SmithKline, Novartis Pharma, Sanofi Aventis Honoraria: Pfizer, Bayer-Schering,<br />
Hoffman La Roche, Glaxo SmithKline, Novartis Pharma, Sanofi Aventis. S. Lee:<br />
Advisory relationships with Pfizer, Novartis, Bayer. Honoraria to disclose from<br />
Pfizer, Novartis, Bayer. K. Fly: Employed by Pfizer Inc. as an Oncology Clinician.<br />
Hold Pfizer stock as does an immediate family member. C. Szczylik: Advisory<br />
relationship with Pfizer, GSK, Bayer. Honoraria from Pfizer, GSK, Bayer. All o<strong>the</strong>r<br />
authors have declared no conflicts of interest.<br />
821P EVEROLIMUS IN PATIENTS WITH METASTATIC RENAL CELL<br />
CARCINOMA WHO PROGRESS AFTER INITIAL VASCULAR<br />
ENDOTHELIAL GROWTH FACTOR RECEPTOR-TYROSINE<br />
KINASE INHIBITOR (VEGFR-TKI) THERAPY: UK RESULTS<br />
FROM THE REACT TRIAL ON BEHALF OF THE UK REACT<br />
INVESTIGATORS<br />
S. Chowdhury 1 , J. Larkin 2<br />
1 Department of Medical Oncology, Guy’s and St. Thomas’ Hospital NHS Trust,<br />
London, UNITED KINGDOM, 2 Department of Medicine, Royal Marsden Hospital,<br />
London, UNITED KINGDOM<br />
Background: The phase III RECORD-1 trial demonstrated clinical benefit of<br />
everolimus in patients with metastatic renal cell carcinoma (mRCC) who had failed<br />
initial VEGFr-TKI <strong>the</strong>rapy. REACT (RAD001 Expanded Access Clinical Trial in<br />
Volume 23 | Supplement 9 | September <strong>2012</strong> doi:10.1093/annonc/mds399 | ix271