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using Drug inCode ® pharmacogenetic service. SNPs in candidate genes, toge<strong>the</strong>r<br />

with clinical characteristics were tested univariately for association with <strong>the</strong> number<br />

of days of SU treatment until <strong>the</strong> first reduction of dose, PFS and OS.<br />

Results: Complete analysis was possible in 25 pts. Pts with CYP1A2*1/*1. a low<br />

metabolizing genotype, had an increased risk of dose reductions due to toxicity<br />

compare to allele *1F (Median time to dose reduction: 2.33 months Vs NR; p <<br />

0.006). Pts with CYP2C19*1/*1, wild type genotype, had an increased risk of dose<br />

reductions due to toxicity versus o<strong>the</strong>r genotypes (Median time to dose reduction:<br />

2.8 months Vs 9.73 months; P < 0.021). No statistically significant associations were<br />

observed among drug metabolizing genes and PFS or OS.<br />

Catechol-O-methyltransferase (COMT) V158M polymorphism was associated with<br />

PFS and OS (Met/Met carriers median PFS and OS NR; Met/Val pts PFS= 15<br />

months; OS = 17.2 months and Val/Val pts PFS = 3.3 months; OS= 4.4 months;<br />

p = 0.005 for PFS and P = 0.003 for OS).<br />

Conclusions: This preliminary analysis suggests that CYP1A2 and CYP2C19 SNPs<br />

may be associated with toxicity in patients with RCC treated with SU. As CYP1A2<br />

and CYP2C19 activity could be affected by a variety of non-genetic factors, if<br />

confirmed, <strong>the</strong>se results could lead to <strong>the</strong> necessity of controlling toxic and dietary<br />

habits of pts treated with SU. SNPs associated with toxicity and survival in this<br />

preliminary analysis are being validated in an independent cohort of RCC treated<br />

with SU (García-Donas J, et al. Lancet Oncol 2011) and will be presented.<br />

Disclosure: All authors have declared no conflicts of interest.<br />

851P A PHASE IV MULTICENTER STUDY OF THE EFFICACY AND<br />

SAFETY OF SUNITINIB AS FIRST-LINE THERAPY IN CHINESE<br />

PATIENTS WITH METASTATIC RENAL CELL CARCINOMA<br />

(MRCC)<br />

S. Qin 1 , J. Jin 2 , J. Guo 3 , J. Wang 4 , F. Zhou 5 , Y. Huang 6 ,X.Ren 7 ,D.Ye 8 ,<br />

Q. Wang 9 ,S.Pan 10<br />

1 Pla Cancer Center, Nanjing Bayi Hospital, Nanjing, CHINA, 2 Urology, Peking<br />

University First Hospital, Beijing, CHINA, 3 Department of Renal Cancer and<br />

Melanoma, Peking University Cancer Hospital and Institute, Beijing, CHINA,<br />

4 Chinese Academy of Medical Sciences and Peking Union Medical College,<br />

Cancer Hospital/Institute, Beijing, CHINA, 5 Cancer Center, Sun Yat-sen<br />

University, Guangzhou, CHINA, 6 Urology, Shanghai Renji Hospital, Shanghai,<br />

CHINA, 7 Bio<strong>the</strong>rapy, Tianjin Medical University Cancer Institute and Hospital,<br />

Tianjin, CHINA, 8 Urology, Fudan University Shanghai Cancer Center, Shanghai,<br />

CHINA, 9 Global Research and Development, Pfizer, Shanghai, CHINA, 10 Clinical<br />

Statistics, Pfizer, New York, NY, UNITED STATES OF AMERICA<br />

Background: Based on <strong>the</strong> effectiveness and safety profile established in two<br />

single-arm phase II trials and a pivotal phase III trial versus interferon-alfa, sunitinib<br />

is approved worldwide for advanced RCC. Here we report a single-arm, open-label<br />

phase IV study to assess use of sunitinib as first-line <strong>the</strong>rapy in Chinese patients with<br />

mRCC.<br />

Methods: Treatment-naïve patients aged ≥18 yr with ECOG performance status 0/1<br />

and histologically confirmed mRCC received oral sunitinib 50 mg/d on <strong>the</strong> approved<br />

4-wk-on-2-wk-off schedule. Treatment continued until disease progression,<br />

unacceptable toxicity, or consent withdrawal. The primary endpoint was<br />

progression-free survival (PFS). Tumor measurements were performed at screening,<br />

regular intervals, suspected disease progression, to confirm response, and end of<br />

treatment/withdrawal. Safety was assessed regularly using NCI CTCAE version 3.0.<br />

Results: 105 patients received treatment. Mean age was 54.6 yr, 75% were male, and<br />

mean BMI was 23.9 kg/m 2 . The most common site of baseline metastases was <strong>the</strong><br />

lungs (76%). Median (range) number of treatment cycles completed was 8 (0–27).<br />

All patients discontinued treatment; reasons included disease progression/relapse<br />

(63%) and treatment-related AEs (8%). In 105 treated patients, median PFS was 61.7<br />

wk (14.2 mo; 95% CI: 45.1–106.3 wk) and median overall survival (OS) was 133.4 wk<br />

(30.7 mo; lower bound of 95% CI: 94.1 wk). In 103 evaluable patients, objective<br />

response rate (ORR) was 31.1% (95% CI: 22.3–40.9%). Most treatment-emergent AEs<br />

were grade 1/2 severity and <strong>the</strong> most common were hand-foot syndrome (64%),<br />

decreased white blood cell count (52%), fatigue (51%), decreased platelet count<br />

(51%), diarrhea (49%), and decreased appetite (43%). There were no occurrences of<br />

treatment-emergent congestive heart failure, left ventricular dysfunction, or<br />

cardiomyopathy.<br />

Conclusions: With median PFS of 61.7 wk (14.2 mo) and OS of 133.4 wk (30.7 mo),<br />

<strong>the</strong>se results compare favorably with those of <strong>the</strong> phase III trial, while ORR of 31.1%<br />

is comparable. The AE profile is acceptable and generally similar to that in o<strong>the</strong>r<br />

single-agent sunitinib studies and/or in patients with advanced RCC.<br />

Disclosure: Q. Wang: Employed by Pfizer Inc. as a clinician.S. Pan: Employed by<br />

Pfizer Inc. as a Director of Clinical Statistics and holds Pfizer stock. All o<strong>the</strong>r authors<br />

have declared no conflicts of interest.<br />

Annals of Oncology<br />

852P PREDICTIVE VALUE OF TIME TO BEST RESPONSE FOR<br />

EFFICACY MTOR INHIBITORS (MTORI) IN METASTATIC<br />

RENAL CELL CARCINOMA (MRCC) PATIENTS (PTS)<br />

R.T. Elaidi 1 , C. Teghom 2 , A. Comte 2 , M. Jebali 2 , J. Fouque 3 , J. Medioni 4 ,<br />

S. Oudard 5<br />

1 Oncology, Hospital G.Pompidou, Paris, FRANCE, 2 Medical Oncology Service,<br />

Hopital European George Pompidou, Paris, FRANCE, 3 Pharmacy, Hopital<br />

Europeen Georges-Pompidou, Paris, FRANCE, 4 Medical Oncology, Georges<br />

Pompidou Hospital and Rene Descartes University, Paris, FRANCE, 5 Medical<br />

Oncology Department, Georges Pompidou Hospital and Rene Descartes<br />

University, Paris, FRANCE<br />

Background: mTORi usually induce stable disease but some patients present with a<br />

rapid objective response. In order to predict early those patients susceptible to<br />

respond to mTORi, we investigated <strong>the</strong> relationship between time to best response<br />

and time to progression.<br />

Methods: Data were retrospectively collected in patients treated with mTORi (Ev:<br />

everolimus, Tem:temsirolimus) for mRCC in 1 st to 4th line setting at <strong>the</strong> European<br />

G. Pompidou Hospital in Paris between 2007 and 2011. Time to best response was<br />

obtained from CT-scan and objective response assessed according to RECIST 2.0.<br />

Efficacy was assessed by time to progression (TTP) from initiation of 1 st mTORi<br />

until disease progression/death. Overall survival (OS) was defined as <strong>the</strong> time from<br />

1 st mTOR to death/last contact. Kaplan-Meier estimates with Log-Rank test were<br />

used for categorical data. Cox model was used for continuous data and hazard ratios<br />

calculation. Only pts having received at least 1 cycle of mTORi were included.<br />

Results: Among <strong>the</strong> 75 pts, 63 presented with a documented response: PR = 6, SD =<br />

40, PD = 17. 12 pts were excluded for mTORi discontinuation due to toxicity before<br />

any response assessment or uncertain date of best response. The 63 eligible pts had a<br />

median age = 61 (range: 28-86), sex ratio = 51/12, Ev/Tem = 37/26. Line setting: 1 st<br />

=7, 2 nd =17, 3 rd =19, 4 th = 17, 5 th = 3. Median follow-up time = 22.8m. Time to<br />

progression= 7.3m (95%CI: [4.3–9.1]). Time to best response: SD = 2.3 (0.7–8.2), PR<br />

= 7.6 (0.7–18.8), PD = 2.1 (0.9–5.0). Time to best response was significantly<br />

associated with TTP (N = 46, 35 events, HR = 0.86, 95% CI [0.76–0.97], p = 0.014),<br />

but also OS (N = 46, 31 events, HR = 0.83, 95% CI [0.70-0.98], p = 0.03]), an early<br />

response leading both to a more rapid progression and being of poor prognosis.<br />

Conclusions: Time to best response was significantly associated to time to<br />

progression and overall survival in pts treated with mTORi for mRCC. Given <strong>the</strong><br />

small sample and <strong>the</strong> rough assessment of RECIST criteria, fur<strong>the</strong>r study is needed<br />

to investigate <strong>the</strong> real value of percentage in tumor decrease at each evaluation and<br />

velocity of response as a more precise predictive marker of efficacy for <strong>the</strong>se drugs.<br />

Disclosure: S. Oudard: Advisory board to disclose: Sanofi Aventis, Bayer, Novartis,<br />

Roche, Pfizer Compensated consultant relatioship to disclose: Novartis, Roche<br />

Honoraria to disclose: Sanofi Aventis, Bayer, Novartis, Roche, PfizerAll o<strong>the</strong>r authors<br />

have declared no conflicts of interest.<br />

853P PRELIMINARY RESULTS OF EARLY ASSESSMENT OF<br />

RESPONSE WITH PERFUSION-CT IN PATIENT WITH<br />

METASTATIC RENAL CELL CARCINOMA TREATED WITH<br />

SUNITINIB<br />

O. Reig Torras 1 , M.C. Sebastia 2 , I. Victoria 1 , B. Paño 3 , M. Campayo 1 ,<br />

C. Nicolau 3 , B. Mellado 1<br />

1 Medical Oncology, Hospital Clinic y Provincial de Barcelona, Barcelona, SPAIN,<br />

2 Radiodiagnóstico, Hospital Clínic de Barcelona, Barcelona, SPAIN, 3 Radiology,<br />

Hospital Clínic de Barcelona, Barcelona, SPAIN<br />

Introduction: The fact that renal cell carcinoma (RCC) is highly dependent of<br />

angiogenesis has allowed <strong>the</strong> development of antiangiogenic drugs (e.g. sunitinib).<br />

The assessment of response was based on Response Evaluation Criteria in Solid<br />

Tumors (RECIST) but in RCC <strong>the</strong>re is no good correlation between response rate<br />

and survival data. So, it is necessary to adopt new image methods that allow a more<br />

accurate assessment of response.<br />

Objectives: To evaluate <strong>the</strong> pattern of response with perfusion-CT one month after<br />

<strong>the</strong> beginning of <strong>the</strong> antiangiogenic treatment and correlate with <strong>the</strong> radiologic<br />

evolution.<br />

Material and methods: Patients (pts) with metastatic RCC and candidates for<br />

sunitinib treatment were selected. A volumetric study (21 cm) with perfusion-CT<br />

(Flash Definition, Siemens, Erlangen, Germany) was done in <strong>the</strong>se patients before<br />

starting <strong>the</strong> treatment, 1 and 4 months after <strong>the</strong> antiangiogenic initiation. We defined<br />

6 types of response patterns based on changes in density (D), perfusion (P) and size<br />

(S) of <strong>the</strong> metastases.<br />

ix282 | <strong>Abstract</strong>s Volume 23 | Supplement 9 | September <strong>2012</strong>

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