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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>