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879 TREATMENT OF PATIENTS WITH METASTATIC KIDNEY<br />

CANCER DURING HAEMODIALYSIS WITH MTOR INHIBITORS<br />

C. Masini 1 , M. Milella 2 , G. Di Lorenzo 3 , A. Onofri 4 , M. Santoni 4 ,V.Prati 5 ,<br />

M. Nicodemo 6 , P.F. Conte 1 , R. Sabbatini 1<br />

1 Dept. of Hematology/oncology, Ospedale Policlinico-Modena, Modena, ITALY,<br />

2 Divisione Di Oncologia Medica A, Istituto Nazionale Tumori Regina Elena, Roma,<br />

ITALY, 3 Genitourinary Cancer Section and Rare-cancer Center, University<br />

Federico II, Napoli, ITALY, 4 Clinica Di Oncologia Medica, AO Ospedali Riuniti,<br />

Università Politecnica delle Marche, Ancona, ITALY, 5 Oncologia Medica A<br />

Direzione Universitaria, Fondazione del Piemonte per l’Oncologia, Istituto per la<br />

Ricerca e la Cura del Cancro, Torino, ITALY, 6 Divisione Di Oncologia, Ospedale<br />

“Sacro Cuore-Don Calabria” Negrar, Verona, ITALY<br />

Background: On <strong>the</strong> basis of a few published data, sunitinib and sorafenib can be<br />

administered safely to patients (pts) with metastatic renal cell carcinoma (mRCC) and<br />

end-stage renal disease on haemodialysis (HD). Aim of this study was to investigate <strong>the</strong><br />

safety and efficacy of temsirolimus and everolimus in pts with mRCC on HD.<br />

Patients and methods: between September 2007 and February <strong>2012</strong>, 13 pts with<br />

mRCC undergoing HD were treated with temsirolimus and everolimus in 6 Italian<br />

Institutions. We retrospectively reviewed <strong>the</strong> medical records of <strong>the</strong>se pts to evaluate <strong>the</strong><br />

doses of mTOR inihibitors administered, <strong>the</strong> tolerability and <strong>the</strong> activity of <strong>the</strong> treatment.<br />

Results: Gender: 9 males/4 females; median age: 63 years (range 47–79). All pts were<br />

undergoing HD, in 7 cases for bilateral nephrectomy; <strong>the</strong> time interval between <strong>the</strong><br />

start of HD and <strong>the</strong> start of mTOR inhibitors treatment was 37 months. Everolimus<br />

was administered at 10 mg daily in 5 pts and at 5 mg in one patient; 7 pts received<br />

temsirolimus at 25 mg weekly. Everolimus was administered as second-line treatment<br />

in 4 pts, as third and fourth-line in two pts; temsirolimus was given as first-line<br />

treatment to 4 pts, as second-line to one patient and as third-line to 2 pts. No<br />

unexpected adverse event (AE) and no grade 4 haematological or<br />

non-haematological toxicity were reported. The most common grade 1–2<br />

non-haematological treatment-related AEs were fatigue (9/13 pts), dyslipidemia (4/13<br />

pts), oral mucositis in 2/13 pts. A grade 3 dyspnea due to interstitial pneumonia led<br />

to treatment discontinuation. The most frequent grade 1–2 haematologic toxicity was<br />

anemia (10/13 pts). None of <strong>the</strong> patients had to change <strong>the</strong> number of dialysis<br />

sessions during mTOR inhibitors treatment. None of <strong>the</strong> pts experienced an objective<br />

response while a disease stabilization was observed in 7 pts. At <strong>the</strong> time of <strong>the</strong><br />

analysis, 7 pts had died due to disease progression. The estimated median<br />

progression-free survival (PFS) of this cohort of pts was 6.1 months.<br />

Conclusions: In this small retrospective series of pts <strong>the</strong> incidence of AEs was as<br />

expected, and a prolonged PFS was observed. The use of temsirolimus and everolimus<br />

is not contraindicated in pts with mRCC and severe renal impairment on HD.<br />

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

880 LIVER TOXICITY IN PATIENTS WITH METASTATIC RENAL CELL<br />

CARCINOMA TREATED WITH PAZOPANIB THERAPY<br />

F.L. Lim 1 , J. Shamash 2 , P. Wilson 2 , T. Powles 3<br />

1 Department of Medical Oncology, St. Bartholomew’s Hospital, London,<br />

UNITED KINGDOM, 2 QMUL, Barts Cancer Insititute, London, UNITED<br />

KINGDOM, 3 Barts Cancer Institute, St Bartholomew’s Hospital QMUL, London,<br />

UNITED KINGDOM<br />

Purpose: Pazopanib is a vascular endo<strong>the</strong>lial growth factor receptor, platelet derived<br />

growth factor receptor and c-kit tyrosine kinase inhibitor, used in <strong>the</strong> treatment of<br />

metastatic renal cell carcinoma. It is associated with liver toxicity, although timing<br />

severity management and consequences of this toxicity is not known.<br />

Patients and methods: Sequential patients who were treated with 1 st line pazopanib<br />

for <strong>the</strong>ir metastatic renal cancer were identified from a prospective data base. Four<br />

weekly liver monitoring occurred. Specific protocols for <strong>the</strong> management of grade<br />

1-4 toxicity were followed. Toxicity was graded based on <strong>the</strong> clinical toxicity criteria<br />

(CTC) grading classification. Patients who developed grade 2 or more toxicity had a<br />

structured treatment interruption and dose reduction according to local policy.<br />

Results: 44 patients were identified as having received pazopanib treatment between<br />

2009-<strong>2012</strong>. Fifteen (34%) of whom developed liver toxicity as evidence by a raise in<br />

ei<strong>the</strong>r bilirubin or alkaline transaminase levels (Maximum CTC grade 1 = 4 (27%),<br />

2 = 6 (40%), 3 = 5 (33%), 4= 0 (0%), 5 = 0 (0%). Maximum toxicity occurred a<br />

median 60 days after commencing <strong>the</strong>rapy (range 14 – 83 days). Resolution occurred<br />

in all but 1 patient (grade 1 or less after stopping <strong>the</strong> treatment for a median of 3-21<br />

days. All patients restarted pazopanib. Twelve (80%) of <strong>the</strong>se with a dose reduction.<br />

Recurrence of raised liver function occurred in 4 (27%) patients (grade 1 = 3 (20%)<br />

grade 2 = 1 (7%) rechallanged with pazopainb. One patient died of progression of<br />

disease with a concurrent transaminitis (grade 1). The development of a<br />

transamitinits was associated with increased progression free survival (HR 0.35 95%<br />

CI 0.15 - 0.87 p = 0.024).<br />

Conclusion: Liver toxicity in patients treated with pazopanib occurs in 1/3 of<br />

patients, usually in <strong>the</strong> first 12 weeks of <strong>the</strong>rapy. Management is facilitated by blood<br />

monitoring, temporary cessation of <strong>the</strong>rapy and dose reductions. Transaminitis may<br />

be associated with improved outcomes.<br />

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

Annals of Oncology<br />

881 SEQUENTIAL USE OF TREATMENT OPTIONS IN ADVANCED<br />

RENAL-CELL CARCINOMA (RCC): A RETROSPECTIVE<br />

ANALYSIS OF 42 PATIENT CASES<br />

L. Derosa 1 , L. Galli 2 , A. Fontana 1 , E. Biasco 3 , R. Marconcini 1 , C. Cianci 4 ,<br />

A. Farnesi 1 , F. Orlandi 1 , A. Falcone 5<br />

1 Polo Oncologico, Azienda Ospedaliero Universitaria S.Chiara, Pisa, ITALY,<br />

2 Azienda Ospedaliero-universitaria Pisana, Istituto Toscano Tumori, Division of<br />

Medical Oncology, Pisa, ITALY, 3 Azienda Ospedaliero-universitaria Pisana, Istituto<br />

Toscano Tumori, 1Division of Medical Oncology, Pisa, ITALY, 4 Istituto Toscano<br />

Tumori, Azienda Ospedaliero-Universitaria Pisana, Pisa, ITALY, 5 Oncologia,<br />

Trapianti E Nuove Tecnologie In Medicina, Polo Oncologico - Azienda<br />

Ospedaliero-Universitaria Pisana - Istituto Toscano Tumori, Pisa, ITALY<br />

The best sequence of targeted <strong>the</strong>rapy options has not been sufficiently defined and<br />

also <strong>the</strong> significance of Cytokine (Cy) in TKI (Sorafenib-So, Sunitinib-Su) and<br />

mTOR era. The objective of this study was to describe <strong>the</strong> clinical activity of<br />

sequence options in 2nd line treatment.<br />

Methods: Retrospective study of 42 patients receiving TKI or Everolimus (EV)<br />

treatment after progression on first-line <strong>the</strong>rapy. Sequence of systemic targeted treatment<br />

consisted of an Cy-TKI-sequence (n = 20; Cy-So, n = 12; Cy-Su, n = 8), TKI-TKI-sequence<br />

(n=15;Su-So,n=11;So-Su,n=4)oranTKI-EV-sequence(n=7;Su-EV,n=7).We<br />

measured response to treatment (RECIST 1.0). Progression free survival (PFS) and overall<br />

survival (OS) were determined using <strong>the</strong> Kaplan-Meier method.<br />

Results: Sequence treatment groups did not significantly differ by gender, MSKCC<br />

prognostic group, or ECOG PS. Best response to 2nd line <strong>the</strong>rapy included CR (Su:<br />

n = 2, sequential <strong>the</strong>rapy after Cy), PR (So: n = 3, after Cy) and SD (EV: n = 5, after<br />

TKI; TKI: n = 13; So: n = 5 after Cy, Su: n= 3 after So, n= 5 after Cy). The estimated<br />

2nd line PFS was 5.2 months for EV and 5.86 months for So sequential <strong>the</strong>rapy after<br />

Su, 6.56 months for So sequential Cy, 6.7 months for Su sequential <strong>the</strong>rapy after So,<br />

6.54 months for Su sequential Cy. The estimated OS was longer for <strong>the</strong> group of<br />

patients receiving <strong>the</strong> Cy-TKI-sequence (49.87 months; 95% CI:16–26 for <strong>the</strong> group<br />

Cy-So and 40.36 months; 95% CI:16–26 for <strong>the</strong> group Cy-Su) and TKI-EV sequence<br />

(40.72 months; 95%CI:32–48) than for those receiving <strong>the</strong> TKI-TKI sequence So-Su<br />

(33.36 months, 95%CI:21–62) and Su-So (16.32 months, 95%CI:13–37). However,<br />

<strong>the</strong> TKI-TKI group was characterized by a relatively short first-line PFS (6.12 months<br />

of <strong>the</strong> Su-So group to 12.37 So-Su compared to 12.8 months of <strong>the</strong> TKI-EV group)<br />

which may at least in part explain <strong>the</strong> observed OS difference.<br />

Conclusions: Common sequence treatment options may have comparable efficacy in<br />

terms of PFS and response. The observed differences in OS await fur<strong>the</strong>r<br />

confirmation in prospective randomized trials.<br />

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

882 USING OF LACTOBACTERIN IN COMBINED TREATMENT OF<br />

SUPERFICIAL URINARY BLADDER CANCER<br />

S. Babakulov 1 , S. Navruzov 2<br />

1 Urology, National Cancer Center of Uzbekistan, Tashkent, UZBEKISTAN,<br />

2 Coloproctology, National Cancer Center of Uzbekistan, Tashkent, UZBEKISTAN<br />

Background: to improve combined treatment results of bladder cancer in<br />

combination with intra-bladder introduction of Lactobacterine. Materials and<br />

methods: During 2010 and 2011 years in National cancer research centre underwent<br />

a course of treatment 50 patients with superficial bladder cancer. Those patients<br />

divided in two groups. Main group 25 patients and control group 25 accordingly. All<br />

patients had morphological confirmed transitional cell carcinoma with histological<br />

differentiation G1-G2. Patients before hospitalization had bacteriological study of<br />

urine. Bacteriological analysis of urine revealed in 14 (28 %) patients presence of - E.<br />

Coli, in 16 (32 %) – S. aureus, in 12 (24%) - Ps. Aeruginosa and in 8 (16%)<br />

Klebsiella. After diagnosing of histological structure of <strong>the</strong> tumor and bladder<br />

microflora patients undergone transurethral resection of tumor. Patients in control<br />

group after TUR took intravisical chemo<strong>the</strong>rapy with doxorubicin 50 mg once in a<br />

week 6 courses. Patients in main group after TUR took intravisical chemo<strong>the</strong>rapy<br />

with doxorubicin 50 mg once in a week 6 courses and instillation of collibacterin.<br />

Treatment regimen was everyday instillation of probiotic collibacterin 20 mg (5<br />

doses) dissolving in 30 ml of 5% glucose solution per day during 5 days. After <strong>the</strong><br />

course patients took 3 mg of dried collibacterin per os during <strong>the</strong> year.<br />

Results: It was detected that side effects of intravisical chemo<strong>the</strong>rapy in <strong>the</strong> form of<br />

bladder disorders in control group was revealed almost in every case. Patients of<br />

main group only 2 of <strong>the</strong>m had insignificant pain during urination. Study of one<br />

year recurrent free survival rate showed that in main group one patient had<br />

recurrence of cancer in 310 th day after surgery. In control group 8 (32%) patients<br />

had recurrence in <strong>the</strong> course of year after operation.<br />

Conclusions: Using of intravisical probiotico<strong>the</strong>rapy in combined treatment of<br />

superficial urinary bladder cancer allows to decrease side effects of chemo<strong>the</strong>rapy and<br />

prolong one year recurrent free survival rate with superficial urinary bladder cancer.<br />

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

ix290 | <strong>Abstract</strong>s Volume 23 | Supplement 9 | September <strong>2012</strong>

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