Circulating Tumor Cells (CTCs) correlate with adverse prognosis in breast, colorectal, lung and prostate cancer patients. Little data is available for Renal Cell Carcinoma (RCC).
We designed a multicenter prospective observational study to assess the correlation between CTC counts and Progression Free Survival (PFS) in metastatic RCC patients treated with an anti-angiogenic tyrosine kinase inhibitor as a first-line regimen; Overall Survival (OS) and response were secondary objectives. CTC counts were enumerated by the Cellsearch® system at 4 time points: day 0 of treatment, day 28, day 56 and then at progression, or at 12 months in the absence of progression.
195 eligible patients with a median age of 69 years were treated with sunitinib (77.5%) or pazopanib (21%). At baseline, 46.7% of patients had 1 or more CTCs/mL (range, 1 to 263). Thirty patients had ≥ 3 CTCs, with a median PFS of 5.8 vs 15 months in the remaining patients (p = 0.002), HR = 1.99, independently of the International Metastatic RCC Database Consortium (IMDC) score at multivariate analysis (HR: 1.91, 95% CI: 1.16-3.14). Patients with ≥ 3 CTCs had a shorter estimated OS of 13.8 months vs 52.8 months in those with <3 CTCs (p = 0.003), HR = 1.99 (multivariate analysis HR: 1.67, 95% CI: 0.95-2.93). Baseline CTC counts did not correlate with response, as well as having CTC sequencing counts ≥ 1, 2, 3, 4 or 5.
We provide prospective evidence that the presence of 3 or more CTCs at baseline is associated with a significantly shorter PFS and OS in mRCC patients.
In this prospective study we evaluated whether the presence of circulating tumor cells (CTC) in the peripheral blood correlate with activity of first-line tyrosine kinase inhibitors in metastatic Renal Cell Carcinoma (RCC). We demonstrated that almost half of patients with metastatic RCC have at least one CTC in their blood and that those patients with ≥ 3 CTCs are at increased risk of early progressive disease and early death due to RCC. Studies incorporating CTC counts in the prognostic algorithms of metastatic RCC are warranted.
The oncologist. 2021 Jun 02 [Epub ahead of print]
Umberto Basso, Antonella Facchinetti, Elisabetta Rossi, Marco Maruzzo, Vincenza Conteduca, Michele Aieta, Francesco Massari, Anna Paola Fraccon, Claudia Mucciarini, Teodoro Sava, Matteo Santoni, Cristina Pegoraro, Emilia Durante, Maurizio Nicodemo, Alessandra Perin, Alessandra Bearz, Carlo Gatti, Pasquale Fiduccia, Alberto Diminutto, Carmen Barile, Ugo De Giorgi, Rita Zamarchi, Vittorina Zagonel
Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy., Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy., Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy., Department of Onco-Hematology, Division of Medical Oncology, Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy., Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy., Medical Oncology, Ospedale P. Pederzoli, Peschiera Del Garda, Peschiera Del Garda (VR), Italy., Medical Oncology Unit, Ramazzini Hospital, Carpi-AUSL Modena., Medical Oncology, Ospedale Borgo Trento, Verona, Italy., Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy., Medical Oncology Ospedale di Montecchio Maggiore, Azienda ULSS 8 Berica, Italy., Department of Medical Oncology, Ospedale di Legnago, Azienda ULSS 9 Scaligera, Italy., Department of Medical Oncology, Sacro Cuore - Don Calabria Hospital, Negrar, Italy., Medical Oncology, Polo Unico Ospedale Santorso, Santorso, Azienda ULSS 7 Pedemontana, Italy., Department of Medical Oncology, Centro Riferimento Oncologico CRO IRCCS, Aviano, Italy., Medical Oncology, Ospedale di Chioggia, Azienda ULSS 3 Serenissima, Chioggia, Italy., Clinical Research Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy., Medical Oncology, Ospedale di Rovigo, Azienda ULSS 5 Polesana, Rovigo, Italy., Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.