Sarcomatoid variant of renal cell carcinoma and chemotherapy – pro

Chemotherapy is not generally considered appropriate for renal cell carcinoma (RCC), for which a variety of non-chemo agents have been FDA approved. However, the Sarcomatoid RCC has a worse prognosis than clear cell even when apparently localized, and many patients relapse after a nephrectomy. This entity is characterized by a high incidence of bone metastasis at presentation (48%) and by a tendency toward pathologic bone fractures.

There is an impression based on case reports and series that this subtype responds better to chemotherapy than RCC. Unfortunately, no prospective studies that corroborate it have been performed.

Paclitaxel/ carboplatin regimen is recently reported in several phase II studies and has not been very active. A 2009 study enrolled seventeen patients, of which 16 patients had papillary and 1 had collecting duct histology. The patient with collecting duct histology had a complete response, but no responses were observed in patients with papillary histology and the trial was thus terminated early. The study concluded:” Carboplatin and paclitaxel is not an active regimen in patients with metastatic papillary RCC. Future studies should explore the role of this or similar regimens in collecting duct carcinoma”. Paclitaxel and Carboplatin in Treating Patients With Locally Advanced or Metastatic Renal Cell Cancer, NCT00077129 has been completed but not yet published.

Case reports suggest high response for gemcitabine. A 2011 phase II study of gemcitabine and doxorubicine was dissapointing. The conclusion fo this study by Robaud G. et al was that , “showed a lower response rate than previously reported. Nevertheless, some patients had prolonged survival outcomes. This combination could be an option in sarcomatoid histology (NCCN guidelines) or rapidly progressive disease, but this population represents an unmet medical need.”.

Currently, there are no guidelines or consensus that this drug should be used, alone or in combinaiton for sarcomatoid variant of renal cell cancer.

Hoshi S, Satoh M, Ohyama C, Hiramatu M, Watanabe R, Hagisawa S, Endo M, Arai Y.Active chemotherapy for bone metastasis in sarcomatoid renal cell carcinoma. Int J Clin Oncol. 2003 Apr;8(2):113-7.

N. Bangalore , P. Bhargava , M. J. Hawkins , and P. Bhargava
Sustained response of sarcomatoid renal-cell carcinoma to MAID chemotherapy: Case report and review of the literature
Ann Oncol 12: 271-274.

Kathryn A. Bylow et al, Phase II Trial of Carboplatin and Paclitaxel in Papillary Renal Cell Carcinoma Journal Clinical Genitourinary Cancer
Volume 7, Number 1 / January 2009 Pages 39-42

J. Verweij, Phase II studies of docetaxel in the treatment of various solid tumoursEuropean Journal of Cancer Volume 31, Supplement 4, October 1995, Pages S21-S24

Fujiwara Y, Kiura K, Tabata M, Takigawa N, Hotta K, Umemura S, Omori M, Gemba K, Ueoka H, Tanimoto M.Remarkable shrinkage of sarcomatoid renal cell carcinoma with single-agent gemcitabine.
Anticancer Drugs. 2008 Apr;19(4):431-3.

Roubaud G, Gross-Goupil M, Wallerand H, de Clermont H, Dilhuydy MS, Ravaud A
Combination of gemcitabine and doxorubicin in rapidly progressive metastatic renal cell carcinoma and/or sarcomatoid renal cell carcinoma. Oncology. 2011;80(3-4):214-8.

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