Papillary Renal Cell Carcinoma makes up approximately 10% to 20% of kidney cancers. These tumors are thought of as being relatively resistant to immunotherapy with some of the newer drugs, of the groups TKI and mTOR inhibitors. Examples of such drugs are Sutent and Torisel. For this reason, Tarceva(erlotinib) has been studiedespecially in the papillary renal cell cancer. There is a reported response rate in low teens and the disease control rate (defined as stable disease for 6 weeks, or confirmed partial response or complete response was 64% in one study(Gordon et al) and this is consistent with what toerh studies show. The median overall survival was 27 months. This study showed that single-agent erlotinib was associated with disease control and survival outcomes of interest, with an expected toxicity profile. The NCCN has now included erlotinib as a category 3 option for first-line therapy for patients with relapsed or medically unresectable stage IV with non–clear cell histology. Category 3 means that the recommendation is based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.
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