Papillary Renal Cell Carcinoma represents approximately 10% to 20% of kidney cancers. These tumors are thought of as being realtively resistant to immunotherapy with TKI and mTOR inhibitors and Tarceva(erlotinib) has been studied in this subgroup. 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 using RECIST [Response Evaluation Criteria in Solid Tumors]) was 64% in one study(Gordon et al). The median overall survival was 27 months. This and other studies 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.
Gordon MS, Hussey M, Nagle RB, Lara PN Jr, Mack PC, Dutcher J, Samlowski W, Clark JI, Quinn DI, Pan CX, Crawford D.
Phase II study of erlotinib in patients with locally advanced or metastatic papillary histology renal cell cancer: SWOG S0317.J Clin Oncol. 2009 Dec 1;27(34):5788-93.
Michael S. Gordon, Michael Hussey, Raymond B. Nagle, Primo N. Lara Jr, Philip C. Mack, Janice Dutcher, Wolfram Samlowski, Joseph I. Clark, David I. Quinn, Chong-Xian Pan and David Crawfor Phase II Study of Erlotinib in Patients With Locally Advanced or Metastatic Papillary Histology Renal Cell Cancer: SWOG S0317
JCO Dec 1, 2009:5788-5793
Gordon MS, Hussey M, Nagle RB, et al. Phase II study of erlotinib in patients with locally advanced or metastatic papillary histology renal cell cancer: SWOG S0317. J Clin Oncol 2009;27:5788–5793.
Robert J. Motzer, MD, Neeraj Agarwal, MD, Clair Beard, MD, Sam Bhayani, MD, Graeme B. Bolger, MD, Michael A. Carducci, MD, Sam S. Chang, MD, Toni K. Choueiri, MD, Steven L. Hancock, MD, Gary R. Hudes, MD, Eric Jonasch, MD, David Josephson, MD, Timothy M. Kuzel, MD, Ellis G. Levine, MD, Daniel W. Lin, MD, Kim A. Margolin, MD, M. Dror Michaelson, MD, PhD, Thomas Olencki, DO, Roberto Pili, MD, Thomas W. Ratliff, MD, Bruce G. Redman, DO, Cary N. Robertson, MD, Charles J. Ryan, MD, Joel Sheinfeld, MD, Philippe E. Spiess, MD, Jue Wang, MD and Richard B. Wilder, MD Kidney Cancer J Natl Compr Canc Netw 2011;9:960-977
For Lay version see here