title: Sarcomatoid renal cell carcinoma: clinical outcome and survival after treatment with sunitinib.
abstract: BACKGROUND
  Renal tumors with sarcomatoid changes are aggressive malignancies with poor prognosis. Immunotherapy and chemotherapy have provided little benefit. The efficacy of treatments targeting the vascular endothelial growth factor pathway is unclear because of the lack of clinical trial data and the small number of published series.
  
  
  METHODS
  We reviewed the clinical records of 23 consecutive patients with advanced sarcomatoid renal cell carcinoma who were treated with sunitinib in our center. Overall survival (OS), progression-free survival, and response rate were evaluated. We also studied the effect on clinical outcome of performance status, prognostic risk group, and proportion of sarcomatoid component.
  
  
  RESULTS
  Median OS was 15.7 months (95% confidence interval [CI], 5.0-21.2). Median progression-free survival was 5.7 months (95% CI, 3.2-12.6). Seven patients (30%) had an objective response, 5 patients (22%) had stable disease, and 11 (48%) had progressive disease. The median survival of the 13 (56.5%) patients with performance status of 0 to 1 was 20.9 months (95% CI, 9.7-63.3) whereas the medial survival of the 10 (43.5%) patients with performance status of 2 to 3 was 5.0 months (95% CI, 1.1-16.5). Objective responses were observed only among the 13 (56.5%) patients with performance status of 0 to 1. Heng prognostic risk group and percentage of sarcomatoid component did not influence outcome.
  
  
  CONCLUSIONS
  Sunitinib shows efficacy in advanced renal tumors with sarcomatoid differentiation particularly in patients with good performance status. Appropriate patient selection and risk-directed treatment remains essential in this aggressive disease.
authors.affiliation: Cancer Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Kunene
authors.affiliation: Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Dipartimento di Oncologia - Ospedale Maggiore, Trieste, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Miscoria
authors.affiliation: Cancer Research Clinical Trial Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pirrie
authors.affiliation: Department of Medicine, The Royal Marsden Hospital, London, United Kingdom.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Islam
authors.affiliation: Cancer Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Mehran
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Cancer Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; Cancer Research Clinical Trial Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom. Electronic address: e.porfiri@bham.ac.uk.
authors.forename: Emilio
authors.initials: E
authors.lastname: Porfiri
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077210:Sunitinib; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: Performance status; Renal cell carcinoma; Risk-directed treatment; Sarcomatoid differentiation; Sunitinib