title: Risk of recurrence and conditional survival in complete responders treated with TKIs plus or less locoregional therapies for metastatic renal cell carcinoma.
abstract: OBJECTIVE
  We retrospectively analyzed the risk of recurrence and conditional Disease-Free Survival (cDFS) in 63 patients with complete remission during treatment with tirosin kinase inhibitor (TKI), alone or with local treatment in metastatic renal cell carcinoma.
  
  
  RESULTS
  37% patients achieve CR with TKI alone, while 63% with additional loco-regional treatments. 49% patients recurred after CR, with a median Disease free survival of 28.2 months. Patients treated with multimodal approaches present lower rate of recurrence (40% vs 61%) and longer Disease free survival compared to patient treated with TKI alone (16.5 vs 41.9 months, p=0.039).Furthermore the rate of recurrence was higher in patients with brain (88%), pancreatic (71%) and bone metastasis (50%). Patients who continued TKI therapy after complete response had a longer disease free survival than patients who stopped therapy, although the difference was not significant (42.1 vs 25.1 months, p=0.254). 2y-cDFS was better in patients treated with multimodal treatment and who continued TKIs than the other patient arms.
  
  
  CONCLUSIONS
  The prognostic value of CR depends on the site where was obtained and how was obtained (with or without locoregional treatment). Cessation of TKI should be carefully considered in complete responder patients.
authors.affiliation: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Clinica di Urologia, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.affiliation: Oncology Unit I, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
authors.affiliation: Oncology Unit I, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Verzoni
authors.affiliation: Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Galli
authors.affiliation: Department of Clinical Medicine, Medical Oncology Unit, Federico II University, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: di Lorenzo
authors.affiliation: Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: De Lisi
authors.affiliation: Sacro Cuore - Don Calabria Hospital, Negrar, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Nicodemo
authors.affiliation: Medical Oncology I, Istituto Oncologico Veneto IOV, IRCCS, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Maruzzo
authors.affiliation: Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Oncology Unit, University Hospital of Parma, Parma, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Buti
authors.affiliation: Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Altobelli
authors.affiliation: Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Biasco
authors.affiliation: Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ricotta
authors.affiliation: IRCCS San Matteo University Hospital Foundation, Pavia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.affiliation: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vincenzi
authors.affiliation: Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.affiliation: Medical Oncology Unit Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Burattini
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Berardi
authors.affiliation: Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muto
authors.affiliation: Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
authors.affiliation: Clinica di Oncologia Medica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.affiliation: Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000201:enzymology / Q000401:mortality / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000201:enzymology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: complete responder patients; conditional survival; renal cell carcinoma; risk of recurrence; tirosin kinase inhibitor