Bevacizumab + Erlotinib於侵犯性乳突狀腎細胞癌包含遺傳性平滑肌瘤性腎細胞癌之治療結果

蘇楷森¹、魏子鈞^1,2、張延驊^1,2、黃志賢^1,2 

¹臺北榮總泌尿部；²國立陽明交通大學醫學系泌尿學科；

³國立陽明交通大學書田泌尿科學研究中心

Results of Bevacizumab plus Erlotinib in Patients with Advanced Papillary Renal Cell Carcinoma (pRCC) Including Hereditary Leiomyomatosis and Renal Cell Carcinoma (HLRCC) Syndrome-Associated RCC

Kai-Sen Su¹, Tzu-Chun Wei^1,2, Yen-Hwa Chang^1,2, William J. Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University

Purpose:

The combination of bevacizumab plus erlotinib showed promising objective response rate (ORR) for type 2 papillary renal cell carcinoma (pRCC) from the phase II study published in ASCO 2020, with 54% in average and even 72% for hereditary leiomyomatosis renal cell carcinoma (HLRCC). Since this study was mainly a Caucasian-based dataset, we would like to study the treatment outcome in type 2 pRCC on Taiwanese patients.

Materials and Methods:

Patients diagnosed of type 2 pRCC treated with bevacizumab plus erlotinib in Taipei Veterans General Hospital were reviewed from June 2020 to March 2021, especially for HLRCC or fumarate hydratase (FH)-deficient RCC . Clinical parameters included performance status, risk stratifications, tumor cell histology, FH mutation status, and treatment-related adverse events (TRAE). The main outcome was ORR, while progression-free survival (PFS) and overall survival (OS) were also evaluated.

Results:

Total seven patients with type 2 pRCC receiving bevacizumab plus erlotinib were included. Median age was 48.6. Five of the patients had upfront cytoreductive nephrectomy. All patients had been treatment-naïve except two (pembrolimuzab plus axitinib; ipilimumab plus nivolumab). The ORR was 14.3% (complete response) and the disease control rate was 71.4%; the median PFS and OS were 5.56 and 6.43 months, respectively. The most frequent TRAE was rash acneiform (85.7%, all grade 3), which was predictable and manageable by topical steroids and oral antibiotics. Only one patient died of bronchopulmonary hemorrhage, instead of cancer-specific.

Conclusions:

This is the first reported real-world outcome of metastatic type 2 pRCC treated with bevacizumab plus erlotinib in Taiwan. This combination therapy showed survival benefit with manageable toxicity, but the ORR was relatively lower than the literature, with most patients remaining stable disease. It could be considered as the first line alternative therapy for metastatic type 2 pRCC.