Response of renal cell carcinoma pancreatic metastasis to sunitinib treatment: a retrospective analysis.

Purpose: Pancreatic metastasis accounts for 2% of metastatic renal cell carcinoma cases. Surgical management is typically recommended because of the limited value of immunotherapy as an effective treatment. Sunitinib recently showed clinical efficacy in patients with advanced renal cell carcinoma. We report a series of patients with pancreatic metastasis treated with sunitinib.

Materials And Methods: We retrospectively studied a population of 15 adults with pancreatic metastasis of renal cell carcinoma at 1 center in France and at 2 in the United States who were treated with sunitinib between 2005 and 2007. Sunitinib monotherapy was given at a dose of 50 mg orally in 6-week cycles, consisting of 4 weeks of treatment followed by 2 weeks of rest. All clinical and radiological data were analyzed.

Results: At a median followup of 20 months the overall tumor response using Response Evaluation Criteria in Solid Tumors was 34%. Median time to relapse was 20 months. Two deaths were noted and median survival was not attained. Responses in the pancreatic metastasis were seen in 28% of patients and were stable in 72%. The main grade 3 and 4 adverse events were diarrhea in 7% of cases and fatigue in 7%. Only grade 1 increased lipase was noted in 27% of patients and no increase in amylase was noted.

Conclusions: Sunitinib is effective in patients with pancreatic metastasis. This raises the question of whether patients with metastatic renal cell carcinoma limited to the pancreas may derive greater clinical benefit from anti-angiogenic agents, rather than from aggressive surgical resection. However, surgery remains the only potential cure in patients with isolated pancreatic metastasis.