Carcinoma renale (I): Posters Review. Elena Verzoni Oncologia Medica 1 SS.Oncologia Genitourinaria Fondazione IRCCS Istituto Nazionale Tumori Milano

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1 Carcinoma renale (I): Posters Review Elena Verzoni Oncologia Medica 1 SS.Oncologia Genitourinaria Fondazione IRCCS Istituto Nazionale Tumori Milano

2 Agenda: Best Posters in Localized RCC Surgery: CN (# 503; # 499), Elderly patients (# 497) Genomic profiling: # 513 Immune profiling: # 511 DFS as surrogate for OS in adjuvant setting: # 459

3 # Abstract 503: Impact of cytoreductive nephrectomy on timing of systemic therapy in metastatic kidney cancer; Macleod LC et al Patients identified in the National Cancer Database (NCDB) from who were 18yo with biopsy-proven mrcc and who were treated initially with systemic therapy (N=14,651) Main outcome: receipt of cytoreductive nephrectomy after initial systemic therapy Secondary outcomes: surgical characteristics/complication- Unadjusted and multivariable logistic regression was performed, identifying factors associated with cytoreductive nephrectomy after initial systemic therapy

4 Table 2: Factors associated with decreased (blue fill) and increased (yellow fill) odds of receiving deferred CN Older age, greater comorbidity, poor risk disease (measured by death 3 mos. post-diagnosis), and adverse histology were associated with decreased utilization of deferred CN Treatment at a cancer center and/or a higher volume center, was associated with increased receipt of deferred CN

5 Median OS Fig 2: Overall survival of patients with deferred surgery compared with no surgery after initial ST (unadjusted, log rank p<0.001) 4.9 mo vs 19 mo Median ST to CN 69 days (IQR 28 to128)

6 # Abstract 499: The role of cytoreductive nephrectomy (CN) in elderly patients with metastatic renal cell carcinoma in an era of targeted therapy; Uprety D et al Objective: To compare overall survival (OS) and cancer-specific survival (CSS) between elderly patients who had or had not undergone CN. Methods: SEER database ( ) RCC patients > 65 years 3365 patients -> 1088 (32%) had CN

7 OS: 22 months vs 5 months Cancer-specific survival: 25 months vs 6 months

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9 # Abstract 497: Management of renal masses in an octogenarian cohort: is there a right approach? Nawlo J et al 113 patients > 80 years old referred at Moffitt Cancer center between Mean age: 83 years (range 80-92) Active Surveillance (AS) Partial Nephrectomy (PN) Radical Nephrectomy (RN) Patients 27 (22%) 33(26.8%) 53 (43%) Mean age Deaths (30.6 mo Fup) for any cause 13 (48%) 10 (30.3%) 29 (54.7%) OS median 55.8 mo 81 mo 57 mo NOT stats significance on multivariate (p 0.29) or univariate (p 0.588)

10 Conclusions Active treatment with PN or RN may not provide a survival benefit among octogenarians

11 # Abstract 513: Genomic profiling of nephrectomy and metastatic sites in patients with advanced clear cell renal cell carcinoma (RCC); G de Velasco et al. Genomic alterations in samples from primary (N) as compared distant mets (M) Tumor mutation burden (TMB) was also assessed as the number of somatic point mutations per megabase of targeted territory Methods: 237 primary RCC nephrectomy specimen and 156 samples from unmatched metastases

12 TMB is similar between primary and mets Conclusions: Primary and Metastatic RCC share the majority of common genomic alterations The study does not provide evidence of genomic alterations landscape in paired samples from the same patients

13 # Abstract 511: Immune cell phenotyping of clear cell renal cell carcinoma; Ghanaat M et al Objective: to characterize the T cell populations in a cohort of largely untreated high risk patients with ccrcc. We prospectively collected ccrcc tumor and adjacent normal kidney (NK) from patients undergoing surgical resection at our institution from 6/ /2016 (n=37 pts)

14 Analysis of immune cell populations were determined by CD45+ staining and corresponding proportions of different T cell populations (CD3+, CD4+, CD4+Treg and CD8+ T cells). Mann-Whitney test was utilized to compare the immune populations between tumor and adjacent NK tissue. Analysis was further conducted by stratifying patients who presented with localized versus metastatic disease.

15 A total of 37 tumor and adjacent NK were analyzed. Overall 84% of tumors had higher immune infiltrate with an average ratio of four-fold increase compared to adjacent NK as determined by CD45+ cells. The other 16% presented with metastatic disease. Our data shows a general trend of immune infiltration in ccrcc when compared to adjacent NK with a diversity of T cell subsets and possible evidence of immune exclusion.

16 # Abstract 459: Meta-analysis of disease free survival (DFS) as a surrogate for overall survival (OS) in localized renal cell carcinoma (RCC); Harshman LC et al

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18 Take home messages Role of CN is still unclear in clinical practice Active surveillance, expecially in older patients could be the first choice We have more to learn about the role of mutations in RCC DFS may be a surrogate of OS in adjuvant setting but we need more data

19 Grazie per l attenzione!