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Published in Renal Cell Carcinoma

Expert Opinion / Cases · March 24, 2015

RCC With Sarcomatoid Features

Written by
Sylvia Richey MD


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  • Eric Wiedower

    Apr 07, 2015

    Patient was found to have metastatic renal cell with 90% sarcomatoid features and 10% clear cell. According to NCCN there are multiple options for this patient with predominantly non-clear cell histology which include the following:
    Clinical trial
    Targeted therapies have predominantly been studied in clear cell RCC due to predominance of this histological subtype. This patient was started on pazopanib 800mg qday which has also shown activity in soft tissue sarcomas. Ongoing clinical trials are underway investigating the efficacy of pazopanib in non-clear cell histology. A phase III, open-label, multicenter study including 435 patients compared pazopanib to placebo with PFS 9.2 mo vs 4.2 mo respectively and ORR of 30% in predominantly clear cell RCC. A noninferiority study called COMPARZ evaluated pazopanib vs sunitinib. This showed similar efficacy profiles with different side effect profiles. PISCES, a randomized phase III trial placed patients on pazopanib 800mg qday for 10 weeks, followed by 2 weeks of placebo and then 10 weeks of sunitinb 50mg qday or vice versa. The primary endpoint was patient preference. Results of this study in predominantly clear cell histology revealed that 70% of patients preferred pazopanib, 22% preferred sunitinib and 8% had no preference. Based on these data, pazopanib has been included as first-line therapy for metastatic, non-clear cell RCC, which is reasonable for this patient.

  • Eric Wiedower

    Jun 16, 2015

    Unfortunately, the patient progressed after ~5 months of therapy. This patient was sent to MD Anderson and was placed on a clinical trial with a PD1 antibody. She tolerated this therapy well and continues to have stable disease. Immunotherapies continue to be explored any many different tumor types. ORR seem to be fairly similar, however those that respond seem to have long-lasting responses. Immunecheckpoint therapy is becoming practice changing in many fields.

  • Nov 28, 2023

    Pending Moderator approval.

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