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    Tissue based biomarkers in non-clear cell RCC: Correlative analysis from the ASPEN clinical trial

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    Authors
    Halabi, S.
    Yang, Q.
    Carmack, A.
    Zhang, S.
    Foo, W. C.
    Eisen, T.
    Stadler, W. M.
    Jones, R. J.
    Garcia, J. A.
    Vaishampayan, U. N.
    Picus, J.
    Hawkins, Robert E
    Hainsworth, J. D.
    Kollmannsberger, C. K.
    Logan, T. F.
    Puzanov, I.
    Pickering, L. M.
    Ryan, C. W.
    Protheroe, A.
    George, D. J.
    Armstrong, A. J.
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    Affiliation
    Department of Biostatistics and Bioinformatics, Duke University, Durham NC
    Issue Date
    2021
    
    Metadata
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    Abstract
    Biomarkers are needed in patients with non-clear cell renal cell carcinomas (NC-RCC), particularly papillary renal cell carcinoma, in order to inform on initial treatment selection and identify potentially novel targets for therapy. We enrolled 108 patients in ASPEN, an international randomized open-label phase 2 trial of patients with metastatic papillary, chromophobe, or unclassified NC-RCC treated with the mTOR inhibitor everolimus (n=57) or the vascular endothelial growth factor (VEGF) receptor inhibitor sunitinib (n=51), stratified by MSKCC risk and histology. The primary endpoint was overall survival (OS) and secondary efficacy endpoints for this exploratory biomarker analysis were radiographic progression-free survival (rPFS) defined by intention-to-treat using the RECIST 1.1 criteria and radiographic response rates. Tissue biomarkers (n=78) of mTOR pathway activation (phospho-S6 and -Akt, c-kit) and VEGF pathway activation (HIF-1α, c-MET) were prospectively explored in tumor tissue by immunohistochemistry prior to treatment and associated with clinical outcomes. We found that S6 activation was more common in poor risk NC-RCC tumors and S6/Akt activation was associated with worse PFS and OS outcomes with both everolimus and sunitinib, while c-kit was commonly expressed in chromophobe tumors and associated with improved outcomes with both agents. C-MET was commonly expressed in papillary tumors and was associated with lower rates of radiographic response but did not predict PFS for either agent. In multivariable analysis, both pAkt and c-kit were statistically significant prognostic biomarkers of OS. No predictive biomarkers of treatment response were identified for clinical outcomes. Most biomarker subgroups had improved outcomes with sunitinib as compared to everolimus.
    Citation
    Halabi S, Yang Q, Carmack A, Zhang S, Foo W-C, et al. Tissue based biomarkers in non-clear cell RCC: Correlative analysis from the ASPEN clinical trial [Internet]. Vol. 19, Kidney Cancer Journal. Kidney Cancer Association (KCA); 2021.
    Journal
    Kidney Cancer Journal
    URI
    http://hdl.handle.net/10541/624790
    DOI
    10.52733/kcj19n3-a1
    PubMed ID
    34765076
    Additional Links
    https://dx.doi.org/10.52733/kcj19n3-a1
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.52733/kcj19n3-a1
    Scopus Count
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