Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma


Background: The pancreas is an uncommon but recognizable site for metastases from renal cell carcinoma (RCC). Isolated pancreatic RCC metastases are still rarer and often present years after initial nephrectomy. Surgical resection has been the treatment of choice because of superior patient survival compared with traditional immunotherapy. In recent years, the advent of targeted therapy has transformed the outcomes of patients with metastatic RCC although little evidence is available on its effectiveness on this subset of patients. We report our experience of 6 patients with pancreatic RCC metastases. Patients and Methods: Between 2007 and 2012, 6 patients (2 men, 4 women; median age 78 years) were diagnosed to have pancreatic RCC metastases at our institute. The clinical features, treatment and outcomes were examined. Results: All 6 patients had a primary RCC of clear cell type. The median interval between initial curative nephrectomy and re-presentation with pancreatic metastases was 12.5 years. Four patients were asymptomatic at the time of diagnosis, one presented with obstructive jaundice and another with acute gastrointestinal bleed. Four patients had extra-pancreatic disease. All were deemed unsuitable or unfit for surgical metastasectomy. Five patients had a Memorial Sloan-Kettering Cancer Center (MSKCC) score of 1 (moderate risk) and the other patient had a score of 0 (good risk). Two patients were commenced on Sunitinib, one received Pazopanib and one received Temsirolimus. Two patients did not undergo further treatment. Of the 4 patients who underwent targeted therapy, the median follow up was 33 months with a median progression free survival of 16 months. One achieved complete response but recurred soon after treatment was stopped. Targetted therapy was recommenced and the disease remained stable. A second patient had long period of stable disease before disease progression. A third achieved partial response since started on targeted therapy and a fourth had disease progression despite treatment. Of the four patients who underwent systemic therapy, three are still alive at the time of this report. Conclusion: Pancreatic metastasis from RCC is a unique subgroup of disease which runs an indolent course, and a higher incidence in an elderly population. Our results demonstrate that targeted therapy can be efficacious in some patients where surgical resection is not suitable or possible.

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K. Chiu, A. Razack and A. Maraveyas, "Targeted Therapy in the Management of Elderly Patients with Pancreatic Metastases from Renal Cell Carcinoma," Journal of Cancer Therapy, Vol. 4 No. 9B, 2013, pp. 15-21. doi: 10.4236/jct.2013.49A2003.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. L. Zweizig, “Cancer of the Kidney,” Clinical Obstetrics and Gynecology, Vol. 45, No. 3, 2002, pp. 884-891.
[2] S. Pyrhonen, E. Salminen, M. Ruutu, T. Lehtonen, M. Nurmi, T. Tammela, et al., “Prospective Randomized Trial of Interferon Alfa-2a Plus Vinblastine versus Vinblastine Alone in Patients with Advanced Renal Cell Cancer,” Journal of Clinical Oncology, Vol. 17, No. 9, 1999, pp. 2859-2867.
[3] R. J. Motzer, B. A. Murphy, J. Bacik, L. H. Schwartz, D. M. Nanus, T. Mariani, et al., “Phase III Trial of Interferon Alfa-2a with or without 13-Cis-Retinoic Acid for Patients with Advanced Renal Cell Carcinoma,” Journal of Clinical Oncology, Vol. 18, No. 16, 2000, pp. 2972-2980.
[4] W. M. Stadler, T. Kuzel, M. Dumas and N. J. Vogelzang, “Multicenter Phase II Trial of Interleukin-2, InterferonAlpha, and 13-Cis-Retinoic Acid in Patients with Metastatic Renal-Cell Carcinoma,” Journal of Clinical Oncology, Vol. 16, No. 5, 1998, pp. 1820-1825.
[5] R. I. Fisher, S. A. Rosenberg and G. Fyfe, “Long-Term Survival Update for High-Dose Recombinant Interleukin-2 in Patients with Renal Cell Carcinoma,” The Cancer Journal From Scientific American, Vol. 6, Suppl. 1, 2000, pp. S55-S57.
[6] D. F. McDermott, M. M. Regan, J. I. Clark, L. E. Flaherty, G. R. Weiss, T. F. Logan, et al., “Randomized Phase III Trial of High-Dose Interleukin-2 versus Subcutaneous Interleukin-2 and Interferon in Patients with Metastatic Renal Cell Carcinoma,” Journal of Clinical Oncology, Vol. 23, No. 1, 2005, pp. 133-141.
[7] S. Negrier, B. Escudier, C. Lasset, J. Y. Douillard, J. Savary, C. Chevreau, et al., “Recombinant Human Interleukin-2, Recombinant Human Interferon Alfa-2a, or Both in Metastatic Renal-Cell Carcinoma,” The New England Journal of Medicine, Vol. 338, No. 18, 1998, pp. 1272-1278.
[8] J. C. Yang, R. M. Sherry, S. M. Steinberg, S. L. Topalian, D. J. Schwartzentruber, P. Hwu, et al., “Randomized Study of High-Dose and Low-Dose Interleukin-2 in Patients with Metastatic Renal Cancer,” Journal of Clinical Oncology, Vol. 21, No. 16, 2003, pp. 3127-3132.
[9] F. Sellner, N. Tykalsky, M. de Santis, J. Pont and M. Klimpfinger “Solitary and Multiple Isolated Metastases of Clear Cell Renal Carcinoma to the Pancreas: An Indication for Pancreatic Surgery,” Annals of Surgical Oncology, Vol. 13, No. 1, 2006, pp. 75-85. 2006.03.064
[10] O. Strobel, T. Hackert, W. Hartwig, F. Bergmann, U. Hinz, M. N. Wente, et al., “Survival Data Justifies Resection for Pancreatic Metastases,” Annals of Surgical Oncology, Vol. 16, No. 12, 2009, pp. 3340-3349.
[11] A. D. Sweeney, M. F. Wu, S. G. Hilsenbeck, F. C. Brunicardi, W. E. Fisher, “Value of Pancreatic Resection for Cancer Metastatic to the Pancreas,” Journal of Surgical Research, Vol. 156, No. 2, 2009, pp. 189-198.
[12] P. J. Tanis, N. A. van der Gaag, O. R. Busch, T. M. van Gulik and D. J. Gouma, “Systematic Review of Pancreatic Surgery for Metastatic Renal Cell Carcinoma,” British Journal of Surgery, Vol. 96, No. 6, 2009, pp. 579-592.
[13] R. J. Motzer, T. E. Hutson, P. Tomczak, M. D. Michaelson, R. M. Bukowski, O. Rixe, et al., “Sunitinib versus Interferon Alfa in Metastatic Renal-Cell Carcinoma,” The New England Journal of Medicine, Vol. 356, No. 2, 2007, pp. 115-124.
[14] R. J. Motzer, T. E. Hutson, P. Tomczak, M. D. Michaelson, R. M. Bukowski, S. Oudard, et al., “Overall Survival and Updated Results for Sunitinib Compared with Interferon Alfa in Patients with Metastatic Renal Cell Carcinoma,” Journal of Clinical Oncology, Vol. 27, No. 22, 2009, pp. 3584-3590.
[15] C. N. Sternberg, I. D. Davis, J. Mardiak, C. Szczylik, E. Lee, J. Wagstaff, et al., “Pazopanib in Locally Advanced or Metastatic Renal Cell Carcinoma: Results of a Randomized Phase III Trial,” Journal of Clinical Oncology, Vol. 28, No. 6, 2010, pp. 1061-1068.
[16] A. Ceschia, “2012 ESMO Congress,” The Lancet Oncology, Vol. 13, No. 11, 2012, p. 1081.
[17] B. Escudier and V. Kataja, “Renal Cell Carcinoma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up,” Annals of Oncology, Vol. 21, Suppl. 5, 2010, pp. v137-v139.
[18] National Institute for Health and Clinical Excellence, “Sunitinib for the First-Line Treatment of Advanced and/or Metastatic Renal Cell Carcinoma (TA169),” National Institute for Health and Clinical Excellence, London, 2009.
[19] J. P. Faure, J. J. Tuech, J. P. Richer, P. Pessaux, J. P. Arnaud and M. Carretier “Pancreatic Metastasis of Renal Cell Carcinoma: Presentation, Treatment and Survival,” Journal of Urology, Vol. 165, No. 1, 2001, pp. 20-22.
[20] M. E. Gore, C. Szczylik, C. Porta, S. Bracarda, G. A. Bjarnason, S. Oudard, et al., “Safety and Efficacy of Sunitinib for Metastatic Renal-Cell Carcinoma: An Expanded-Access Trial,” The Lancet Oncology, Vol. 10, No. 8, 2009, pp. 757-763.
[21] D. M. Parkin, F. Bray, J. Ferlay and P. Pisani, “Global Cancer Statistics, 2002,” CA: A Cancer Journal for Clinicians, Vol. 55, No. 2, 2005, pp. 74-108.
[22] R. J. Motzer, N. H. Bander and D. M. Nanus, “Renal-Cell Carcinoma,” The New England Journal of Medicine, Vol. 335, No. 12, 1996, pp. 865-875.
[23] A. Antonelli, A. Cozzoli, D. Zani, T. Zanotelli, M. Nicolai, S. C. Cunico, et al., “The Follow-Up Management of Non-Metastatic Renal Cell Carcinoma: Definition of a Surveillance Protocol,” BJU International, Vol. 99, No. 2, 2007, pp. 296-300. 2006.06616.x
[24] C. F. Roland and J. A. van Heerden, “Nonpancreatic Primary Tumors with Metastasis to the Pancreas,” Surgery Gynecology & Obstetrics, Vol. 168, No. 4, 1989, pp. 345-347.
[25] K. Z’graggen, C. C. Fernandez-del, D. W. Rattner, H. Sigala and A. L. Warshaw, “Metastases to the Pancreas and Their Surgical Extirpation,” Archives of Surgery, Vol. 133, No. 4, 1998, pp. 413-417.
[26] A. Kassabian, J. Stein, N. Jabbour, K. Parsa, D. Skinner, D. Parekh, et al. “Renal Cell Carcinoma Metastatic to the Pancreas: A Single-Institution Series and Review of the Literature,” Urology, Vol. 56, No. 2, 2000, pp. 211-215.
[27] E. G. Robbins, D. Franceschi and J. S. Barkin, “Solitary Metastatic Tumors to the Pancreas: A Case Report and Review of the Literature,” The American Journal of Gastroenterology, Vol. 91, No. 11, 1996, pp. 2414-2417.
[28] L. E. Harrison, N. Merchant, A. M. Cohen and M. F. Brennan, “Pancreaticoduodenectomy for Nonperiampullary Primary Tumors,” The American Journal of Surgery, Vol. 174, No. 4, 1997, pp. 393-395.
[29] R. Kanzaki, M. Higashiyama, A. Fujiwara, T. Tokunaga, J. Maeda, J. Okami, et al., “Long-Term Results of Surgical Resection for Pulmonary Metastasis from Renal Cell Carcinoma: A 25-Year Single-Institution Experience,” European Journal Cardio-Thoracic Surgery, Vol. 39, No. 2, 2011, pp. 167-172.
[30] M. D. Staehler, J. Kruse, N. Haseke, T. Stadler, A. Roosen, A. Karl, et al., “Liver Resection for Metastatic Disease Prolongs Survival in Renal Cell Carcinoma: 12-Year Results from a Retrospective Comparative Analysis,” World Journal of Urology, Vol. 28, No. 4, 2010, pp. 543-547.
[31] R. Ballarin, M. Spaggiari, N. Cautero, N. de Ruvo, R. Montalti, C. Longo, et al., “Pancreatic Metastases from Renal Cell Carcinoma: The State of the Art,” World Journal of Gastroenterology, Vol. 17, No. 43, 2011, pp. 4747-4756.
[32] G. Hudes, M. Carducci, P. Tomczak, J. Dutcher, R. Figlin, A. Kapoor, et al., “Temsirolimus, Interferon Alfa, or Both for Advanced Renal-Cell Carcinoma,” The New England Journal of Medicine, 2007, Vol. 356, No. 22, pp. 2271-2281.
[33] M.E. Gore and J.M. Larkin, “Challenges and Opportunities for Converting Renal Cell Carcinoma into a Chronic Disease with Targeted Therapies,” Br J Cancer, Vol. 104, No. 3, 2011, pp. 399-406.
[34] B. Escudier, T. Eisen, W.M. Stadler, C. Szczylik, S. Oudard, M. Staehler, et al., “Sorafenib for Treatment of Renal Cell Carcinoma: Final Efficacy and Safety Results of the Phase III Treatment Approaches in Renal Cancer Global Evaluation Trial,” Journal of Clinical Oncology, Vol. 27, No. 20, 2009, pp. 3312-3318.

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