Sarcomatoid renal cell carcinoma

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	Teja Ganta, MD Icahn School of Medicine at Mount Sinai New York, NY, USA LinkedIn		Ali Raza Khaki, MD Stanford University Palo Alto, CA, USA LinkedIn

Note: these are regimens tested in histology-specific populations, please see the main RCC page for other regimens.

2 regimens on this page 2 variants on this page

Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

NCCN

• NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Kidney Cancer.

Metastatic disease, first-line

Doxorubicin & Gemcitabine

Regimen

Study	Dates of enrollment	Evidence
Haas et al. 2012 (ECOG 8802)	2004-2007	Phase 2

Chemotherapy

• Doxorubicin (Adriamycin) 50 mg/m² IV push once on day 1
• Gemcitabine (Gemzar) 1500 mg/m² IV over 30 minutes once on day 1

Supportive therapy

• One of the following:
  • Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting on day 2 or 3, given until day 10
  • Pegfilgrastim (Neulasta) 6 mg SC once on day 2

14-day cycle for 6 to 9 cycles (cumulative doxorubicin dose of 300 to 450 mg/m², depending on cardiac function)

References

1. ECOG 8802: Haas NB, Lin X, Manola J, Pins M, Liu G, McDermott D, Nanus D, Heath E, Wilding G, Dutcher J. A phase II trial of doxorubicin and gemcitabine in renal cell carcinoma with sarcomatoid features: ECOG 8802. Med Oncol. 2012 Jun;29(2):761-7. Epub 2011 Feb 6. link to original article contains dosing details in manuscript link to PMC article PubMed NCT00068393

Gemcitabine & Sunitinib

Regimen

Study	Dates of enrollment	Evidence
Michaelson et al. 2015 (MGH 07-212)	2007-2013	Phase 2

Chemotherapy

• Gemcitabine (Gemzar) 1000 mg/m² IV once per day on days 1 & 8

Targeted therapy

• Sunitinib (Sutent) 37.5 mg PO once per day on days 1 to 14

21-day cycles

References

1. MGH 07-212: Michaelson MD, McKay RR, Werner L, Atkins MB, Van Allen EM, Olivier KM, Song J, Signoretti S, McDermott DF, Choueiri TK. Phase 2 trial of sunitinib and gemcitabine in patients with sarcomatoid and/or poor-risk metastatic renal cell carcinoma. Cancer. 2015 Oct 1;121(19):3435-43. Epub 2015 Jun 8. link to original article PubMed NCT00556049