Metastatic Renal Medullary and Collecting Duct Carcinoma in the Era of Antiangiogenic and Immune Checkpoint Inhibitors: A Multicentric Retrospective Study

Collecting duct carcinoma (CDC) and renal medullary carcinoma (RMC) are two rare subtypes of kidney cancer with a poor prognosis in the metastatic setting. Beyond first-line treatment, there are no standard-of-care therapies. This retrospective study assessed the efficacy of treatments after first-line chemotherapy in 57 patients with metastatic (m) CDC (n = 35) or RMC (n = 22) treated between 2010 and 2019 at 11 French centers. The median age was 53 years; overall, 60% (n = 34) of patients were metastatic at diagnosis. After a median follow-up of 13 months, the median overall survival was 12 (95% CI, 11-16) months. All patients received first-line platinum chemotherapy +/- bevacizumab, with a median time to progression of 7.27 (95% CI, 7-100 months and an objective response rate (ORR) of 39% (95% CI, 26-52%). Patients received a median of two (1-5) treatment lines. Subsequent treatments included tyrosine kinase inhibitors (n = 12), chemotherapy (n = 34), and checkpoint inhibitors (n = 20), with ORR ranging 10-15% and disease control rates ranging 24-50%. The duration of response for all treatments was similar to 2 months. Notably, nine patients with CDC were still alive > two years after metastatic diagnosis. Beyond first-line therapy, treatments showed very low antitumor activity in mCDC/RMC. A better understanding of the biology of those rare tumors is urgently needed in order to identify potential targets.

Automated summary

Collecting duct carcinoma (CDC) and renal medullary carcinoma (RMC) are rare subtypes of kidney cancer with poor prognosis in the metastatic setting. Treatments after first-line chemotherapy showed very low antitumor activity in mCDC/RMC, highlighting the urgent need for a better understanding of the biology of these rare tumors.