Bevacizumab plus erlotinib combination therapy for advanced hereditary leiomyomatosis and renal cell carcinoma-Associated renal cell carcinoma: A multicenter retrospective analysis in korean patients

Purpose Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare genetic syndrome resulting from germline mutations in fumarate hydratase. The combination of bevacizumab plus erlotinib showed promising interim results for HLRCC-Associated renal cell carcinoma (RCC). Based on these results, we analyzed the outcome of bevacizumab plus erlotinib in Korean patients with HLRCC-Associated RCC. Materials and Methods We retrospectively reviewed the efficacy and safety of bevacizumab plus erlotinib in patients with HLRCC-Associated RCC who were confirmed to have germline mutations in fumarate hydratase. The primary endpoint was the objective response rate (ORR), while the secondary endpoints were progression-free survival (PFS) and overall survival (OS). Results We identified 10 patients with advanced HLRCC-Associated RCC who received bevacizumab plus erlotinib. Median age at diagnosis was 41 years, and five of the patients had received the combination as first-or second-line treatments. The ORR was 50% and the median PFS and OS were 13.3 and 14.1 months, respectively. Most adverse events were predictable and manageable by conventional measures, except for one instance where a patient died of gastrointestinal bleeding. Conclusion This is the first real-world outcome of the treatment of advanced HLRCC-Associated RCC. Bevacizumab plus erlotinib therapy showed promising activity with moderate toxicity. We should be increasingly aware of HLRCC-Associated RCC and bevacizumab plus erlotinib should be a first-line treatment for this condition, unless other promising data are published.