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Ambring A, Björholt I, Lesén E, Stierner U, Odén A. Treatment with sorafenib and sunitinib in renal cell cancer: a Swedish register-based study. Med Oncol 2012; 30:331. [PMID: 23254966 PMCID: PMC3586400 DOI: 10.1007/s12032-012-0331-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/03/2012] [Indexed: 11/21/2022]
Abstract
Sorafenib and sunitinib are used for renal cell carcinoma (RCC). The objective was to study the treatment duration and time to death in Swedish RCC patients on sorafenib or sunitinib as first-line or monotherapy or as sequential therapy. Patients with an RCC diagnosis were identified in the Swedish Cancer Register. Information on treatment with sorafenib and sunitinib was collected from the Swedish Prescribed Drug Register, and time of death from the Cause of Death Register. Outcome measures were duration of treatment and time to death on sorafenib or sunitinib as first-line or monotherapy and sequential therapy (sorafenib–sunitinib versus sunitinib–sorafenib). Poisson regression models were used to estimate hazard ratios (HR) with 95 % confidence intervals (CI). No difference was observed for sorafenib (n = 123 patients) versus sunitinib (n = 261 patients) in treatment duration (HR 1.00; CI 0.80–1.24) or risk for death (HR 1.30; CI 0.91–1.85) when used as first-line or monotherapy. The same applied for sequential therapy with sorafenib–sunitinib (n = 43 patients) versus sunitinib–sorafenib (n = 54 patients), HR 1.47 (CI 0.71–3.02) and HR 2.01 (CI 0.86–4.68), respectively. There was a difference between the two treatments in how the duration of first-line treatment influenced the duration of second-line treatment and time to death, in favor of starting with sorafenib. In conclusion, no difference was detected between sorafenib and sunitinib in the duration of treatment or time to death when used as first-line or monotherapy. The impact of the duration of first-line treatment differed between the two sequences, and the results indicated that sorafenib as first-line treatment is a favorable choice.
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Affiliation(s)
- Anneli Ambring
- Nordic Health Economics, Medicinaregatan 8b, 413 90 Göteborg, Sweden
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52
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Oudard S, Elaidi RT. Sequential therapy with targeted agents in patients with advanced renal cell carcinoma: Optimizing patient benefit. Cancer Treat Rev 2012; 38:981-7. [DOI: 10.1016/j.ctrv.2011.12.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/16/2011] [Accepted: 12/20/2011] [Indexed: 02/01/2023]
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Edeline J, Vauléon E, Rioux-Leclercq N, Perrin C, Bensalah CVK, Laguerre B. Safety and Efficacy of Sorafenib in Renal Cell Carcinoma. CANCER GROWTH AND METASTASIS 2012. [DOI: 10.4137/cgm.s7526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article reviews data on sorafenib use in renal cell carcinoma. Mechanisms of actions and pharmacokinetics are briefly described. Major clinical trials are presented, summarizing efficacy and safety of sorafenib. Its place in current treatment of renal cell carcinoma is discussed. Sorafenib is likely to remain one of the mainstays of RCC treatment in coming years.
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Affiliation(s)
- Julien Edeline
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | - Elodie Vauléon
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
| | - Nathalie Rioux-Leclercq
- CHU Pontchaillou, Pathology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | - Christophe Perrin
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | | | - Brigitte Laguerre
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
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Giuliani J, Drudi F. Immunotherapy and targeted therapies in metastatic renal cell carcinoma: is there a preferred sequence? Cancer Biother Radiopharm 2012; 27:513-8. [PMID: 22738404 DOI: 10.1089/cbr.2012.1250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Currently, the best sequence of targeted therapy in patients with metastatic renal cell carcinoma (mRCC) has not been sufficiently defined and is based on the patient's and physician's decision, which may be influenced by comorbidities and toxicity profiles. The aim of this study was to evaluate the outcome of target therapies on clinical practice after the era of cytokine-based therapy in mRCC. MATERIALS AND METHODS We retrospectively analyzed all consecutive patients with mRCC treated at our Clinical Oncology Unit from June 1998 to September 2010. RESULTS We evaluated 61 patients: 21 (34.4%) with only cytokine-based therapy (95.2% interferon-α), 24 (39.3%) with target therapies in first line (100% sunitinib), and 16 (26.2%) with target therapies in second or subsequent line. Median time follow-up was 16.18 months (range 2.1-171.1). Considering the type of therapy, the univariate analysis for overall survival showed statistically significant advantages for the use of target therapies in second or subsequent line (p=0.024). CONCLUSIONS Our data and consequently our proposal to revaluate the role of immunotherapy (also with the possibility of adding bevacizumab) in the first line are heavily provocative to point out the attention to this actually partially unsolved question; other larger experiences, pre-eminent opinion, and clinical trials are needed.
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Affiliation(s)
- Jacopo Giuliani
- Clinical Oncology Unit, St. Anna University Hospital , Ferrara, Italy.
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Grünwald V, Merseburger AS. Axitinib for the treatment of patients with advanced metastatic renal cell carcinoma (mRCC) after failure of prior systemic treatment. Onco Targets Ther 2012; 5:111-7. [PMID: 22787405 PMCID: PMC3390993 DOI: 10.2147/ott.s23273] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The landscape of renal cell carcinoma (RCC) treatment has changed dramatically during recent years. Bevacizumab/interferon, sunitinib, sorafenib, temsirolimus, everolimus, and pazopanib have been proven effective in metastatic RCC. Axitinib is a novel tyrosine kinase inhibitor, which inhibits the vascular endothelial growth factor receptor (VEGFR) at subnanomolar level. Based on this extraordinary VEGFR inhibition, axitinib is considered a next-generation agent. The recent AXIS trial reported on axitinib's efficacy in second line treatment of RCC, which led to its recent approval in the USA. This review focuses on the clinical efficacy of axitinib in RCC patients.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
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Pantaleo MA, Mandrioli A, Saponara M, Nannini M, Erente G, Lolli C, Biasco G. Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib. BMC Cancer 2012; 12:231. [PMID: 22687270 PMCID: PMC3407789 DOI: 10.1186/1471-2407-12-231] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 06/11/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKIs) are currently approved for the treatment of metastatic renal cell carcinoma (mRCC). The cardiotoxic effects of sorafenib and sunitinib may cause hypertension, left ventricular ejection fraction (LVEF) dysfunction and/or congestive heart failure (CHF), and arterial thrombo-embolic events (ATE). Only three cases of coronary artery disease related to sorafenib therapy have been described in the literature, and all were due to arterial vasospasm without evidence of coronary artery stenosis on angiography. Cardiotoxicity is commonly associated with the presence of cardiovascular risk factors, such as a history of hypertension or coronary artery disease. CASE PRESENTATION We describe a patient who experienced an unusual cardiac event after 2 years of sorafenib treatment. A 58-year-old man with mRCC developed acute coronary syndrome (ischemia/infarction) associated with critical sub-occlusion of the common trunk of the left coronary artery and some of its branches, which was documented on coronary angiography. The patient underwent triple coronary artery bypass surgery, and sorafenib treatment was discontinued. He did not have any cardiovascular risk factors, and his cardiac function and morphology were normal prior to sorafenib treatment. CONCLUSIONS Further investigation of a larger patient population is needed to better understand cardiac damage due to TKI treatment. Understanding the usefulness of careful cardiovascular monitoring might be important for the prevention of fatal cardiovascular events, and to avoid discontinuation of therapy for the underlying cancer.
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Affiliation(s)
- Maria Abbondanza Pantaleo
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- “Giorgio Prodi” Cancer Research Center, University of Bologna, Bologna, Italy
- University of Bologna, Department of Hematology and Oncological Sciences "L.A. Seragnoli", S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Anna Mandrioli
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maristella Saponara
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giovanna Erente
- Laboratorio di Emodinamica, Struttura Complessa di Cardiologia (Direttore Dr Angelo Ramondo), Ospedale S. Bassiano, Bassano del Grappa, Verona, Italy
| | - Cristian Lolli
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Biasco
- Department of Hematology and Oncological Sciences “L&A Seràgnoli”, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- “Giorgio Prodi” Cancer Research Center, University of Bologna, Bologna, Italy
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Pooleri GK, Nair TB, Sanjeevan KV, Thomas A. Neo adjuvant treatment with targeted molecules for renal cell cancer in current clinical practise. Indian J Surg Oncol 2012; 3:114-9. [PMID: 23730100 PMCID: PMC3392483 DOI: 10.1007/s13193-011-0100-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/21/2011] [Indexed: 12/19/2022] Open
Abstract
Target molecule Treatment (TMT) have emerged as the primary treatment in metastatic renal cell carcinoma. Majority of the patients in pivot trials were post nephrectomy cases. The benefit of cytoreductive nephrectomy in the era of TMT is debated. The role of these molecules in the adjuvant settings and in neo adjuvant/pre surgical role has evoked interest. In this review the different molecules used in the treatment of metastatic renal cancer and its effect on the primary renal tumour is discussed. Information available in the public domain about the presurgical/neoadjuvant targeted molecular treatment (TMT) is reviewed to understand the benefits and adverse effects of this modality of treatment. Sunitinib and sorafenib are the most commonly used and effective molecules in the neo adjuvant/re surgical treatment of renal cell carcinoma . Bevacizumab is less effective and has more chance of surgical complications in these settings mainly due to poor wound healing secondary to prolonged wash off period . The patent and the surgeon should be aware of the unpredictability and possible adverse effects before advising these molecule pre operatively. The response of the primary renal tumour to the target molecule is different from that of the metastatic tumour. The side effects of the molecules and its effect on the peri operative morbidity and mortality should also be considered when we advise these molecules as pre surgical/neo adjuvant treatment.
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Affiliation(s)
- Ginil Kumar Pooleri
- Uro-Oncology division, Department of Urology, Amrita Institute of Medical Sciences, AIMS-Ponekkara(PO), Kochi 41, Kerala India
| | - Tiyadath Balagopalan Nair
- Department of Urology, Amrita Institute of Medical Sciences, AIMS-Ponekkara(PO), Kochi 41, Kerala India
| | - Kalavampara V. Sanjeevan
- Department of Urology, Amrita Institute of Medical Sciences, AIMS-Ponekkara(PO), Kochi 41, Kerala India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences, AIMS-Ponekkara(PO), Kochi 41, Kerala India
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Escudier B, Szczylik C, Porta C, Gore M. Treatment selection in metastatic renal cell carcinoma: expert consensus. Nat Rev Clin Oncol 2012; 9:327-37. [PMID: 22473096 DOI: 10.1038/nrclinonc.2012.59] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In metastatic renal cell carcinoma (mRCC), many factors influence clinical decisions, including histology, tumour burden, prognostic factors, comorbidities, and the ability of the patient to tolerate treatment. Progression-free survival (PFS) durations reported from randomized trials of targeted therapies vary considerably, in part because of differences in patient characteristics. For first-line therapy, an estimate of PFS with sunitinib, bevacizumab plus interferon, or sorafenib in a 'general' population is 8-9 months, but each regimen is suitable for different patient categories. For example, sunitinib is suitable for all-prognosis groups, particularly younger, fitter patients; pazopanib for patients with a good or intermediate prognosis; bevacizumab plus interferon for good-prognosis patients or those with indolent disease; and sorafenib for patients at all prognostic risk levels, particularly the elderly and those with comorbidities. Sequential therapy with targeted agents provides significant benefit, and should be considered in all patients who can tolerate such treatment. Level 1 evidence supports sequential use of tyrosine kinase inhibitors, as well as these agents followed by everolimus. We consider how patient characteristics have influenced the results of studies of first-line therapy, and we provide expert opinion on the most appropriate treatment choices for particular patient groups receiving first-line and second-line therapy.
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Affiliation(s)
- Bernard Escudier
- Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France.
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59
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Seidel C, Busch J, Weikert S, Steffens S, Fenner M, Ganser A, Grünwald V. Progression free survival of first line vascular endothelial growth factor-targeted therapy is an important prognostic parameter in patients with metastatic renal cell carcinoma. Eur J Cancer 2012; 48:1023-30. [PMID: 22436979 DOI: 10.1016/j.ejca.2012.02.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE Intrinsic resistance in metastatic renal cell carcinoma (mRCC) was recently associated with poor overall survival (OS), suggesting that VEGF inhibitor sensitivity may represent a valuable prognostic marker. We explored the duration of progression free survival (PFS) in first-line treatment and other variables as prognostic markers in mRCC. METHODS Medical records from 119 mRCC patients receiving first line treatment with tyrosine kinase inhibitors (TKI) were retrieved retrospectively. Kaplan-Meier and log-rank analyses were employed on PFS and OS and multivariate Cox proportional hazard model analysed clinical parameters for their prognostic relevance. RESULTS The median PFS of first line treatment was 8.4 months (95% confidence interval 5.8-11) associated with a median OS of 28.2 months (95% CI 20.9-35.4). Second line therapy with another TKI or mTOR-inhibitor was applied to 81 patients (68%). PFS of any second line therapy was 5.1 and 3.7 months in first line treatment responders and non-responders (p = 0.3), respectively. Univariate analyses revealed bone metastases, prior cytokine treatment, Memorial Sloan Kettering cancer centre (MSKCC) score, objective response rate, Eastern Cooperative Oncology Group (ECOG) performance status, first line PFS with 6 months taken as cut-off parameter and second line treatment as prognostic variables. Multivariate analyses proved first line PFS above 6 months (95% CI 0.154-0.641; HR 0.314), second line treatment (95% CI 0.162-0.657; HR 0.326), MSKCC score (95% CI 1.07-3.392; HR 1.905) and objective response rate (95% CI 0.358-0.989; HR 0.595) to be independent prognostic markers. CONCLUSIONS The duration of first line PFS is an independent prognostic variable but not predictive for subsequent therapy.
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Affiliation(s)
- Christoph Seidel
- Department of Hematology, Hemostatis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
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Abstract
The management of advanced genitourinary malignancies has undergone a major transformation with the advent of novel drugs and targeted therapies in recent years. Assessment of the treatment risks and benefits is required for each patient and therefore better knowledge of the different clinical and molecular aspects of these diseases is warranted. The results of further studies and biomarker validations are expected to provide more treatment options and improve outcomes in the future management of genitourinary malignancies.
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Nozawa M, Yamamoto Y, Minami T, Shimizu N, Hatanaka Y, Tsuji H, Uemura H. Sorafenib rechallenge in patients with metastatic renal cell carcinoma. BJU Int 2012; 110:E228-34. [DOI: 10.1111/j.1464-410x.2011.10905.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Park SJ, Lee JL, Park I, Park K, Ahn Y, Ahn JH, Lee DH, Ahn S, Song C, Hong JH, Kim CS, Ahn H. Comparative Efficacy of Sunitinib versus Sorafenib as First-Line Treatment for Patients with Metastatic Renal Cell Carcinoma. Chemotherapy 2012; 58:468-74. [DOI: 10.1159/000346484] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/13/2012] [Indexed: 11/19/2022]
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63
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Stenner F, Chastonay R, Liewen H, Haile SR, Cathomas R, Rothermundt C, Siciliano RD, Stoll S, Knuth A, Buchler T, Porta C, Renner C, Samaras P. A Pooled Analysis of Sequential Therapies with Sorafenib and Sunitinib in Metastatic Renal Cell Carcinoma. Oncology 2012; 82:333-40. [DOI: 10.1159/000338001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
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64
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Sequence Therapy in Patients with Metastatic Renal Cell Carcinoma: Comparison of Common Targeted Treatment Options Following Failure of Receptor Tyrosine Kinase Inhibitors. Eur Urol 2011; 60:1163-70. [DOI: 10.1016/j.eururo.2011.07.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/08/2011] [Indexed: 02/02/2023]
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65
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Heng DY, Mackenzie MJ, Vaishampayan UN, Bjarnason GA, Knox JJ, Tan MH, Wood L, Wang Y, Kollmannsberger C, North S, Donskov F, Rini BI, Choueiri TK. Primary anti-vascular endothelial growth factor (VEGF)-refractory metastatic renal cell carcinoma: clinical characteristics, risk factors, and subsequent therapy. Ann Oncol 2011; 23:1549-55. [PMID: 22056973 DOI: 10.1093/annonc/mdr533] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A subset of patients treated with initial anti-vascular endothelial growth factor (VEGF) therapy exhibit progressive disease (PD) as the best response per RECIST criteria. METHODS Data from patients with metastatic renal cell carcinoma (mRCC) treated with anti-VEGF therapy were collected through the International mRCC Database Consortium from 12 centers. RESULTS One thousand and fifty-six assessable patients received initial VEGF inhibitors and 272 (26%) of these patients had PD as best response. Initial treatment included sunitinib (n = 203), sorafenib (n = 51), or bevacizumab (n = 18). Six percent of patients were at favorable risk, 55% at intermediate risk, and 39% at poor risk. On multivariable analysis, predictors of PD were Karnofsky performance status < 80% [odds ratio (OR) = 2.3, P < 0.0001], diagnosis to treatment < 1 year (OR = 2.1, P < 0.0001), neutrophilia (OR = 1.9, P = 0.0021), thrombocytosis (OR = 1.7, P = 0.0068), and anemia (OR = 1.6, P = 0.0058). Median progression-free survival (PFS) in patients with PD versus without PD was 2.4 versus 11 months (P < 0.0001) and overall survival (OS) was 6.8 versus 29 months (P < 0.0001), respectively. One hundred and eight (40%) VEGF-refractory patients proceeded to receive further systemic therapies. Response rate, PFS, and OS for subsequent therapy were 9%, 2.5 months, and 7.4 months, respectively, with no statistical differences between patients who received VEGF versus mammalian target of rapamycin (mTOR) inhibitors. CONCLUSIONS Primary anti-VEGF-refractory mRCC patients have a dismal prognosis. Second-line anti-mTOR and anti-VEGF agents produce similar outcomes.
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Affiliation(s)
- D Y Heng
- Department of Medical Oncology, University of Calgary, Calgary, Canada.
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66
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Vasudev NS, Larkin JM. Tyrosine kinase inhibitors in the treatment of advanced renal cell carcinoma: focus on pazopanib. Clin Med Insights Oncol 2011; 5:333-42. [PMID: 22084622 PMCID: PMC3210627 DOI: 10.4137/cmo.s7263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Advances in our understanding of renal cancer biology have led to a new treatment paradigm in renal cancer. Tyrosine kinase inhibitors (TKI), that target the intracellular kinase domain of the VEGF receptor, have become established as the most successful class of agent in this disease. Three TKIs are currently approved for use in patients with advanced disease. Newer, more potent inhibitors have reached phase III clinical testing, meaning others are likely to follow. In 2009, pazopanib became the most recent TKI to receive FDA approval. This review sets out to discuss the key opportunities and challenges associated with TKI use in RCC, focusing particularly on pazopanib. We also review the current place of pazopanib in the management of patients with advanced disease, in what is a rapidly evolving therapeutic landscape.
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Affiliation(s)
| | - James M.G. Larkin
- Consultant Medical Oncologist, Renal Cancer Unit, Department of Medicine, Royal Marsden Hospital, London SW3 6JJ, UK
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Porta C, Tortora G, Linassier C, Papazisis K, Awada A, Berthold D, Maroto JP, Powles T, De Santis M. Maximising the duration of disease control in metastatic renal cell carcinoma with targeted agents: an expert agreement. Med Oncol 2011; 29:1896-907. [PMID: 21735145 DOI: 10.1007/s12032-011-0016-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/20/2011] [Indexed: 12/01/2022]
Abstract
With six targeted agents approved (sorafenib, sunitinib, temsirolimus, bevacizumab [+interferon], everolimus and pazopanib), many patients with metastatic renal cell carcinoma (mRCC) will receive multiple therapies. However, the optimum sequencing approach has not been defined. A group of European experts reviewed available data and shared their clinical experience to compile an expert agreement on the sequential use of targeted agents in mRCC. To date, there are few prospective studies of sequential therapy. The mammalian target of rapamycin (mTOR) inhibitor everolimus was approved for use in patients who failed treatment with inhibitors of vascular endothelial growth factor (VEGF) and VEGF receptors (VEGFR) based on the results from a Phase III placebo-controlled study; however, until then, the only licensed agents across the spectrum of mRCC were VEGF(R) inhibitors (sorafenib, sunitinib and bevacizumab + interferon), and as such, a large body of evidence has accumulated regarding their use in sequence. Data show that sequential use of VEGF(R) inhibitors may be an effective treatment strategy to achieve prolonged clinical benefit. The optimal place of each targeted agent in the treatment sequence is still unclear, and data from large prospective studies are needed. The Phase III AXIS study of second-line sorafenib vs. axitinib (including post-VEGF(R) inhibitors) has completed, but the data are not yet published; other ongoing studies include the Phase III SWITCH study of sorafenib-sunitinib vs. sunitinib-sorafenib (NCT00732914); the Phase III 404 study of temsirolimus vs. sorafenib post-sunitinib (NCT00474786) and the Phase II RECORD 3 study of sunitinib-everolimus vs. everolimus-sunitinib (NCT00903175). Until additional data are available, consideration of patient response and tolerability to treatment may facilitate current decision-making regarding when to switch and which treatment to switch to in real-life clinical practice.
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Affiliation(s)
- C Porta
- Medical Oncology, IRCCS San Matteo University Hospital Foundation, Piazzale C Golgi 19, I-27100 Pavia, Italy.
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Ellrichmann G, Harati A, Müller T. Deep brain stimulation improves performance of complex instrumental paradigms. Eur Neurol 2008; 60:32-6. [PMID: 18437046 DOI: 10.1159/000127977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 11/13/2007] [Indexed: 11/19/2022]
Abstract
Patients with Parkinson's disease (PD) show deficits of motion behaviour and cognitive function, which were assessed with various instrumental paradigms. Objectives of the present trial were to investigate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on the performance of complex and simple movement series, on the execution of simple reaction time (SRT) paradigms following an acoustic or a visual stimulus, on scored motor symptoms and the interrelation of the various study parameters in PD patients. Motor symptoms, operation of complex movements, and the execution of SRT tasks significantly improved when the stimulator was switched on. Execution of simple movement series did not differ between the on and off conditions of the stimulator. Instrumental test results significantly correlated with scored motor symptoms in particular during the off condition. During the on state, significant correlations were found between the performance of complex motion sequences and the SRT outcomes. PD patients treated with DBS of the STN show better results for more complex instrumental paradigms with a higher need for cognitive effort during the on situation due to improvements in motor performance, function of the basal ganglia-thalamocortical circuitry and cognitive function.
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Affiliation(s)
- Gisa Ellrichmann
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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