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Umeyama Y, Shibasaki Y, Akaza H. Axitinib in metastatic renal cell carcinoma: beyond the second-line setting. Future Oncol 2017; 13:1839-1852. [PMID: 28707479 DOI: 10.2217/fon-2017-0104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Treatment options for advanced and metastatic renal cell carcinoma have advanced considerably in the past decade with the approval of several targeted agents, including axitinib. Axitinib is a potent and selective inhibitor of VEGFRs 1-3, and is well established as second-line treatment. This article summarizes factors to be considered when administering axitinib, such as individualized dose titration and axitinib-associated adverse events, in order to retain patients longer on treatment, which would likely lead to improved efficacy outcomes. In addition, potential clinical perspectives for axitinib beyond the second-line setting, including its role in the first-line setting, sequential therapy, neoadjuvant and adjuvant therapies, and combination therapy with immunotherapy, in particular, immune checkpoint inhibitors, are discussed.
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Affiliation(s)
- Yoshiko Umeyama
- Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo 151-8589, Japan
| | | | - Hideyuki Akaza
- Strategic Investigation on Comprehensive Cancer Network, Interfaculty Initiative in Information Studies/Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
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Matias M, Le Teuff G, Albiges L, Guida A, Brard C, Bacciarelo G, Loriot Y, Massard C, Lassau N, Fizazi K, Escudier B. Real world prospective experience of axitinib in metastatic renal cell carcinoma in a large comprehensive cancer centre. Eur J Cancer 2017; 79:185-192. [DOI: 10.1016/j.ejca.2017.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
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Abstract
Targeted therapies that act via unique molecular pathways and interfere with cancer cell growth and tumor progression have dramatically changed the cancer treatment paradigm. However, although, ideally, these therapies intend to target only cancer cells, they do often affect nonmalignant tissue. Numerous renal side effects have been reported to date. This article will review clinical presentation, presumed pathophysiology, and treatment of kidney side effects of targeted therapies. Feasibility of the continuation of cancer therapy despite renal toxicity will also be addressed.
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104
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Ornstein MC, Wood LS, Elson P, Allman KD, Beach J, Martin A, Zanick BR, Grivas P, Gilligan T, Garcia JA, Rini BI. A Phase II Study of Intermittent Sunitinib in Previously Untreated Patients With Metastatic Renal Cell Carcinoma. J Clin Oncol 2017; 35:1764-1769. [DOI: 10.1200/jco.2016.71.1184] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Sunitinib is a standard initial therapy in metastatic renal cell carcinoma (mRCC), but chronic dosing requires balancing toxicity with clinical benefit. The feasibility and clinical outcome with intermittent sunitinib dosing in patients with mRCC was explored. Patients and Methods Patients with treatment-naïve, clear cell mRCC were treated with four cycles of sunitinib (50 mg once per day, 4 weeks of receiving treatment followed by 2 weeks of no treatment). Patients with a ≥ 10% reduction in tumor burden (TB) after four cycles had sunitinib held, with restaging scans performed every two cycles. Sunitinib was reinitiated for two cycles in those patients with an increase in TB by ≥ 10%, and again held with ≥ 10% TB reduction. This intermittent sunitinib dosing continued until Response Evaluation Criteria in Solid Tumors-defined disease progression while receiving sunitinib, or unacceptable toxicity occurred. The primary objective was feasibility, defined as the proportion of eligible patients who underwent intermittent therapy. Results Of 37 patients enrolled, 20 were eligible for intermittent therapy and all patients (100%) entered the intermittent phase. Patients were not eligible for intermittent sunitinib because of progressive disease (n = 13), toxicity (n = 1), or consent withdrawal (n = 3) before the end of cycle 4. The objective response rate was 46% after the first four cycles of therapy. The median increase in TB during the periods off sunitinib was 1.6 cm (range, −2.9 to 3.4 cm) compared with the TB immediately before stopping sunitinib. Most patients exhibited a stable sawtooth pattern of TB reduction while receiving sunitinib and TB increase while not receiving sunitinib. Median progression-free survival to date is 22.4 months (95% CI, 5.4 to 37.6 months) and median overall survival is 34.8 months (95% CI, 14.8 months to not applicable). Conclusion Periodic extended sunitinib treatment breaks are feasible and clinical efficacy does not seem to be compromised.
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Affiliation(s)
- Moshe C. Ornstein
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Laura S. Wood
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Paul Elson
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | - Jennifer Beach
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Allison Martin
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Beth R. Zanick
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Petros Grivas
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Tim Gilligan
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Jorge A. Garcia
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I. Rini
- All authors: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
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Oya M, Tomita Y, Fukasawa S, Shinohara N, Habuchi T, Rini BI, Fujii Y, Kamei Y, Umeyama Y, Bair AH, Uemura H. Overall survival of first-line axitinib in metastatic renal cell carcinoma: Japanese subgroup analysis from phase II study. Cancer Sci 2017; 108:1231-1239. [PMID: 28267243 PMCID: PMC5480076 DOI: 10.1111/cas.13232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 12/03/2022] Open
Abstract
Subgroup analyses of a randomized global phase II study of axitinib showed objective response rate of 66% and median progression-free survival of 27.6 months in treatment-naïve Japanese patients with metastatic renal cell carcinoma (RCC). This analysis evaluated overall survival (OS) and safety in 44 Japanese patients and compared the results with 169 non-Japanese patients. In addition, baseline characteristics for predictive factors that may influence OS in first-line metastatic RCC were explored in all patients using a Cox proportional hazard model. With median follow-up of 33 months, fewer than half (16 of 44) of the Japanese patients had died and median OS was not reached (95% confidence interval [CI], 38.8 months-not estimable), whereas 107 of 169 (63%) non-Japanese patients had died and median OS was 33.9 months (95% CI, 28.9-42.7). Estimated 1-year, 2-year and 3-year survival probability (95% CI) was 86.4% (76.2-96.5), 75.0% (62.2-87.8) and 68.2% (54.4-81.9), respectively, in Japanese patients, and was higher than that in non-Japanese patients (75.1% [68.4-81.8], 62.1% [54.5-69.7] and 47.2% [39.3-55.1], respectively). The updated safety analysis did not reveal any new adverse events of concern among Japanese or non-Japanese patients. The multivariate analysis identified that lower baseline Eastern Cooperative Oncology Group performance status, lower baseline tumor burden, and longer time from histopathological diagnosis to treatment were significant positive predictors of OS. The current analysis confirmed the clinical activity of axitinib in treatment-naïve Japanese patients with metastatic RCC, with an acceptable toxicity profile.
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Affiliation(s)
- Mototsugu Oya
- Department of UrologyKeio University School of MedicineTokyoJapan
| | - Yoshihiko Tomita
- Department of UrologyYamagata University Faculty of MedicineYamagataJapan
- Present address: Niigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Satoshi Fukasawa
- Prostate Center and Division of UrologyChiba Cancer CenterChibaJapan
| | - Nobuo Shinohara
- Department of UrologyHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Tomonori Habuchi
- Department of UrologyAkita University School of MedicineAkitaJapan
| | - Brian I. Rini
- Department of Solid Tumor OncologyCleveland ClinicTaussig Cancer InstituteClevelandOhioUSA
| | | | | | | | | | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsakaJapan
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Roman-Gonzalez A, Jimenez C. Malignant pheochromocytoma-paraganglioma: pathogenesis, TNM staging, and current clinical trials. Curr Opin Endocrinol Diabetes Obes 2017; 24:174-183. [PMID: 28234804 DOI: 10.1097/med.0000000000000330] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Pheochromocytomas and paragangliomas (PPGs) are rare neuroendocrine tumors. Over the last 15 years, substantial progress has been made toward understanding the clinical aspects and molecular origins of this disease. Nevertheless, predicting and managing malignancy remains the biggest challenge in clinical practice. The natural history of patients with malignant PPGs has not yet been described, and their prognosis varies. Currently, the diagnosis of malignant PPGs relies on the presence of metastases, by which time the disease is usually advanced. Better understanding of the clinical and molecular characteristics of patients with malignant PPGs has spurred several prospective clinical trials. RECENT FINDINGS Several molecular targeted therapies, a novel radiopharmaceutical medication that targets the catecholamine transporter, and immunotherapy are under evaluation for the treatment of patients with malignant PPGs. Furthermore, the identification of clinical predictors of malignancy and survival has led to the first TNM staging classification for PPGs. SUMMARY Prospective clinical trials are providing patients with therapeutic options beyond systemic chemotherapy. The knowledge derived from these trials and from the evaluation of the TNM staging in clinical practice will help to clarify how to most effectively treat malignant PPGs.
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Affiliation(s)
- Alejandro Roman-Gonzalez
- aDepartment of Endocrinology, Hospital Universitario San Vicente Fundacion-Universidad de Antioquia, Medellín, Colombia bDepartment of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Bamias A, Escudier B, Sternberg CN, Zagouri F, Dellis A, Djavan B, Tzannis K, Kontovinis L, Stravodimos K, Papatsoris A, Mitropoulos D, Deliveliotis C, Dimopoulos MA, Constantinides CA. Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation. Oncologist 2017; 22:667-679. [PMID: 28592625 PMCID: PMC5469586 DOI: 10.1634/theoncologist.2016-0435] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
The landscape of local and systemic therapy of renal cell carcinoma (RCC) is rapidly changing. The increase in the incidental finding of small renal tumors has increased the application of nephron-sparing procedures, while ten novel agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin pathways, or inhibiting the interaction of the programmed death 1 receptor with its ligand, have been approved since 2006 and have dramatically improved the prognosis of metastatic RCC (mRCC). These rapid developments have resulted in continuous changes in the respective Clinical Practice Guidelines/Expert Recommendations. We conducted a systematic review of the existing guidelines in MEDLINE according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, aiming to identify areas of agreement and discrepancy among them and to evaluate the underlying reasons for such discrepancies. Data synthesis identified selection criteria for nonsurgical approaches in renal masses; the role of modern laparoscopic techniques in the context of partial nephrectomy; selection criteria for cytoreductive nephrectomy and metastasectomy in mRCC; systemic therapy of metastatic non-clear-cell renal cancers; and optimal sequence of available agents in mRCC relapsed after anti-VEGF therapy as the major areas of uncertainty. Agreement or uncertainty was not always correlated with the availability of data from phase III randomized controlled trials. Our review suggests that the combination of systematic review and critical evaluation can define practices of wide applicability and areas for future research by identifying areas of agreement and uncertainty among existing guidelines. IMPLICATIONS FOR PRACTICE Currently, there is uncertainity on the role of surgery in MRCC and on the choice of available guidelines in relapsed RCC. The best practice is individualization of targeted therapies. Systematic review of guidelines can help to identify unmet medical needs and areas of future research.
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Affiliation(s)
- Aristotle Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | | | - Cora N Sternberg
- Department of Medical Oncology San Camillo and Forlanini Hospitals, Rome, Italy
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Athanasios Dellis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bob Djavan
- Department of Onology, Medical School, New York University, New York, New York, USA
- Department of Onology, Medical School, University of Vienna, Vienna, Austria
| | | | | | - Konstantinos Stravodimos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Athanasios Papatsoris
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Charalampos Deliveliotis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | - Constantine A Constantinides
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
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Schindler E, Amantea MA, Karlsson MO, Friberg LE. A Pharmacometric Framework for Axitinib Exposure, Efficacy, and Safety in Metastatic Renal Cell Carcinoma Patients. CPT Pharmacometrics Syst Pharmacol 2017; 6:373-382. [PMID: 28378918 PMCID: PMC5488123 DOI: 10.1002/psp4.12193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 01/15/2023] Open
Abstract
The relationships between exposure, biomarkers (vascular endothelial growth factor (VEGF), soluble VEGF receptors (sVEGFR)-1, -2, -3, and soluble stem cell factor receptor (sKIT)), tumor sum of longest diameters (SLD), diastolic blood pressure (dBP), and overall survival (OS) were investigated in a modeling framework. The dataset included 64 metastatic renal cell carcinoma patients (mRCC) treated with oral axitinib. Biomarker timecourses were described by indirect response (IDR) models where axitinib inhibits sVEGFR-1, -2, and -3 production, and VEGF degradation. No effect was identified on sKIT. A tumor model using sVEGFR-3 dynamics as driver predicted SLD data well. An IDR model, with axitinib exposure stimulating the response, characterized dBP increase. In a time-to-event model the SLD timecourse predicted OS better than exposure, biomarker- or dBP-related metrics. This type of framework can be used to relate pharmacokinetics, efficacy, and safety to long-term clinical outcome in mRCC patients treated with VEGFR inhibitors. (ClinicalTrial.gov identifier NCT00569946.).
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Affiliation(s)
- E Schindler
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - M O Karlsson
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - L E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Lalani AKA, McKay RR, Lin X, Simantov R, Kaymakcalan MD, Choueiri TK. Proton Pump Inhibitors and Survival Outcomes in Patients With Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2017. [PMID: 28645482 DOI: 10.1016/j.clgc.2017.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) are potent inhibitors of gastric acid secretion and can affect the optimal absorption of concomitant oral medications, such as vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs). The purpose of this study was to investigate the effect of PPI use on survival in metastatic renal cell carcinoma (mRCC) patients treated in the targeted therapy era. MATERIALS AND METHODS We conducted a pooled analysis of mRCC patients treated in phase II and III clinical trials. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method. RESULTS We identified 2188 patients treated with sunitinib (n = 952), axitinib (n = 626) or sorafenib (n = 610), of whom 120 were PPI users. Overall, PPI users showed similar overall survival compared with non-PPI users (hazard ratio [HR], 1.051; 95% confidence interval [CI], 0.769-1.438; P = .754; median, 24.1 vs. 21.3 months). Similarly, progression-free survival (HR, 1.016; 95% CI, 0.793-1.301; P = .902; median, 5.5 vs. 8.0 months) and objective response rates (23.3% vs. 27.4%; P = .344) were not different between PPI users and nonusers. These findings were consistent across International mRCC Database Consortium risk groups and according to line of therapy. Adverse events were similar between PPI users and nonusers. CONCLUSION We showed that PPI use does not appear to negatively affect the efficacy and safety of select VEGF-TKIs in patients with mRCC. Documentation of concomitant medications and patient education on potential drug interactions are critical for optimizing the use of oral cancer-targeting therapy.
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Affiliation(s)
- Aly-Khan A Lalani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Division of Hematology/Oncology, Department of Medicine, University of California San Diego, Moores Cancer Center, La Jolla, CA
| | - Xun Lin
- Pfizer Oncology, Pfizer Inc, New York, NY
| | | | - Marina D Kaymakcalan
- Department of Pharmacy and Clinical Support, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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MacLean E, Cisar L, Mehle K, Eremina D, Quigley JM. Real-World Axitinib Use in the United States: A Retrospective Study Using Linked Datasets. J Manag Care Spec Pharm 2017; 22:723-732u. [PMID: 27231799 PMCID: PMC10397709 DOI: 10.18553/jmcp.2016.22.6.723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Axitinib is approved by the FDA for the treatment of advanced renal cell carcinoma (RCC) after failure of 1 previous systemic therapy and is distributed primarily through specialty pharmacies. Although the efficacy and safety of axitinib have been established in clinical trials, information from real-world populations will help to elucidate patients' clinical profiles and utilization patterns. Prescription records alone provide limited information on patient characteristics and other treatment experiences. Expansion of these data with information from medical claims databases should yield observational real-world data that may help to optimize therapy for patients with advanced RCC. OBJECTIVE To link information from a specialty pharmacy database with information from medical and pharmacy claims databases to characterize real-world treatment patterns of axitinib as subsequent systemic therapy in patients with RCC in the United States. METHODS This retrospective, observational, cohort study linked de-identified patient-level data from 22 specialty pharmacies that dispense axitinib with databases of longitudinal medical and pharmacy claims. Eligible patients had a diagnosis of RCC (> 1 claim for RCC defined as ICD-9-CM code 189.0), previously received > 1 systemic therapy, had the first prescription for axitinib dispensed between May 2012 and April 2013 (index), and had consistent claims reporting by pharmacies and physicians. All treatment data were used to calculate cycle, line of therapy, and duration of therapy; prescription data were used to determine axitinib dose modifications. Multivariate and logistic regression analyses were conducted to assess the effect of patient/prescriber characteristics on duration of axitinib therapy and dose modifications, respectively. RESULTS In all, 1,175 patients met the study inclusion criteria and had data present in specialty pharmacy and claims databases. Most patients (74%) were male, and 68% were aged 55-74 years. Mean (SD) Charlson Comorbidity Index score was 2.7 (± 1.1); the most common comorbidity was hypertension (in 199 patients, 17%). Based on Rx-Risk-V, the most frequent concomitant conditions were pain (40%) and ischemic heart disease/hypertension (30%); the most frequent concomitant medications were antihypertensive medications (46%) and opiates (40%). Most prescribers (63%) were affiliated with an academic center, and all U.S. geographic regions were represented. In all, 847 patients (72%) had commercial insurance. Axitinib was prescribed as second-line therapy in 659 patients (56%), as third-line therapy in 326 patients (28%), and as fourth-line or later therapy in 190 patients (16%). In the overall population, mean (SD) duration of axitinib therapy was 168.6 (± 148.4) days. Axitinib treatment duration was 21 days longer in males than females (P = 0.013); 28 days longer in patients in the Northeast than in the Midwest or West (P = 0.010 and P = 0.016, respectively); and 26 days longer in patients receiving baseline hypothyroidism treatment (P = 0.004). In patients receiving second-line axitinib, the most common first-line therapy was sunitinib (56%), followed by pazopanib (16%) and everolimus (12%). Mean (SD) duration of second-line axitinib treatment was 172.3 (± 150.6) days and ranged from 127 days in patients who previously received temsirolimus to 196 days in those who previously received sorafenib. Of 1,025 patients who initiated axitinib at the standard 5 mg twice daily starting dose, 70% remained at this dose throughout treatment, whereas 10% had a dose increase. Younger age and gender (male) were associated with dose increases (OR = 0.958, 95% CI = 0.941-0.975 and OR = 0.573, 95% CI = 0.364-0.903, respectively). Baseline hypothyroidism treatment was associated with dose decreases and increases (OR = 1.662, 95% CI = 1.088-2.539 and OR = 2.149, 95% CI = 1.353-3.413, respectively). CONCLUSIONS This analysis demonstrates the feasibility and utility of linking specialty pharmacy data to other longitudinal databases to better understand patient, provider, and reimbursement characteristics. These data provide insight into routine clinical use of axitinib as subsequent RCC therapy in the United States in the period following FDA approval, as well as additional information on sequencing of targeted agents in patients with advanced RCC. DISCLOSURES This study was sponsored by Pfizer. MacLean and Cisar are employees of and hold stock in Pfizer. At the time of this analysis, Mehle, Eremina, and Quigley were employees of IMS Health who were paid consultants to Pfizer during the conduct of this study and in connection with the development of this manuscript. MacLean and Cisar contributed to study design and manuscript development. Mehle, Eremina, and Quigley contributed to study design, analysis, and manuscript development.
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Affiliation(s)
- Elizabeth MacLean
- 1 Outcomes and Evidence, Global Health and Value, New York, New York
| | - Laura Cisar
- 2 US Medical Affairs, Oncology, Pfizer, New York, New York
| | - Kimberly Mehle
- 3 Commercial Effectiveness Services, IMS Health, Plymouth Meeting, Pennsylvania
| | - Daria Eremina
- 4 Statistical Methodology, IMS Health, Plymouth Meeting, Pennsylvania
| | - Jane M Quigley
- 5 Commercial Effectiveness Services, IMS Health, Plymouth Meeting, Pennsylvania
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Ornstein MC, Wood L, Elson P, Allman K, Beach J, Martin A, Gilligan T, Garcia JA, Rini BI. Clinical Effect of Dose Escalation After Disease Progression in Patients With Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2017; 15:e275-e280. [DOI: 10.1016/j.clgc.2016.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 12/15/2022]
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112
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Rini BI, Gruenwald V, Jonasch E, Fishman MN, Tomita Y, Michaelson MD, Tarazi J, Cisar L, Hariharan S, Bair AH, Rosbrook B, Hutson TE. Long-term Duration of First-Line Axitinib Treatment in Advanced Renal Cell Carcinoma. Target Oncol 2017; 12:333-340. [DOI: 10.1007/s11523-017-0487-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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113
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de Velasco G, McKay RR, Lin X, Moreira RB, Simantov R, Choueiri TK. Comprehensive Analysis of Survival Outcomes in Non-Clear Cell Renal Cell Carcinoma Patients Treated in Clinical Trials. Clin Genitourin Cancer 2017; 15:652-660.e1. [PMID: 28410911 DOI: 10.1016/j.clgc.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinical data from patients with non-clear cell renal cell carcinoma (nccRCC) receiving targeted therapy are limited, and many clinical trials have excluded these patients from study entry. We sought to investigate the outcomes of patients with nccRCC treated in clinical trials in the modern era compared with the outcomes of patients with clear cell RCC (ccRCC). PATIENTS AND METHODS We conducted a retrospective study of patients with metastatic RCC who had received targeted therapy in Pfizer-sponsored phase II and III clinical trials from 2003 to 2013. Associations between the histologic type and treatment outcome (overall survival [OS] and progression-free survival [PFS]) were assessed using the log-rank test on univariate analysis or the Wald χ2 test from Cox regression on multivariable analysis, adjusted for baseline characteristics, including age, sex, Eastern Cooperative Oncology Group performance status, body mass index, International Metastatic RCC Database Consortium risk factors, previous nephrectomy, previous therapy, metastatic sites, angiotensin system inhibitor use, and statin use. RESULTS We identified 4527 patients with metastatic RCC: 4235 with ccRCC and 337 with nccRCC. Overall, the median OS was shorter for those with nccRCC than for those with ccRCC (15.7 vs. 20.2 months; hazard ratio [HR], 1.41; 95% confidence interval 1.22-1.63; P < .001). When stratified by the International Metastatic RCC Database Consortium risk group, the median OS was inferior for the intermediate- and poor-risk patients with nccRCC than for those with ccRCC. However, no differences were found in the favorable risk group for nccRCC versus ccRCC. The patients with nccRCC who had received vascular endothelial growth factor-targeted therapy had shorter PFS compared with that of ccRCC patients (median, 6.1 vs. 8.5 months; HR, 1.49; P < .001) but similar PFS when treated with mammalian target of rapamycin inhibitors (median, 4.3 vs. 4.4 months; HR, 0.92; P = .63). CONCLUSION Our findings have confirmed that patients with nccRCC are underrepresented in clinical trials and highlight the need for further prospective studies exploring current and novel agents for this patient population.
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Affiliation(s)
- Guillermo de Velasco
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Xun Lin
- Pfizer Oncology, Pfizer Inc, La Jolla, CA
| | - Raphel B Moreira
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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114
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Porta C, Chiellino S, Ferrari A, Mariucci S, Liguigli W. Pharmacotherapy for treating metastatic clear cell renal cell carcinoma. Expert Opin Pharmacother 2017; 18:205-216. [DOI: 10.1080/14656566.2017.1282462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Camillo Porta
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
- Italian Nephro-Oncology Group/Gruppo Italiano di Oncologia Nefrologica (G.I.O.N.), Pavia, Italy
| | - Silvia Chiellino
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Sara Mariucci
- Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Wanda Liguigli
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
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Tyrosine Kinase and Mammalian Target of Rapamycin Inhibitors in the Treatment of Advanced Renal Cell Carcinoma: Practical Clinical Implications of Pharmacologic Features. Clin Genitourin Cancer 2017; 15:7-22. [DOI: 10.1016/j.clgc.2016.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/12/2016] [Accepted: 05/18/2016] [Indexed: 12/28/2022]
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Abstract
Colorectal cancer is commonly diagnosed throughout the world, and treatment options have greatly expanded over the last 2 decades. Targeting angiogenesis has been a major focus of study in a variety of malignancy types. Targeting angiogenesis has been achieved by several mechanisms in colorectal cancer, including use of antiangiogenic small molecule tyrosine kinase inhibitors (TKIs). There have been many attempts and failures to prove efficacy of TKIs in the treatment of colorectal cancer including sorafenib, sunitinib, vatalanib, and tivozanib. Regorafenib was the first TKI to demonstrate efficacy and is an orally active inhibitor of angiogenic (including the vascular endothelial growth factor receptors 1, 2, and 3), stromal, and oncogenic receptor tyrosine kinases. There are ongoing investigations of both regorafenib and ninetanib; however, there remains a critical need to better understand novel combinations with TKIs that could prove more efficacious than available options.
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Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis. Case Rep Otolaryngol 2017; 2017:9242374. [PMID: 28168075 PMCID: PMC5266817 DOI: 10.1155/2017/9242374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/15/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022] Open
Abstract
Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy.
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118
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Grünwald V, Hornig M. Systemic and Sequential Therapy in Advanced Renal Cell Carcinoma. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_64-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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119
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Voss MH, Bhatt RS, Plimack ER, Rini BI, Alter RS, Beck JT, Wilson D, Zhang X, Mutyaba M, Glasser C, Attie KM, Sherman ML, Pandya SS, Atkins MB. The DART Study: Results from the Dose-Escalation and Expansion Cohorts Evaluating the Combination of Dalantercept plus Axitinib in Advanced Renal Cell Carcinoma. Clin Cancer Res 2016; 23:3557-3565. [PMID: 28031424 DOI: 10.1158/1078-0432.ccr-16-2395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/30/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Activin receptor-like kinase 1 (ALK1) is a novel target in angiogenesis. Concurrent targeting of ALK1 and VEGF signaling results in augmented inhibition of tumor growth in renal cell carcinoma (RCC) xenograft models. Dalantercept is an ALK1-receptor fusion protein that acts as a ligand trap for bone morphogenetic proteins 9 and 10. The DART Study evaluated the safety, tolerability, pharmacokinetics, pharmacodynamics, and antitumor activity of dalantercept plus axitinib in patients with advanced RCC and determined the optimal dose for further testing.Experimental Design: Patients received dalantercept 0.6, 0.9, or 1.2 mg/kg subcutaneously every 3 weeks plus axitinib 5 mg by mouth twice daily until disease progression or intolerance.Results: Twenty-nine patients were enrolled in the dose escalation (n = 15) and expansion (n = 14) cohorts. There were no dose-limiting toxicities or grade 4/5 treatment-related adverse events. In addition to common VEGFR tyrosine kinase inhibitor effects, such as fatigue and diarrhea, commonly seen treatment-related adverse events were peripheral edema, epistaxis, pericardial effusion, and telangiectasia. The objective response rate by RECIST v1.1 was 25% with responses seen at all dose levels. The overall median progression-free survival was 8.3 months.Conclusions: The combination of dalantercept plus axitinib is well tolerated and associated with clinical activity. On the basis of safety and efficacy results, the 0.9 mg/kg dose level was chosen for further study in a randomized phase II trial of dalantercept plus axitinib versus placebo plus axitinib. Clin Cancer Res; 23(14); 3557-65. ©2016 AACR.
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Affiliation(s)
- Martin H Voss
- Memorial Sloan Kettering Cancer Center, New York, New York.
- Department of Medicine, Weill Medical College of Cornell University, New York, New York
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Robert S Alter
- John Theurer Cancer Center Hackensack UMC, Hackensack, New Jersey
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Kumbla RA, Figlin RA, Posadas EM. Recent Advances in the Medical Treatment of Recurrent or Metastatic Renal Cell Cancer. Drugs 2016; 77:17-28. [DOI: 10.1007/s40265-016-0665-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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121
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Rini BI, Tomita Y, Melichar B, Ueda T, Grünwald V, Fishman MN, Uemura H, Oya M, Bair AH, Andrews GI, Rosbrook B, Jonasch E. Overall Survival Analysis From a Randomized Phase II Study of Axitinib With or Without Dose Titration in First-Line Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2016; 14:499-503. [DOI: 10.1016/j.clgc.2016.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/27/2022]
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122
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Improvement in survival end points of patients with metastatic renal cell carcinoma through sequential targeted therapy. Cancer Treat Rev 2016; 50:109-117. [DOI: 10.1016/j.ctrv.2016.09.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
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123
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Tomita Y, Fukasawa S, Oya M, Uemura H, Shinohara N, Habuchi T, Rini BI, Chen Y, Bair AH, Ozono S, Naito S, Akaza H. Key predictive factors for efficacy of axitinib in first-line metastatic renal cell carcinoma: subgroup analysis in Japanese patients from a randomized, double-blind phase II study. Jpn J Clin Oncol 2016; 46:1031-1041. [PMID: 27572087 PMCID: PMC5091032 DOI: 10.1093/jjco/hyw103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/03/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To conduct Japanese subgroup analyses of a randomized, global Phase II study of axitinib with and without dose titration in first-line metastatic renal cell carcinoma and to explore predictive factors for axitinib efficacy in first-line metastatic renal cell carcinoma. METHODS The data included 44 Japanese and 169 non-Japanese treatment-naïve patients with metastatic renal cell carcinoma. Patients received twice-daily axitinib 5 mg during a 4-week lead-in period. Patients who met the pre-defined randomization criteria were stratified by Eastern Cooperative Oncology Group performance status and randomly assigned (1:1) to axitinib or placebo titration. The primary endpoint was objective response rate; secondary endpoints included progression-free survival and safety. Predictive factors were analyzed using data from all patients. RESULTS The objective response rate (95% confidence interval) was 66% (50-80%) vs. 44% (36-52%) in Japanese and non-Japanese patients, respectively. At the primary analysis, median progression-free survival could not be estimated for Japanese patients, and was 27.6 months (95% confidence interval: 16.6-33.2) in an updated analysis. Hypertension, diarrhea, hand-foot syndrome, dysphonia, hypothyroidism and proteinuria were common adverse events in Japanese patients. Due to a small number of randomized patients, effects of axitinib dose titration could not sufficiently be confirmed among Japanese patients. The multivariate analysis identified time from histopathological diagnosis to treatment and sum of the longest diameter for target lesion at baseline as independent predictive factors for progression-free survival. CONCLUSIONS Axitinib is effective and well tolerated as first-line metastatic renal cell carcinoma therapy in Japanese patients. Predictive factors for axitinib efficacy endpoints identified in this setting warrant further investigation.
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Affiliation(s)
- Yoshihiko Tomita
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo
| | - Hirotsugu Uemura
- Department of Urology, Kinki University School of Medicine, Osaka
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Hokkaido
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Brian I. Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | | | - Seiichiro Ozono
- Department of Urology, Hamamatsu University School of Medicine, Shizuoka
| | - Seiji Naito
- Department of Urology, Kyushu University, Graduate School of Medical Sciences, Fukuoka
| | - Hideyuki Akaza
- Strategic Investigation on Comprehensive Cancer Network, Interfaculty Initiative in Information Studies/Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
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Derosa L, Izzedine H, Albiges L, Escudier B. Hypertension and Angiotensin System Inhibitors in Patients with Metastatic Renal Cell Carcinoma. Oncol Rev 2016; 10:298. [PMID: 27994768 PMCID: PMC5136757 DOI: 10.4081/oncol.2016.298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/06/2016] [Accepted: 11/02/2016] [Indexed: 12/23/2022] Open
Abstract
Arterial hypertension (HTN) is a class effect of anti-vascular endothelial growth factor (VEGF) therapies, including the monoclonal antibody bevacizumab. Data are conflicting regarding the role of the renin-angiotensin system on angiogenesis and recent data suggest that the use of angiotensin system inhibitors (ASIs; angiotensin receptor blockers or angiotensin-converting enzyme inhibitors) is associated with improved survival in metastatic renal cell carcinoma (mRCC), particularly when used with VEGF targeted therapies. The aim of this review is to discuss the available treatment options for mRCC and associated incidence of hypertension as well as summarize the known data about ASIs use and mRCC. Additionally, given that the optimal management of HTN remains unclear, we will focus on prevention strategies and propose potential therapeutic approaches.
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Affiliation(s)
- Lisa Derosa
- Gustave Roussy Cancer Center, University of Paris-Saclay, Villejuif, France
| | - Hassane Izzedine
- Department of Nephrology and Pathology, Pitié Salpêtrière Hospital, Paris, France
| | - Laurence Albiges
- Gustave Roussy Cancer Center, University of Paris-Saclay, Villejuif, France
| | - Bernard Escudier
- Gustave Roussy Cancer Center, University of Paris-Saclay, Villejuif, France
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125
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Ornstein MC, Rini BI. Pharmacokinetically Guided Dosing of Oral Drugs: True Precision Oncology? Clin Cancer Res 2016; 22:5626-5628. [PMID: 27663599 DOI: 10.1158/1078-0432.ccr-16-1833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/27/2016] [Indexed: 11/16/2022]
Abstract
Higher plasma concentrations of tyrosine kinase inhibitors (TKI), such as pazopanib, are associated with improved clinical outcomes. However, TKI pharmacokinetics exhibit significant interpatient variability, resulting in inconsistent and unpredictable plasma drug levels. An individualized dosing approach based on patient pharmacokinetics data and toxicity can potentially optimize plasma concentrations of pazopanib. Clin Cancer Res; 22(23); 5626-8. ©2016 AACRSee related article by Verheijen et al., p. 5738.
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Affiliation(s)
- Moshe C Ornstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Brian I Rini
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
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126
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Abstract
Axitinib (Inlyta(®)) is a potent, selective inhibitor of vascular endothelial growth factor receptor-1, -2 and -3. This article reviews the clinical efficacy and tolerability of axitinib in patients with previously-treated advanced renal cell carcinoma (RCC), as well as summarizing its pharmacological properties. Axitinib was effective in the second-line treatment of advanced RCC, according to the results of the pivotal, phase III AXIS trial. Median progression-free survival (PFS) was significantly prolonged with axitinib versus sorafenib (primary endpoint; independent review committee assessment); this PFS benefit was seen in patients who had received prior treatment with cytokines or sunitinib. The objective response rate was also significantly higher with axitinib than with sorafenib, with no significant between-group difference in median overall survival. Axitinib had a manageable tolerability profile in the AXIS trial, with the most commonly reported treatment-related adverse events including diarrhoea, hypertension, fatigue, decreased appetite, nausea, dysphonia, hand-foot syndrome and hypothyroidism. In conclusion, axitinib is an important option in previously-treated patients with advanced RCC.
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127
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Verheijen RB, Bins S, Mathijssen RHJ, Lolkema MP, van Doorn L, Schellens JHM, Beijnen JH, Langenberg MHG, Huitema ADR, Steeghs N. Individualized Pazopanib Dosing: A Prospective Feasibility Study in Cancer Patients. Clin Cancer Res 2016; 22:5738-5746. [PMID: 27470967 DOI: 10.1158/1078-0432.ccr-16-1255] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Pazopanib is a tyrosine kinase inhibitor approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Retrospective analyses have shown that an increased median progression-free survival and tumor shrinkage appear in patients with higher plasma trough levels (Cmin). Therefore, patients with low Cmin might benefit from pharmacokinetically guided individualized dosing. EXPERIMENTAL DESIGN We conducted a prospective multicenter trial in 30 patients with advanced solid tumors. Pazopanib Cmin was measured weekly by LC-MS/MS. At weeks 3, 5, and 7, the pazopanib dose was increased if the measured Cmin was <20 mg/L and toxicity was <grade 3. RESULTS In total, 17 patients had at least one Cmin <20 mg/L at weeks 3, 5, and 7. Of these, 10 were successfully treated with a pharmacokinetically guided dose escalation, leading to daily dosages ranging from 1,000 to 1,800 mg. Cmin in these patients increased significantly from 13.2 (38.0%) mg/L [mean (CV%)] to 22.9 mg/L (44.9%). Thirteen patients had all Cmin levels ≥20.0 mg/L. Of these, 9 patients with a high Cmin of 51.3 mg/L (45.1%) experienced ≥grade 3 toxicity and subsequently required a dose reduction to 600 or 400 mg daily, yet in these patients, Cmin remained above the threshold at 28.2 mg/L (25.3%). CONCLUSIONS A pharmacokinetically guided individualized dosing algorithm was successfully applied and evaluated. The dosing algorithm led to patients being treated at dosages ranging from 400 to 1,800 mg daily. Further studies are needed to show a benefit of individualized dosing on clinical outcomes, such as progression-free survival. Clin Cancer Res; 22(23); 5738-46. ©2016 AACRSee related commentary by Ornstein and Rini, p. 5626.
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Affiliation(s)
- Remy B Verheijen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - Sander Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Leni van Doorn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Jan H M Schellens
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Marlies H G Langenberg
- Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Claret L, Zheng J, Mercier F, Chanu P, Chen Y, Rosbrook B, Yazdi P, Milligan PA, Bruno R. Model-based prediction of progression-free survival in patients with first-line renal cell carcinoma using week 8 tumor size change from baseline. Cancer Chemother Pharmacol 2016; 78:605-10. [DOI: 10.1007/s00280-016-3116-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022]
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129
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Ryan CW. Dosing strategies and optimization of targeted therapy in advanced renal cell carcinoma. J Oncol Pharm Pract 2016; 23:43-55. [PMID: 26625878 DOI: 10.1177/1078155215618769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Within the past decade, treatment options for metastatic renal cell carcinoma have expanded dramatically. Currently, seven targeted agents are approved for use in metastatic renal cell carcinoma and have superseded the use of parenteral cytokine therapy with interleukin-2 or interferon, the former standards of care for metastatic renal cell carcinoma. Targeted agents include inhibitors of the vascular endothelial growth factor pathway (i.e. sorafenib, sunitinib, pazopanib, axitinib, and bevacizumab) and inhibitors of the mammalian target of rapamycin pathway (i.e. temsirolimus and everolimus). These newer therapies have been shown to improve progression-free survival compared with previous approaches. Because most of these targeted agents are taken orally, responsibility for dose administration has shifted to patients, which might result in variable adherence. Additionally, with new treatments for metastatic renal cell carcinoma comes the challenge of selecting dosing schemes that maximize therapeutic benefit and minimize adverse events. Much of the information related to the effectiveness of dose modifications for targeted therapies in metastatic renal cell carcinoma has been gathered from clinical studies that have strict inclusion and exclusion criteria, which might not translate directly to real-world patient populations. This review discusses the impact of dose adherence on the effectiveness of targeted agents to treat metastatic renal cell carcinoma, assesses the literature regarding the effectiveness of approved dosing strategies, and provides a summary of alternative dosing strategies.
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Affiliation(s)
- Christopher W Ryan
- Oregon Health and Science University Knight Cancer Institute, Portland, OR, USA
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130
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Stein J, Mann J. Specialty pharmacy services for patients receiving oral medications for solid tumors. Am J Health Syst Pharm 2016; 73:775-96. [DOI: 10.2146/ajhp150863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jill Stein
- Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA
| | - Janelle Mann
- St. Louis College of Pharmacy, St. Louis, MO, and Department of Pharmacy Practice, Division of Specialty Care Pharmacy, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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131
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Grünwald V, Lin X, Kalanovic D, Simantov R. Early Tumour Shrinkage: A Tool for the Detection of Early Clinical Activity in Metastatic Renal Cell Carcinoma. Eur Urol 2016; 70:1006-1015. [PMID: 27238653 DOI: 10.1016/j.eururo.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/08/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The predictive role of objective remission remains undefined for targeted agents in metastatic renal cell carcinoma (mRCC); however, early tumour shrinkage (eTS) was shown to be predictive and/or prognostic for overall survival (OS) and progression-free survival (PFS) in mRCC in several small studies. OBJECTIVE To evaluate the degree of eTS following systemic therapy that may predict survival in mRCC. DESIGN, SETTING, AND PARTICIPANTS Data from 4334 patients with mRCC in phase 2 and 3 clinical trials between 2003 and 2013 were pooled for analyses. Early tumour shrinkage was assessed based on percentage change in sum of the longest diameters of target lesions at first postbaseline scan. Patients were categorised by a more or equal versus less optimal threshold of eTS, assessed using receiver operating characteristic (ROC) analysis. OS and PFS in patients with eTS were summarised using the Kaplan-Meier method. INTERVENTION Axitinib, bevacizumab, interferon α, sorafenib, sunitinib, or temsirolimus. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We measured optimal thresholds of eTS and eTS as a predictor of OS or PFS. RESULTS AND LIMITATIONS Optimal threshold of eTS for the prediction of OS and PFS was determined to be approximately 10%. In Cox proportional hazards models, compared with patients without eTS, those with eTS had significantly longer OS (hazard ratio [HR]: 0.615; p<0.0001; median: 28.5 vs 16.0 mo) and PFS (HR: 0.628; p<0.0001; median: 10.5 vs 5.3 mo). The major limitation was the retrospective nature of our analysis, including different lines and types of therapy, although subset analyses detected a similar predictive pattern for eTS across all lines and types of therapy. CONCLUSIONS Early tumour shrinkage ≥10% at first postbaseline assessment could serve as a putative early end point in patients with mRCC. A prospective evaluation of eTS in clinical trials is warranted. PATIENT SUMMARY Early tumour shrinkage may be used to identify patients with metastatic renal cell carcinoma who would benefit from treatment with antitumour agents. TRIAL REGISTRATION The clinical trials are registered on ClinicalTrials.gov (NCT00267748, NCT00338884, NCT00835978, NCT00065468, NCT00083889, NCT00631371, NCT00920816, NCT00077974, NCT00137423, NCT00054886, NCT00678392, and NCT00474786).
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Affiliation(s)
| | - Xun Lin
- Pfizer Oncology, La Jolla, CA, USA
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132
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Grünwald V. Checkpoint Blockade - a New Treatment Paradigm in Renal Cell Carcinoma. Oncol Res Treat 2016; 39:353-8. [PMID: 27259695 DOI: 10.1159/000446718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022]
Abstract
Nivolumab is the first checkpoint inhibitor for the treatment of renal cell carcinoma (RCC), which is in line for approval in Europe. Despite its novelty in the treatment algorithm of RCC, it offers a whole new strategy of therapy management with safe applicability. The aim of this work was to review current data on checkpoint inhibitors in RCC and discuss future perspectives for this novel approach in RCC. A selective literature search was performed in the Pubmed database: Nivolumab is a first-in-class agent for the treatment of RCC, and its European label is anticipated for 2016. Contrary to many other agents, nivolumab was able to show a benefit in overall survival and health-related quality of life when compared to everolimus. Current trials focus on optimizing and expanding its use to metastatic RCC. In conclusion, nivolumab has already acquired a role in the treatment algorithm of RCC. However, which patient population derives the most benefit as well its optimal use in the treatment algorithm remain to be determined. A number of ongoing trials will provide novel insights and might help to untangle this novel network of therapy management for immunotherapies.
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Affiliation(s)
- Viktor Grünwald
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hanover Medical School, Hanover, Germany
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133
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Czarnecka AM, Kawecki M, Lian F, Korniluk J, Szczylik C. Feasibility, efficacy and safety of tyrosine kinase inhibitor treatment in hemodialyzed patients with renal cell cancer: 10 years of experience. Future Oncol 2016; 11:2267-82. [PMID: 26260806 DOI: 10.2217/fon.15.112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Sine efficiency of tyrosine kinase inhibitor (TKI) therapy in dialyzed patients is still unclear we aim to analyze the outcome of treatment in such cohort. PATIENTS & METHODS We analyzed treatment outcomes of patients with clear cell renal cell carcinoma (ccRCC) with special focus on those who were also treated with hemodialysis and described treatment safety and progression-free survival of eight patients treated with TKIs and hemodialysis. DISCUSSION & CONCLUSION Our report supports statement that TKI treatment of dialyzed patients is safe and effective. ccRCC increases risk of developing renal insufficiency as well as end-stage renal disease that require dialysis. Introduction of multitargeted receptor kinase inhibitors (TKIs), including sunitinib, sorafenib and pazopanib significantly expanded life time expectancy of metastatic renal clear cell carcinoma. The advance also applies to patients with ccRCC and end-stage renal disease who undergo dialyses.
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Affiliation(s)
- Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Kawecki
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Fei Lian
- Emory University School of Medicine Atlanta, GA, USA
| | - Jan Korniluk
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
| | - Cezary Szczylik
- Department of Oncology, Military Institute of Medicine, Warsaw, Poland
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Quiroga Matamoros W, Fernandez F, Citarella Otero D, Rangel J, Estrada Guerrero A, Patiño ID. Guía de manejo del carcinoma de células renales. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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135
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Narayan V, Haas NB. Axitinib in the treatment of renal cell carcinoma: patient selection and perspectives. Int J Nephrol Renovasc Dis 2016; 9:65-72. [PMID: 27099525 PMCID: PMC4822864 DOI: 10.2147/ijnrd.s83874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Axitinib is a next-generation, selective tyrosine kinase inhibitor targeting the vascular endothelial growth factor receptors. It is approved for the treatment of metastatic renal cell carcinoma (mRCC) based on a demonstrated progression-free survival advantage over sorafenib in the second-line treatment setting. However, given the variety of available targeted therapies for mRCC, appropriate patient selection for the available therapies remains a significant clinical challenge. PURPOSE This review summarizes the available evidence on the clinical, toxicity, and pharmacologic considerations for determining appropriate patient selection for axitinib therapy. In addition, it describes recent data on the use of predictive biomarkers to guide clinical management. This paper consists of material obtained via PubMed and Medline literature searches through October 2015. CONCLUSION Axitinib has a well-established role in the management of mRCC. Consistent clinical efficacy has been demonstrated across prognostic risk groups and prior therapeutic exposures. Although axitinib is generally well tolerated, appropriate toxicity management is critical to maximizing drug delivery and optimizing treatment outcomes. Although incident hypertension has been associated with improved clinical outcomes on axitinib, there are currently no validated clinical or genetic predictive biomarkers to guide patient selection.
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Affiliation(s)
- Vivek Narayan
- Division of Hematology/Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Balzer Haas
- Division of Hematology/Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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136
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Mangoni AA, Woodman RJ, Kichenadasse G, Rowland A, Sorich MJ. Anti-VEGF-induced hypertension and cancer outcomes: translating research into clinical practice. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1155963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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137
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Parekh H, Griswold J, Rini B. Axitinib for the treatment of metastatic renal cell carcinoma. Future Oncol 2016; 12:303-11. [DOI: 10.2217/fon.15.322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Renal cell carcinoma is a cancer that results from a genetic inactivation of the VHL tumor suppressor gene leading to an upregulation of VEGF. Targeted therapies against VEGF receptors have piqued substantial interest among clinicians and researchers, and these drugs are now the standard of care in the treatment of advanced renal cell carcinoma. One of these VEGF receptor inhibitors, axitinib, has been shown to be a superior second-line therapy when compared with sorafenib. Although axitinib has clinical activity and a manageable safety profile in patients with treatment-naive metastatic renal cell carcinoma, utility in the front-line setting is area of ongoing investigation. Another area of ongoing research is dose titration of axitinib to achieve the maximum clinical benefit. Interestingly, the axitinib-related side effect of hypertension has shown to be associated with more favorable clinical outcomes. This article describes the development of axitinib and discusses the current indications for clinical use in the management of metastatic renal cell carcinoma.
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Affiliation(s)
- Hiral Parekh
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Mail Code R35, Cleveland, OH 44195, USA
| | - Julianne Griswold
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Mail Code R35, Cleveland, OH 44195, USA
| | - Brian Rini
- Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, Mail Code R35, Cleveland, OH 44195, USA
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138
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Fischer S, Gillessen S, Rothermundt C. Sequence of treatment in locally advanced and metastatic renal cell carcinoma. Transl Androl Urol 2016; 4:310-25. [PMID: 26816832 PMCID: PMC4708238 DOI: 10.3978/j.issn.2223-4683.2015.04.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The spectrum of drugs that have shown activity in advanced or metastatic renal cell carcinoma (RCC) has led to a debate on the optimal sequence of treatments. There is agreement on recommending targeted agents as the standard of care in this disease. Uncertainty, however, remains on the best first-line drug choice. Physicians and patients may select sunitinib, bevacizumab in combination with interferon-alpha (IFN-α), pazopanib, or-in poor risk patients-temsirolimus. There are also a variety of therapies with proven efficacy on hand in the second-line setting: sorafenib, pazopanib, axitinib, and everolimus. While most randomized RCC trials assessed progression free survival (PFS) as primary endpoint, some agents were shown to improve median overall survival (OS), and given in sequence they have extended the life expectancy of RCC patients from 13 months in the cytokine era to over 30 months. Despite the progress made, there are sobering aspects to the oncologic success story in RCC, as the new treatments do not obtain an objective response or disease stabilization (SD) in all patients. There are also as yet no predictors to select patients who might benefit and those who are primary resistant to specific drugs, and ultimately almost all patients will experience disease progression. Bearing inevitable treatment failure in mind, availability of further drugs and switching therapy while the patient is in a condition to continue pharmacotherapy is essential. Of note, depending on the setting, only 33-59% of patients receive second-line treatment. In this review we present data on first-, second-, and third-line treatment in RCC, and discuss the difficulties in their interpretation in the context of treatment sequence. We summarize biological aspects and discuss mechanisms of resistance to anti-angiogenic therapy and their implications for treatment selection.
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Affiliation(s)
- Stefanie Fischer
- Division of Oncology/Haematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Silke Gillessen
- Division of Oncology/Haematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Christian Rothermundt
- Division of Oncology/Haematology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
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Lu D, Lu T, Stroh M, Graham RA, Agarwal P, Musib L, Li CC, Lum BL, Joshi A. A survey of new oncology drug approvals in the USA from 2010 to 2015: a focus on optimal dose and related postmarketing activities. Cancer Chemother Pharmacol 2016; 77:459-76. [PMID: 26811176 PMCID: PMC4767861 DOI: 10.1007/s00280-015-2931-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 11/24/2015] [Indexed: 11/24/2022]
Abstract
The maximally tolerated dose (MTD) of cytotoxic agents has historical precedence in treating cancer, as it was believed that dose and therapeutic effect are intrinsically linked and that the MTD would provide greatest therapeutic value. With molecularly targeted agents, the premise of preventing toxicity to normal tissues while modulating tumor growth provides a potential for an increased therapeutic window. Results from these targeted agents suggest we are entering an era of chronic cancer management, which will require design of regimens with long-term tolerability. A corresponding switch from MTD-based (toxicity-driven) dosing strategies to alternative paradigms is also expected. The challenge with these targeted agents is to fully understand the complex relationship between pharmacokinetics, pharmacodynamics, and safety and efficacy in early-stage trials, so that the optimal dose and schedule for registration trials may be identified. This review provides a systematic survey of the applications submitted to the United States Food and Drug Administration (FDA) for oncology indications, from 2010 through early 2015, and summarizes the dose selection rationale for registrational trials, the relationship of the MTD to outcomes of the final label dose, the postmarketing requirements or commitments related to dose optimization activities, the role of biomarkers, and typical exposure-response modeling methods.
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Affiliation(s)
- Dan Lu
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Tong Lu
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Mark Stroh
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Richard A Graham
- Department of Clinical Pharmacology, Theravance Biopharma U.S., Inc., South San Francisco, CA, USA
| | - Priya Agarwal
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Luna Musib
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Chi-Chung Li
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
| | - Bert L Lum
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA.
| | - Amita Joshi
- Department of Clinical Pharmacology, Genentech, Inc., 1 DNA Way, MS 463A, South San Francisco, CA, 94080, USA
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140
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Nozawa M, Sugimoto K, Ohzeki T, Minami T, Shimizu N, Adomi S, Saito Y, Nose K, Yoshimura K, Uemura H. Axitinib-induced proteinuria and efficacy in patients with metastatic renal cell carcinoma. Int J Clin Oncol 2015; 21:748-755. [PMID: 26694813 DOI: 10.1007/s10147-015-0933-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/24/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND No report has evaluated axitinib-induced proteinuria as a biomarker for predicting treatment efficacy and survival of patients with metastatic renal cell carcinoma (mRCC). METHODS The subjects were patients with mRCC treated with axitinib at Kinki University Hospital from February 2008 to November 2014. Clinical records were retrospectively reviewed including baseline patient characteristics, time-dependent changes of urinary protein status, computed tomography scans of metastatic lesions, treatment duration with axitinib, and survival time. RESULTS A total of 45 patients were evaluable. Median tumor shrinkage rates were 32.3 and 35.0 % in patients with urinary protein increases ≥+2 and <+2, respectively (p = 0.496). Objective response rates were also similar between the two groups. Median progression-free survival (PFS) times with axitinib were 13.5 months [95 % confidence interval (CI) 0.0-27.5] and 11.0 months (95 % CI 0.0-26.7) in patients with urinary protein increases ≥+2 and <+2, respectively (p = 0.975). The maximum tumor shrinkage rate with axitinib was significantly associated with PFS with axitinib as a result of multivariate analysis (p = 0.002). Median overall survival (OS) times were 39.8 months (95 % CI 12.7-67.0) and 25.4 months (95 % CI 11.2-39.6) in patients with axitinib-induced urinary protein increases ≥+2 and <+2, respectively (p = 0.250). The number of metastatic sites (p = 0.006), the MSKCC risk (p = 0.009), and the maximum tumor shrinkage rate with axitinib (p = 0.019) were significantly associated with OS as a result of multivariate analysis. CONCLUSIONS The degree of urinary protein increase during axitinib treatment was not associated with objective response, PFS, and OS in mRCC patients treated with axitinib.
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Affiliation(s)
- Masahiro Nozawa
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Koichi Sugimoto
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takayuki Ohzeki
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takafumi Minami
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Nobutaka Shimizu
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shogo Adomi
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoshitaka Saito
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kazuhiro Nose
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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141
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Goldstein D, Rosenberg JE, Figlin RA, Townsend RR, McCann L, Carpenter C, Pandite L. Is change in blood pressure a biomarker of pazopanib and sunitinib efficacy in advanced/metastatic renal cell carcinoma? Eur J Cancer 2015; 53:96-104. [PMID: 26702763 DOI: 10.1016/j.ejca.2015.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/24/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
AIM Pazopanib, an oral antiangiogenic agent, is associated with improved outcomes in patients with metastatic renal cell carcinoma. In this retrospective analysis, we explore hypertension, an on-target adverse event, as a predictive marker. METHODS Data from the pazopanib arm of the phase III COMPARZ trial (NCT00720941) comprised the test set. Pooled data from phase II (NCT00244764) and III (NCT00334282) pazopanib trials comprised the validation set. Data from the sunitinib arm of COMPARZ were analysed separately. Measures of efficacy were response rate, progression-free survival (PFS), and overall survival (OS). Mean arterial blood pressure (MAP) was the primary metric, and systolic hypertension (S-HTN) and diastolic hypertension (D-HTN) were secondary metrics; 4- and 12-week landmark analyses were performed. RESULTS Analyses revealed no significant associations at the landmarks between response and MAP. We observed a trend towards improved PFS with S-HTN at week 4 (hazard ratio [HR] = 0.79, P = 0.060) and week 12 (HR = 0.75, P = 0.073) among pazopanib-treated patients in COMPARZ. This trend was not confirmed at week 12 in the validation set or in sunitinib-treated patients. In the test set, there was a trend towards increased OS in patients with S-HTN by week 4 (HR = 0.76, P = 0.062) and with D-HTN by week 4 (HR = 0.71, P = 0.016) but not by week 12. No significant differences in OS were observed in sunitinib-treated patients for S-HTN or D-HTN. CONCLUSION Neither hypertension nor any blood pressure elevation above baseline was associated with efficacy outcomes of pazopanib or sunitinib. Accordingly, management of tyrosine kinase inhibitor-induced hypertension is unlikely to compromise outcome.
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Affiliation(s)
- David Goldstein
- University of New South Wales and Prince of Wales Hospital, High St., Randwick, Sydney 2031, Australia.
| | - Jonathan E Rosenberg
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
| | - Robert A Figlin
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA.
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Lini Pandite
- GlaxoSmithKline, Five Moore Drive, PO Box 13398, Research Triangle Park, NC, USA.
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Študentová H, Indráková J, Petrová P, Kamínek M, Kalábová H, Šrámek V, Adam T, Melichar B. Risk factors of atherosclerosis during systemic therapy targeting vascular endothelial growth factor. Oncol Lett 2015; 11:939-944. [PMID: 26893672 PMCID: PMC4733961 DOI: 10.3892/ol.2015.4017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 09/09/2015] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to examine the changes in intima-media thickness (IMT) and myocardial perfusion in association with other laboratory risk factors for atherosclerosis in patients treated with therapy that targeted vascular endothelial growth factor (VEGF). IMT, myocardial perfusion and laboratory risk factors of atherosclerosis were studied in 58 patients with metastatic colorectal carcinoma or metastatic renal cell carcinoma prior to and at 3-monthly intervals during anti-VEGF treatment. Compared with the pretreatment IMT, the results indicated that the IMT was consistently increased during therapy in the two patient groups. Patient blood pressure and concentration of troponin T increased transiently. An increase in the concentration of high-density lipoprotein cholesterol and decrease in the concentrations of C-reactive protein and homocysteine were also observed. Novel myocardial ischemia was evident in individual patients. In conclusion, anti-VEGF therapy affects the laboratory risk factors of atherosclerosis and results in an acceleration of atherosclerosis, as demonstrated by increased IMT.
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Affiliation(s)
- Hana Študentová
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Jarmila Indráková
- Department of Medicine, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Pavla Petrová
- Department of Clinical Biochemistry, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Milan Kamínek
- Department of Nuclear Medicine, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Hana Kalábová
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Vlastislav Šrámek
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Tomáš Adam
- Department of Clinical Biochemistry, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic; Institute of Molecular and Translational Medicine, Palacký University Medical School and Teaching Hospital, Olomouc 775 20, Czech Republic
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143
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Chen Y, Rini BI, Bair AH, Mugundu GM, Pithavala YK. Population pharmacokinetic-pharmacodynamic modelling of 24-h diastolic ambulatory blood pressure changes mediated by axitinib in patients with metastatic renal cell carcinoma. Clin Pharmacokinet 2015; 54:397-407. [PMID: 25343945 DOI: 10.1007/s40262-014-0207-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Increased blood pressure (BP) is commonly observed in patients treated with vascular endothelial growth factor pathway inhibitors, including axitinib. Ambulatory BP monitoring (ABPM) and pharmacokinetic data were collected in a randomised, double-blind phase II study of axitinib with or without dose titration in previously untreated patients with metastatic renal cell carcinoma. OBJECTIVE Aims of these analyses were to (1) develop a population pharmacokinetic-pharmacodynamic model for describing the relationship between axitinib exposure and changes in diastolic BP (dBP) and (2) simulate changes in dBP with different axitinib dosing regimens. METHODS We employed a three-stage modelling approach, which included development of (1) a baseline 24-h ABPM model, (2) a pharmacokinetic model from serial and sparse pharmacokinetic data, and (3) an indirect-response, maximum-effect (Emax) model to evaluate the exposure-driven effect of axitinib on dBP. Simulations (N = 1,000) were performed using the final pharmacokinetic-pharmacodynamic model to evaluate dBP changes on days 4 and 15 of treatment with different axitinib doses. RESULTS Baseline ABPM data from 62 patients were best described by 24-h mean dBP and two cosine terms. The final indirect-response Emax model showed good agreement between observed 24-h ABPM data and population and individual predictions. The maximum increase in dBP was 20.8 %, and the axitinib concentration at which 50 % of the maximal increase in dBP was reached was 12.4 ng/mL. CONCLUSION Our model adequately describes the relationship between axitinib exposure and dBP increases. Results from these analyses may potentially be applied to infer dBP changes in patients administered axitinib at nonstandard doses.
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Affiliation(s)
- Ying Chen
- Pfizer Oncology, Clinical Pharmacology, Pfizer Inc, 10555 Science Center Drive, San Diego, CA, 92121, USA,
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144
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Nishida H, Fukuhara H, Yamagishi A, Sakurai T, Shibasaki T, Kawazoe H, Kato T, Tomita Y. Sequential molecularly targeted drug therapy including axitinib for a patient with end-stage renal failure and metastatic renal cell carcinoma. Hemodial Int 2015; 20:E1-4. [PMID: 26306562 DOI: 10.1111/hdi.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 62-year-old male patient with end-stage renal disease and metastatic renal cell carcinoma (RCC) was referred to our hospital. Sequential targeted therapy consisting of sorafenib, sunitinib, and everolimus was administered, but the patient's disease gradually progressed. Axitinib was subsequently administered at a decreased dose of 6 mg/day for 2 weeks, after which the dose was escalated to 10 mg/day. Axitinib therapy was maintained for a total of 6 months without severe adverse effects. Sequential molecularly targeted drug therapy including axitinib, with careful monitoring, is one possible treatment option for patients with metastatic RCC with renal impairment.
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Affiliation(s)
- Hayato Nishida
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Hiroki Fukuhara
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Atsushi Yamagishi
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Toshihiko Sakurai
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Tomohiro Shibasaki
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Hisashi Kawazoe
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Iida-nishi Yamagata, Japan
| | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Wang HK, Zhang HL, Zhu Y, Yao XD, Zhang SL, Dai B, Shen YJ, Zhu YP, Shi GH, Qin XJ, Ma CG, Lin GW, Xiao WJ, Ye DW. A Phase II trial of dosage escalation of sorafenib in Asian patients with metastatic renal cell carcinoma. Future Oncol 2015; 10:1941-51. [PMID: 25386811 DOI: 10.2217/fon.14.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To investigate the role of sorafenib dosage escalation in Asian patients with metastatic renal cell carcinoma that had progressed after routine dosages. PATIENTS & METHODS Sorafenib dosage escalation to 600 or 800 mg twice a day was offered to 41 patients with metastatic renal cell carcinoma who had progressed on normal dosages. Clinical outcome, toxicity and favorable clinical covariables for progression-free survival (PFS) were evaluated. RESULTS The median PFS with dosage-escalated therapy was 7 months. Drug-related adverse events were tolerable. The pre-escalation Karnofsky performance status, serum calcium concentration, neutrophil/lymphocyte ratio, PFS and the highest toxicity grade at the routine dosage were associated with a longer PFS in the dosage-escalation period. CONCLUSION Sorafenib dosage escalation was efficacious and tolerable in Asian patients. TRIAL REGISTRATION Chinese Clinical Trial Registry (no. ChiCTR-ONRC-12002088).
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Affiliation(s)
- Hong-kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
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Rini BI, Escudier B, Hariharan S, Roberts WG, Tarazi J, Rosbrook B, Askerova Z, DeAnnuntis LL, Motzer RJ. Long-Term Safety With Axitinib in Previously Treated Patients With Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2015; 13:540-7.e1-7. [PMID: 26320662 DOI: 10.1016/j.clgc.2015.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/01/2015] [Accepted: 07/11/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Axitinib is an approved treatment for advanced renal cell carcinoma (RCC) after failure of 1 systemic therapy. PATIENTS AND METHODS Long-term safety with single-agent axitinib was analyzed using pooled data from clinical trials in 672 previously treated patients with metastatic RCC (mRCC) and in 1304 patients with different advanced solid tumors. In all studies, except the phase I first-in-human, dose-finding study, the starting dose of oral axitinib was 5 mg twice daily continuously. Common long-term treatment-emergent adverse events (AEs) were identified in patients who received axitinib for ≥ 2 years, then evaluated in all patients, and assessed using interval, cumulative, and latency analyses. RESULTS In all, 108 (16%) previously treated patients with mRCC received axitinib for ≥ 2 years. In interval analysis, most AEs occurred during the first 6 months of treatment, with rates stable or decreased over time; rates increased for proteinuria, peripheral edema, and increased blood creatinine. Common Grade ≥ 3 AE rates declined or plateaued over time, except for increased amylase and myocardial infarction. Results were similar in cumulative analysis in this population, and in interval and cumulative analyses in all patients with mRCC and those with advanced solid tumors. CONCLUSION Declining or stable rates of most AEs support an acceptable long-term safety profile for axitinib in patients with mRCC. However, increases in the rates of some AEs warrant monitoring. This analysis is limited in that it was retrospective and included a relatively small patient population.
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Affiliation(s)
- Brian I Rini
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH.
| | | | | | | | | | | | | | | | - Robert J Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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147
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Tan Q, Wang W, Long Y, Chen G. Therapeutic effects and associated adverse events of multikinase inhibitors in metastatic renal cell carcinoma: A meta-analysis. Exp Ther Med 2015; 9:2275-2280. [PMID: 26136973 DOI: 10.3892/etm.2015.2427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 03/11/2015] [Indexed: 12/14/2022] Open
Abstract
This study aimed to compare the therapeutic effects and adverse events of the multikinase inhibitors sorafenib, sunitinib, pazopanib and axitinib in advanced renal cell carcinoma (RCC). A meta-analysis of randomized controlled trials was performed to assess the effects of multikinase inhibitors among patients with advanced RCC. The data of median progression-free survival (PFS), median overall survival (OS), progressive disease rate (PDR), objective response rate (ORR) and grade 3/4 adverse events were extracted to assess therapeutic effects and toxicity, respectively. It was found that multikinase inhibitors are more effective in extending PFS [hazard ratio (HR)=0.58; 95% confidence interval (CI): 0.45-0.74; P<0.0001), controlling tumor progression [relative risk (RR)=0.67; 95% CI: 0.55-0.83; P=0.0002) and ORR (RR=2.93; 95% CI: 1.40-6.14; P=0.004) compared with placebo or interferon-α. Patients treated with multikinase inhibitors had significantly higher rates of grade 3 or 4 hypertension (RR=6.00; 95% CI: 3.36-10.69; P<0.00001), diarrhea (RR=5.84; 95% CI: 3.06-11.16; P<0.00001), nausea (RR=2.30; 95% CI: 1.16-4.54; P=0.02), vomiting (RR=1.84; 95% CI: 1.00-3.41; P=0.05) and hand-foot skin reaction (RR=11.78; 95% CI: 5.16-26.93; P<0.00001). Multikinase inhibitors can significantly control disease progress and improve the ORR. However, they are also associated with a higher risk of grade 3 and 4 hypertension and gastrointestinal events. Proper management of these events is necessary to improve patient quality of life.
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Affiliation(s)
- Qinxiang Tan
- Nephrology Department, Longgang Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong 518000, P.R. China
| | - Weihua Wang
- Nephrology Department, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, Guangdong 510000, P.R. China
| | - Youhong Long
- Nephrology Department, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, Guangdong 510000, P.R. China
| | - Guozi Chen
- Nephrology Department, Longgang Hospital of Traditional Chinese Medicine, Shenzhen, Guangdong 518000, P.R. China
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148
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Mir O, Dumont S, Armand JP. Pharmacokinetic and pharmacodynamic end points with anti-VEGFR: the more it hurts, the more it works? Ann Oncol 2015; 26:1277-8. [PMID: 26078469 DOI: 10.1093/annonc/mdv246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Dumont
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - J-P Armand
- Department of Drug Development, Gustave Roussy Cancer Campus, Villejuif, France
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149
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Zakharia Y, Zakharia K, Rixe O. Axitinib: from preclinical development to future clinical perspectives in renal cell carcinoma. Expert Opin Drug Discov 2015; 10:925-35. [DOI: 10.1517/17460441.2015.1045411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yousef Zakharia
- 1University of Iowa Division of Hematology/Oncology and Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Kais Zakharia
- 2Mayo Clinic College of Medicine - Division of Gastroenterology and Hepatology, Rochester, Minnesota, USA
| | - Olivier Rixe
- 3University of New Mexico Cancer Center, Division of Hematology/Oncology, Albuquerque, New Mexico, USA
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150
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McKay RR, Rodriguez GE, Lin X, Kaymakcalan MD, Hamnvik OPR, Sabbisetti VS, Bhatt RS, Simantov R, Choueiri TK. Angiotensin system inhibitors and survival outcomes in patients with metastatic renal cell carcinoma. Clin Cancer Res 2015; 21:2471-9. [PMID: 25724518 PMCID: PMC4566854 DOI: 10.1158/1078-0432.ccr-14-2332] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/07/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The renin-angiotensin system may play a role in carcinogenesis. The purpose of this study was to evaluate the impact of angiotensin system inhibitors (ASI) on outcomes in metastatic renal cell carcinoma (mRCC) patients treated in the targeted therapy era. EXPERIMENTAL DESIGN We conducted a pooled analysis of mRCC patients treated on phase II and III clinical trials. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method. RESULTS A total of 4,736 patients were included, of whom 1,487 received ASIs and 783 received other antihypertensive agents. Overall, ASI users demonstrated improved overall survival (OS) compared with users of other antihypertensive agents (adjusted HR, 0.838, P = 0.0105, 26.68 vs. 18.07 months) and individuals receiving no antihypertensive therapy (adjusted HR, 0.810, P = 0.0026, 26.68 vs. 16.72 months). When stratified by therapy type, a benefit in OS was demonstrated in ASI users compared with nonusers in individuals receiving VEGF therapy (adjusted HR, 0.737, P < 0.0001, 31.12 vs. 21.94 months) but not temsirolimus or IFNα. An in vitro cell viability assay demonstrated that sunitinib in combination with an ASI significantly decreased RCC cell viability compared with control at physiologically relevant doses. This effect was not observed with either agent alone or with other non-ASI antihypertensives or temsirolimus. CONCLUSIONS In the largest analysis to date, we demonstrate that ASI use improved survival in mRCC patients treated in the targeted therapy era. Further studies are warranted to investigate the mechanism underlying this interaction and verify our observations to inform clinical practice.
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Affiliation(s)
- Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Xun Lin
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Marina D Kaymakcalan
- Department of Pharmacy and Clinical Support, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ole-Petter R Hamnvik
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Woman's Hospital, Boston, Massachusetts
| | | | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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