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Jo JK, Seo SI, Kang M, Chung J, Kwak C, Hong SH, Song C, Park JY, Jeong CW, Choi SH, Kim SH, Chang Hwang E, Lee CH, Lee H. Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study. Asian J Urol 2024; 11:450-459. [PMID: 39139527 PMCID: PMC11318389 DOI: 10.1016/j.ajur.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/08/2022] [Indexed: 03/18/2023] Open
Abstract
Objective The purpose of the study was to identify the best sequence of therapy beginning with a tyrosine kinase inhibitor (TKI) as the first-line therapy for patients with metastatic renal cell carcinoma (mRCC) in terms of overall survival (OS), progression-free survival (PFS), and rates of discontinuation and adverse effects during the treatment period. Methods This is a retrospective, nationwide multicenter study of patients with mRCC after diagnosis at 10 different tertiary medical centers in Korea from January 1992 to December 2017. We focused on patients at either "favorable" or "intermediate" risk according to the International mRCC Database Consortium criteria, and they were followed up (median 335 days). Finally, a total of 1409 patients were selected as the study population. We generated a Cox proportional hazard model adjusted for covariates, and the different therapy schemes were statistically tested in terms of OS as well as PFS. In addition, frequencies of discontinuation and adverse events were compared among the therapy schemes. Results Of the primary patterns of treatment sequences (24 sequences), "sunitinib-pazopanib" and "sunitinib-everolimus-immunotherapy" showed the most beneficial results in both OS and PFS with significantly lower hazards than "sunitinib", which is the most commonly treated agent in Korea. Considering that the "TKI-TKI" structure showed relatively higher discontinuation rates with higher adverse effects, the overall beneficial sequence would be "sunitinib-everolimus-immunotherapy". Conclusion Among several sequential therapy starting with TKIs, "sunitinib-everolimus- immunotherapy" was found to be the best scheme for mRCC patients with "favorable" or "intermediate" risks.
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Affiliation(s)
- Jung Ki Jo
- Department of Urology, Medical and Digital Engineering, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - MinYong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Kangnam St Mary's Hospital, Seoul, Republic of Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok Hwan Choi
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sung Han Kim
- Department of Urology, National Cancer Center, Goyang, Republic of Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Hakmin Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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2
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Iaxx R, Lefort F, Domblides C, Ravaud A, Bernhard JC, Gross-Goupil M. An Evaluation of Cabozantinib for the Treatment of Renal Cell Carcinoma: Focus on Patient Selection and Perspectives. Ther Clin Risk Manag 2022; 18:619-632. [PMID: 35677148 PMCID: PMC9169675 DOI: 10.2147/tcrm.s251673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/22/2022] [Indexed: 12/09/2022] Open
Abstract
Cabozantinib is an oral tyrosine kinase inhibitor (TKI) with activity against several receptors involved in the angiogenesis pathway, including vascular endothelial growth factor receptor (VEGFR), c-MET and AXL. The antiangiogenic properties of cabozantinib led to its use as a monotherapy for the treatment of metastatic renal cell cancer (RCC), and quickly resulted in this treatment becoming part of the standard of care for these tumors. Since the advent of immune checkpoint inhibitors (ICIs), new standards of care have emerged in first-line settings, involving dual ICI or ICI–VEGF-TKI (including ICI–cabozantinib) combination treatments, and leading to a more complex algorithm of care. Cabozantinib remains an option in second-line settings and is still a first-line standard of care treatment in cases where the use of ICIs is contraindicated. This review focuses on the selection of patients who may benefit most from cabozantinib therapy, including those with bone and brain metastases and those with a non-clear cell RCC histology. The need to consider disease-related symptoms, comorbidities, age, drug interactions and biomarker analyses in the choice of therapeutic strategy is also highlighted. Finally, the perspectives for the use of cabozantinib in RCC treatment are discussed.
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Affiliation(s)
- Romain Iaxx
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
| | - Felix Lefort
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- Bordeaux University, Bordeaux, France
| | - Charlotte Domblides
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- Bordeaux University, Bordeaux, France
- ImmunoConcEpt, CNRS UMR 5164, Bordeaux University, Bordeaux, 33076, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- Bordeaux University, Bordeaux, France
| | - Jean-Christophe Bernhard
- Bordeaux University, Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France
- Correspondence: Marine Gross-Goupil, Hôpital Saint-André, 1 rue Jean Burguet, Bordeaux Cedex, 33076, France, Tel +33556795808, Fax +33556795896, Email
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3
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Therapeutic sequencing in the era of first-line immune checkpoint inhibitor combinations, a novel challenge in patients with metastatic clear-cell renal cell carcinoma. Bull Cancer 2022; 109:2S31-2S38. [DOI: 10.1016/s0007-4551(22)00236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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4
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Cheung P, Patel S, North SA, Sahgal A, Chu W, Soliman H, Ahmad B, Winquist E, Niazi T, Patenaude F, Lim G, Heng DYC, Dubey A, Czaykowski P, Wong RKS, Swaminath A, Morgan SC, Mangat R, Keshavarzi S, Bjarnason GA. Stereotactic Radiotherapy for Oligoprogression in Metastatic Renal Cell Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Phase 2 Prospective Multicenter Study. Eur Urol 2021; 80:693-700. [PMID: 34399998 DOI: 10.1016/j.eururo.2021.07.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the paucity of prospective evidence, stereotactic radiotherapy (SRT) is increasingly being considered in the setting of oligoprogression to delay the need to change systemic therapy. OBJECTIVE To determine the local control (LC), progression-free survival (PFS), cumulative incidence of changing systemic therapy, and overall survival (OS) after SRT to oligoprogressive metastatic renal cell carcinoma (mRCC) lesions in patients who are on tyrosine kinase inhibitor (TKI) therapy. DESIGN, SETTING, AND PARTICIPANTS A prospective multicenter study was performed to evaluate the use of SRT in oligoprogressive mRCC patients. Patients with mRCC who had previous stability or response after ≥3 mo of TKI therapy were eligible if they developed progression of five of fewer metastases. Thirty-seven patients with 57 oligoprogressive tumors were enrolled. INTERVENTION Oligoprogressive tumors were treated with SRT, and the same TKI therapy was continued afterward. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk analyses and the Kaplan-Meir methodology were used to report the outcomes of interest. RESULTS AND LIMITATIONS The median duration of TKI therapy prior to study entry was 18.6 mo; 1-yr LC of the irradiated tumors was 93% (95% confidence interval [CI] 71-98%). The median PFS after SRT was 9.3 mo (95% CI 7.5-15.7 mo). The cumulative incidence of changing systemic therapy was 47% (95% CI 32-68%) at 1 yr, with a median time to change in systemic therapy of 12.6 mo (95% CI 9.6-17.4 mo). One-year OS was 92% (95% CI 82-100%). There were no grade 3-5 SRT-related toxicities. CONCLUSIONS LC of irradiated oligoprogressive mRCC tumors was high, and the need to change systemic therapy was delayed for a median of >1 yr. PATIENT SUMMARY The use of stereotactic radiotherapy in metastatic kidney cancer patients, who develop growth of a few tumors while on oral targeted therapy, can significantly delay the need to change to the next line of drug therapy.
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Affiliation(s)
- Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Samir Patel
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Scott A North
- Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William Chu
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Belal Ahmad
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Eric Winquist
- Division of Medical Oncology, Department of Oncology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Francois Patenaude
- Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Gerald Lim
- Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Daniel Yick Chin Heng
- Division of Medical Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Arbind Dubey
- Department of Radiation Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Rebecca K S Wong
- Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Anand Swaminath
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Scott C Morgan
- Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | | | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Georg A Bjarnason
- Division of Medical Oncology, Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
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5
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Comparable efficacy and safety between second-line and later-line nivolumab therapy for metastatic renal cell carcinoma. Int J Clin Oncol 2019; 25:705-712. [PMID: 31858306 DOI: 10.1007/s10147-019-01605-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this study was to compare the efficacy and safety of nivolumab as second-line and later-line (third-line or thereafter) therapy in metastatic renal cell carcinoma (mRCC). METHODS Sixty-seven patients who received nivolumab after the failure of at least one molecular-targeted therapy were evaluated. The patients were divided into two groups based on the line of nivolumab: second-line and later-line groups. Efficacy was assessed using progression-free survival and overall survival (OS) after nivolumab initiation, and objective response rate. Safety was assessed using the incidence of immune-related adverse events. These outcomes were compared between the second-line and later-line groups. RESULTS Forty-two patients (62.7%) received nivolumab as second-line therapy. There was no significant difference in the progression-free survival (median: 5.06 vs. 6.28 months, p = 0.691) or objective response rate (35.7% vs. 32.0%, p = 0.757) between the second-line and later-line groups. The OS tended to be longer in the second-line group (not reached vs. 26.0 months, p = 0.118), and the rate of patients who received subsequent therapy after nivolumab failure was significantly higher in the second-line group (90.9% vs. 55.0%, p = 0.0025). There was no difference in the incidences of immune-related adverse events between the second-line and later-line groups (any grade: 54.8% vs. 48.0%, p = 0.592; grade ≥ 3: 19.1% vs. 20.0%, p = 0.924). CONCLUSIONS The efficacy of nivolumab did not deteriorate and the tolerability was also maintained even in later-line therapy. However, a tendency of longer OS and a higher chance of subsequent therapy after nivolumab failure were observed with nivolumab as second-line therapy.
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6
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D'Aniello C, Berretta M, Cavaliere C, Rossetti S, Facchini BA, Iovane G, Mollo G, Capasso M, Pepa CD, Pesce L, D'Errico D, Buonerba C, Di Lorenzo G, Pisconti S, De Vita F, Facchini G. Biomarkers of Prognosis and Efficacy of Anti-angiogenic Therapy in Metastatic Clear Cell Renal Cancer. Front Oncol 2019; 9:1400. [PMID: 31921657 PMCID: PMC6917607 DOI: 10.3389/fonc.2019.01400] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/27/2019] [Indexed: 12/30/2022] Open
Abstract
In the last decades, the prognosis of metastatic renal cell carcinoma (mRCC) has remarkably improved following the advent of the "targeted therapy" era. The expanding knowledge on the prominent role played by angiogenesis in RCC pathogenesis has led to approval of multiple anti-angiogenic agents such as sunitinib, pazopanib, axitinib, cabozantinib, sorafenib, and bevacizumab. These agents can induce radiological responses and delay cancer progression for months or years before onset of resistance, with a clinically meaningful activity. The need for markers of prognosis and efficacy of anti-angiogenic agents has become more compelling as novel systemic immunotherapy agents have also been approved in RCC and can be administered as an alternative to angiogenesis inhibitors. Anti PD-1 monoclonal antibody nivolumab has been approved in the second-line setting after tyrosine kinase inhibitors failure, while combination of nivolumab plus anti CTLA-4 monoclonal antibody ipilimumab has been approved as first-line therapy of RCC patients at intermediate or poor prognosis. In this review article, biomarkers of prognosis and efficacy of antiangiogenic therapies are summarized with a focus on those that have the potential to affect treatment decision-making in RCC. Biomarkers predictive of toxicity of anti-angiogenic agents have also been discussed.
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Affiliation(s)
- Carmine D'Aniello
- Division of Medical Oncology, A.O.R.N. dei COLLI “Ospedali Monaldi-Cotugno-CTO,”Naples, Italy
| | - Massimiliano Berretta
- Division of Medical Oncology, Istituto Nazionale Tumori, IRCCS CRO Aviano (PN), Milan, Italy
| | - Carla Cavaliere
- UOC of Medical Oncology, ASL NA 3 SUD, Ospedali Riuniti Area Nolana, Nola, Italy
| | - Sabrina Rossetti
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
| | - Bianca Arianna Facchini
- Division of Medical Oncology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gelsomina Iovane
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
| | - Giovanna Mollo
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
| | - Mariagrazia Capasso
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
| | | | - Laura Pesce
- Oncology Unit, San Luca Hospital, Vallo Della Lucania, Italy
| | - Davide D'Errico
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
| | - Carlo Buonerba
- CRTR Rare Tumors Reference Center, AOU Federico II, Naples, Italy
- Environment & Health Operational Unit, Zoo-Prophylactic Institute of Southern Italy, Portici, Italy
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
- Department of Medicine, University of Molise, Campobasso, Italy
| | - Salvatore Pisconti
- Department of Onco-Hematology, Medical Oncology, S.G. Moscati Hospital, Taranto, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gaetano Facchini
- Departmental Unit of Experimental Uro-Andrologic Clinical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale—IRCCS, Naples, Italy
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7
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Treatment Decisions for Metastatic Clear Cell Renal Cell Carcinoma in Older Patients: The Role of TKIs and Immune Checkpoint Inhibitors. Drugs Aging 2019; 36:395-401. [PMID: 30784023 DOI: 10.1007/s40266-019-00644-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Given the underrepresentation of older patients in registration trials for metastatic renal cell carcinoma (mRCC), data to support the use of any particular systemic therapy over others, based on age, is limited. This is further complicated by clinical trials not commonly reporting adverse events by age. Thus, recommendations on treatment of older patients with mRCC are generally extrapolated from data on younger patients enrolled in these trials, which may not be ideal as many older patients are frail, have age-related organ dysfunction, or have multiple medical co-morbidities. In the last decade, the treatment landscape for mRCC has drastically changed with the approval of more than ten targeted therapies, as well as immune checkpoint inhibitors. Thus, treatment selection and sequencing of treatments can be especially challenging for clinicians. We begin this review by analyzing the available efficacy and toxicity data of these treatments in younger and older patients. We also discuss a network meta-analysis that compares the efficacy of these agents in older patients with mRCC. Utilizing this data, we suggest that nivolumab plus ipilimumab and cabozantinib may be favored for first-line treatment of specific populations of older patients. For salvage treatment, we suggest that cabozantinib may be the preferred agent for older patients.
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8
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Drug resistance in papillary RCC: from putative mechanisms to clinical practicalities. Nat Rev Urol 2019; 16:655-673. [PMID: 31602010 DOI: 10.1038/s41585-019-0233-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 11/08/2022]
Abstract
Papillary renal cell carcinoma (pRCC) is the second most common renal cell carcinoma (RCC) subtype and accounts for 10-15% of all RCCs. Despite clinical need, few pharmacogenomics studies in pRCC have been performed. Moreover, current research fails to adequately include pRCC laboratory models, such as the ACHN or Caki-2 pRCC cell lines. The molecular mechanisms involved in pRCC development and drug resistance are more diverse than in clear-cell RCC, in which inactivation of VHL occurs in the majority of tumours. Drug resistance to multiple therapies in pRCC occurs via genetic alteration (such as mutations resulting in abnormal receptor tyrosine kinase activation or RALBP1 inhibition), dysregulation of signalling pathways (such as GSK3β-EIF4EBP1, PI3K-AKT and the MAPK or interleukin signalling pathways), deregulation of cellular processes (such as resistance to apoptosis or epithelial-to-mesenchymal transition) and interactions between the cell and its environment (for example, through activation of matrix metalloproteinases). Improved understanding of resistance mechanisms will facilitate drug discovery and provide new effective therapies. Further studies on novel resistance biomarkers are needed to improve patient prognosis and stratification as well as drug development.
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9
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Tomura K, Naito Y, Sunaga T, Kurihara T, Usuda M, Nagatani A, Ogawa Y, Akiyama N, Sasaki H, Murata T, Sakamaki H, Kogo M, Sasaki T. [A Cost-effectiveness Analysis of Sunitinib vs. Interferon-alpha in Patient with Advanced Renal Cell Carcinoma in Japan]. YAKUGAKU ZASSHI 2018; 138:1397-1407. [PMID: 30381648 DOI: 10.1248/yakushi.17-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sunitinib has been shown to offer clinical benefits during the treatment of advanced renal cell carcinoma. However, molecular targeting drugs are expensive and can have a significant impact on medical expenses. The purpose of this study was to assess the cost-effectiveness of sunitinib as a first-line therapy compared with interferon-alpha (IFN-α) in metastatic renal cell carcinoma patients. A Markov model was used to show the clinical courses of patients with metastatic renal cell carcinoma who received sunitinib or IFN-α. The transition probabilities and utilities employed in this Markov model were derived from two sources. This study focused on the perspective of public healthcare payer, as only direct medical costs were estimated from the treatment schedule for metastatic renal cell cancer. In the cost-effectiveness analysis, outcomes were valued in terms of life years (LYs) and quality-adjusted life years (QALYs). We calculated the incremental cost-effectiveness ratio (ICER) during the cost-effectiveness analysis. The results were tested using Monte Carlo simulations. Sunitinib and IFN-α treatment resulted in LYs of 2.40 years and 2.03 years, QALYs of 1.58 and 1.25, and expected costs of 13,572,629 yen and 6,083,002 yen, respectively. As a result, the ICER associated with replacing IFN-α with sunitinib was 22,695,839 yen/QALYs. Our results suggest that compared with IFN-α, sunitinib prolongs LYs and QALYs, but the increases in quality achieved by sunitinib are more expensive than those produced by IFN-α.
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Affiliation(s)
- Kazuki Tomura
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Yuki Naito
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Tomiko Sunaga
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Tatsuya Kurihara
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Masahiro Usuda
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Akiko Nagatani
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Yumiko Ogawa
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Nao Akiyama
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Haruaki Sasaki
- Department of Urology, Showa University Fujigaoka Hospital
| | | | | | - Mari Kogo
- Department of Pharmacy, Showa University Fujigaoka Hospital.,Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Tadanori Sasaki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
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10
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Lakomy R, Poprach A, Bortlicek Z, Melichar B, Chloupkova R, Vyzula R, Zemanova M, Kopeckova K, Svoboda M, Slaby O, Kiss I, Studentova H, Juracek J, Fiala O, Kopecky J, Finek J, Dusek L, Hejduk K, Buchler T. Utilization and efficacy of second-line targeted therapy in metastatic renal cell carcinoma: data from a national registry. BMC Cancer 2017; 17:880. [PMID: 29268716 PMCID: PMC5740580 DOI: 10.1186/s12885-017-3901-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background It is well known that patient characteristics and survival outcomes in randomized trials may not necessarily be similar to those in real-life clinical practice. The aim of the present study was to analyse second line treatment strategies in the real-world practice and to estimate the outcomes of patients treated with second-line targeted therapy for metastatic renal cell carcinoma (mRCC). Methods This is a retrospective, registry-based study using data from the national registry of targeted therapies for mRCC. The RENIS registry contains data on 3049 patients who started the therapy with at least one targeted agent before 31 December, 2014. Of these patients, 1029 had a record of at least two different targeted therapies and sufficient data for analysis. Survival analysis was carried out using the Kaplan-Meier method. Statistical significance of differences in survival between subgroups was assessed using the log-rank test. Results The median overall survival from the start of second-line treatment was 17.0 months (95% confidence interval [CI] 14.5–19.5 months), 17.1 months (95% CI 14.5–19.8), and 15.4 months (95% CI 11.0–19.7) for second-line everolimus, sorafenib, and sunitinib, respectively. Patients receiving second-line everolimus were older at the start of second-line treatment, more likely to have metachronous disease, and less likely to be previously treated with cytokines or to continue to third-line treatment than patients treated with second-line sunitinib or sorafenib. Progression-free survival (PFS) correlated with PFS on first-line treatment only for everolimus. Conclusions In this retrospective study, no significant differences in survival were observed between the cohorts treated with different second-line agents including everolimus, sorafenib, and sunitinib.
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Affiliation(s)
- Radek Lakomy
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Alexandr Poprach
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Zbynek Bortlicek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School and Teaching Hospital, I.P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Renata Chloupkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Rostislav Vyzula
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Milada Zemanova
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 499/2, 128 08, Prague, Czech Republic
| | - Katerina Kopeckova
- Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Marek Svoboda
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Ondrej Slaby
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Igor Kiss
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Hana Studentova
- Department of Oncology, Palacky University Medical School and Teaching Hospital, I.P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Jaroslav Juracek
- Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic
| | - Ondrej Fiala
- Department of Oncology, Charles University and University Hospital, Svobody 80, 304 60, Pilsen, Czech Republic
| | - Jindrich Kopecky
- Department of Oncology, Hradec Králové University Hospital and Faculty of Medicine, Charles University, Hradec Králové, Sokolská 581, 50005, Hradec Králové, Czech Republic
| | - Jindrich Finek
- Department of Oncology, Charles University and University Hospital, Svobody 80, 304 60, Pilsen, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, 140 59, Prague, Czech Republic.
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11
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Duran I, Lambea J, Maroto P, González-Larriba JL, Flores L, Granados-Principal S, Graupera M, Sáez B, Vivancos A, Casanovas O. Resistance to Targeted Therapies in Renal Cancer: The Importance of Changing the Mechanism of Action. Target Oncol 2017; 12:19-35. [PMID: 27844272 DOI: 10.1007/s11523-016-0463-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Renal cell carcinoma (RCC) is a complex disease characterized by mutations in several genes. Loss of function of the von Hippel-Lindau (VHL) tumour suppressor gene is a very common finding in RCC and leads to up-regulation of hypoxia-inducible factor (HIF)-responsive genes accountable for angiogenesis and cell growth, such as platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). Binding of these proteins to their cognate tyrosine kinase receptors on endothelial cells promotes angiogenesis. Promotion of angiogenesis is in part due to the activation of the phosphatidylinositol-3-kinase (PI3K)/AKT/mechanistic target of rapamycin (mTOR) pathway. Inhibition of this pathway decreases protein translation and inhibits both angiogenesis and tumour cell proliferation. Although tyrosine kinase inhibitors (TKIs) stand as the main first-line treatment option for advanced RCC, eventually all patients will become resistant to TKIs. Resistance can be overcome by using second-line treatments with different mechanisms of action, such as inhibitors of mTOR, c-MET, programmed death 1 (PD-1) receptor, or the combination of an mTOR inhibitor (mTORi) with a TKI. In this article, we briefly review current evidence regarding mechanisms of resistance in RCC and treatment strategies to overcome resistance with a special focus on the PI3K/AKT/mTOR pathway.
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Affiliation(s)
- I Duran
- Sección de Oncología Médica, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Laboratorio de Terapias Avanzadas y Biomarcadores en Oncología, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - J Lambea
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Maroto
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - S Granados-Principal
- Servicio de Oncología Médica, Complejo Hospitalario de Jaén, Jaén, Spain.,GENYO, Centre for Genomics and Oncological Research (Pfizer/University of Granada/Andalusian Regional Government), PTS Granada, Granada, Spain
| | - M Graupera
- Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - B Sáez
- Departmento de Bioquímica, Biología Molecular y Celular, Instituto Universitario de Investigación en Nanociencia de Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - A Vivancos
- Departamento de Bioquímica y Biología Molecular, Universidad Pompeu Fabra, Barcelona, Spain
| | - O Casanovas
- ProCURE Research Program, Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat, Avinguda Gran Via, 199-203, 08907, Barcelona, Spain.
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12
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Kim SH, Suh YS, Kim JK, Joung JY, Seo HK, Lee KH, Chung J. Survival outcomes of double- and triple-sequential targeted therapy in patients with metastatic renal cell carcinoma: a retrospective comparison. Oncotarget 2017; 8:100056-100065. [PMID: 29245960 PMCID: PMC5725002 DOI: 10.18632/oncotarget.21926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/26/2017] [Indexed: 01/05/2023] Open
Abstract
Objective To evaluate the progression-free survival (PFS) and overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) treated with double- and triple-sequence targeted therapy (TT) using tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors (mTORi). Materials and Methods Records of 292 patients with mRCC, treated with TT between January 2005 and July 2015, were analyzed retrospectively. Kaplan-Meier and log-rank analyses were used to calculate and compare the total PFS (tPFS) and OS when patients underwent double- or triple-TT using TKIs or mTORi. Results Eighty-one (27.7%) patients who underwent second-line TT were enrolled; 30 (10.3%) of whom underwent third-line TT. The tPFS and OS of double-TT using TKI-mTORi (5.4 and 30 months, respectively) were significantly better compared with TKI-TKI (0.3 and 2 months) or mTORi-TKI (2 and 6 months) (p <0.001). For triple-TT, the tPFS and OS of TKI-mTORi-TKI (22.8 and 25 months, respectively) were significantly superior compared with those for TKI-TKI-mTORi (4 and 9 months) (p <0.05). For patients with intermediate-risk according to the Heng or Memorial Sloan-Kettering Cancer Center risk models, TKI-mTORi was associated with a significantly longer tPFS and OS compared with TKI-TKI [expect for OS in the Heng group (p = 0.086)]. For the triple TT group, TKI-mTORi-TKI resulted in improved tPFS and OS compared with TKI-TKI-TKI or TKI-TKI-mTORi (p <0.05). Conclusion In patients with mRCC, sequential administration of TKI-mTORi led to a significantly superior tPFS compared with any other TT sequence. By contrast, OS did not differ significantly according to TT sequence.
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Affiliation(s)
- Sung Han Kim
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Yoon Seok Suh
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jung Kwon Kim
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Kyung Seo
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Kang Hyun Lee
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jinsoo Chung
- Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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13
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Malouf GG, Flippot R, Khayat D. Therapeutic Strategies for Patients With Metastatic Renal Cell Carcinoma in Whom First-Line Vascular Endothelial Growth Factor Receptor-Directed Therapies Fail. J Oncol Pract 2017; 12:412-20. [PMID: 27170687 DOI: 10.1200/jop.2016.011809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Metastases are present in one third of renal cell carcinomas at diagnosis. The overall survival duration in metastatic renal cell carcinoma is approximately 22 months, which underlines the need for more effective systemic treatments. Therapies on the basis of antiangiogenic agents and inhibitors of the mammalian target of rapamycin have been approved for treatment of metastatic renal cell carcinoma, but only benefits for progression-free survival were demonstrated in the second-line setting. Fortunately, promising treatments are emerging, from new antiangiogenic agents to immune checkpoint inhibitors. For the first time, both an immune checkpoint inhibitor (nivolumab) and a dual inhibitor of the tyrosine kinases c-Met and vascular endothelial growth factor receptor-2 (cabozantinib) have demonstrated improvements in overall survival in the second-line setting. Finding the best sequence for these novel agents will be crucial to improving outcomes in patients with metastatic renal cell carcinoma. This article comprises both a systematic review of the literature and recommendations for second-line therapeutic strategies for patients with metastatic clear cell renal cell carcinoma in whom inhibitors of vascular endothelial growth factor have failed.
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Affiliation(s)
- Gabriel G Malouf
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, AP-HP, University Pierre and Marie Curie, Paris, France
| | - Ronan Flippot
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, AP-HP, University Pierre and Marie Curie, Paris, France
| | - David Khayat
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, AP-HP, University Pierre and Marie Curie, Paris, France
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14
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Grande E, Glen H, Aller J, Argenziano G, Lamas MJ, Ruszniewski P, Zamorano JL, Edmonds K, Sarker S, Staehler M, Larkin J. Recommendations on managing lenvatinib and everolimus in patients with advanced or metastatic renal cell carcinoma. Expert Opin Drug Saf 2017; 16:1413-1426. [PMID: 28920492 DOI: 10.1080/14740338.2017.1380624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There are several second-line treatment options for patients with renal cell carcinoma after first-line failure of a tyrosine kinase inhibitor, especially with the recent approvals of cabozantinib, nivolumab, and the lenvatinib plus everolimus combination. A lack of reliable biomarkers and an overall lack of prospective head-to-head comparisons make it a challenge to choose a second-line treatment in the clinic. Areas covered: In this review/meta-opinion, we describe the safety profile of the lenvatinib plus everolimus combination in renal cell carcinoma. The combination of lenvatinib plus everolimus has achieved the highest rates of objective responses and the longest progression free and overall survival in cross-comparison trials. At the same time, the safety profile of this combination, including the rate of total and severe adverse events, the percentage of dose reductions required, and the rate of treatment discontinuation, was less favorable compared with available monotherapy options, suggesting that better management could help to maximize the activity of this combination while protecting patients from undue harm. Expert opinion: Herein, we aim to postulate multidisciplinary recommendations on the advice to offer to patients and caregivers before starting treatment and how to manage the combination from the perspective of daily clinical practice.
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Affiliation(s)
- E Grande
- a Medical Oncology Department , Ramón y Cajal University Hospital , Madrid , Spain
| | - H Glen
- b Consultant in Medical Oncology, Honorary Clinical Senior Lecturer, NRS Research Fellow , Beatson West of Scotland Cancer Centre , Glasgow , UK
| | - J Aller
- c Endocrinology Department , Puerta de Hierro University Hospital , Madrid , Spain
| | - G Argenziano
- d Dermatology Unit , University of Campania , Naples , Italy
| | - M J Lamas
- e Pharmacy Department , Complexo Hospitalario de Santiago de Compostela , Santiago de Compostela , Spain
| | - P Ruszniewski
- f Paris Diderot University. Gastroenterology Department , Beaujon Hospital, Assistance Publique-Hôpitaux de Paris , Clichy , France
| | - J L Zamorano
- g Head of Cardiology, CIBERCV , University Hospital Ramon y Cajal , Madrid , Spain
| | - K Edmonds
- h Oncology Nurse , Royal Marsden Hospital , London , UK
| | - S Sarker
- h Oncology Nurse , Royal Marsden Hospital , London , UK
| | - M Staehler
- i Urology Department , Klinikum der Ludwig-Maximilians Universität , Munich , Germany
| | - J Larkin
- j Medical Oncology Department , Royal Marsden Hospital , London , UK
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15
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Genitourinary tumours in the targeted therapies era: new advances in clinical practice and future perspectives. Anticancer Drugs 2017; 27:917-43. [PMID: 27400375 DOI: 10.1097/cad.0000000000000405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genitourinary cancers represent a heterogeneous group of malignancies arising from genitourinary tract, and are responsible for almost 359 000 newly diagnosed cases and 58 420 related deaths in USA. Continuous advances in cancer genetics and genomics have contributed towards changing the management paradigms of these neoplasms. Neoangiogenesis, through the activation of the tyrosine-kinase receptors signalling pathways, represents the key mediator event in promoting tumour proliferation, differentiation, invasiveness and motility. In the last decade, several treatments have been developed with the specific aim of targeting different cell pathways that have been recognized to drive tumour progression. The following review attempts to provide a comprehensive overview of the literature, focusing on new advances in targeted therapies for genitourinary tumours. Furthermore, the promising results of the latest clinical trials and future perspectives will be discussed.
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16
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Ishibashi K, Haber T, Breuksch I, Gebhard S, Sugino T, Kubo H, Hata J, Koguchi T, Yabe M, Kataoka M, Ogawa S, Hiraki H, Yanagida T, Haga N, Thüroff JW, Prawitt D, Brenner W, Kojima Y. Overriding TKI resistance of renal cell carcinoma by combination therapy with IL-6 receptor blockade. Oncotarget 2017; 8:55230-55245. [PMID: 28903416 PMCID: PMC5589655 DOI: 10.18632/oncotarget.19420] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Metastatic renal cell carcinoma (RCC) is a tumor entity with poor prognosis due to limited therapy options. Tyrosine kinase inhibitors (TKI) represent the standard of care for RCCs, however a significant proportion of RCC patients develop resistance to this therapy. Interleukin-6 (IL-6) is considered to be associated with poor prognosis in RCCs. We therefore hypothesized that TKI resistance and IL-6 secretion are causally connected. We first analyzed IL-6 expression after TKI treatment in RCC cells and RCC tumor specimens. Cell proliferation and signal transduction activity were then quantified after co-treatment with tocilizumab, an IL-6R inhibitor, in vitro and in vivo. 786-O RCC cells secrete high IL-6 levels after low dose stimulation with the TKIs sorafenib, sunitinib and pazopanib, inducing activation of AKT-mTOR pathway, NFκB, HIF-2α and VEGF expression. Tocilizumab neutralizes the AKT-mTOR pathway activation and results in reduced proliferation. Using a mouse xenograft model we can show that a combination therapy with tocilizumab and low dosage of sorafenib suppresses 786-O tumor growth, reduces AKT-mTOR pathway and inhibits angiogenesis in vivo more efficient than sorafenib alone. Furthermore FDG-PET imaging detected early decrease of maximum standardized uptake values prior to extended central necrosis. Our findings suggest that a combination therapy of IL-6R inhibitors and TKIs may represent a novel therapeutic approach for RCC treatment.
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Affiliation(s)
- Kei Ishibashi
- Department of Urology, Fukushima Medical University, Fukushima, Japan.,Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Tobias Haber
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ines Breuksch
- Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Susanne Gebhard
- Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Takashi Sugino
- Department of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hitoshi Kubo
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Tomoyuki Koguchi
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Michihiro Yabe
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Hiraki
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Tomohiko Yanagida
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukushima Medical University, Fukushima, Japan
| | - Joachim W Thüroff
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Dirk Prawitt
- Center for Pediatrics and Adolescent Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Walburgis Brenner
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany.,Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University, Fukushima, Japan
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17
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Davis ID, Xie W, Pezaro C, Donskov F, Wells JC, Agarwal N, Srinivas S, Yuasa T, Beuselinck B, Wood LA, Ernst DS, Kanesvaran R, Knox JJ, Pantuck A, Saleem S, Alva A, Rini BI, Lee JL, Choueiri TK, Heng DY. Efficacy of Second-line Targeted Therapy for Renal Cell Carcinoma According to Change from Baseline in International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Category. Eur Urol 2017; 71:970-978. [DOI: 10.1016/j.eururo.2016.09.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
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18
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Ratta R, Prisciandaro M, Procopio G. Personalized therapy in renal cell carcinoma: are the different tyrosine kinase inhibitors the same for any patient? EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1289066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Raffaele Ratta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Reprofiling Metastatic Samples for Chromosome 9p and 14q Aberrations as a Strategy to Overcome Tumor Heterogeneity in Clear-cell Renal Cell Carcinoma. Appl Immunohistochem Mol Morphol 2017; 25:39-43. [DOI: 10.1097/pai.0000000000000257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Kok VC, Kuo JT. Pazopanib as a second-line treatment for non-cytokine-treated metastatic renal cell carcinoma: a meta-analysis of the effect of treatment. BMC Urol 2016; 16:34. [PMID: 27377922 PMCID: PMC4932732 DOI: 10.1186/s12894-016-0156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 06/16/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The currently recommended treatment algorithm for patients with advanced renal cell carcinoma who fail the first-line targeted therapy does not normally include pazopanib as a second-line treatment option. It would therefore be of interest to determine the efficiency of pazopanib in this setting in terms of the partial response rate (PRR), disease control rate (DCR), and progression-free survival (PFS). METHODS Peer-reviewed clinical reports without language restriction, both full papers and conference abstracts, which assessed the second-line use of pazopanib following failure of first-line non-cytokine-targeted therapy, were included. After the literature retrieval, we conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-compliant systematic review of the literature and meta-analysis of the size of the effect of each outcome measure (PRR, DCR, and PFS). The effect size and 95 % confidence interval (CI) were calculated using fixed-effect or random-effects models based on the heterogeneity represented by I(2) of selected studies. Meta-analysis forest plots with a fixed-effect model showing the PRR and DCR were created. RESULTS Our results show that there are no available comparative studies on pazopanib second-line treatment. Only phase II trials or retrospective analysis reports were retrievable. Six studies (comprising 217 patients) were included in the qualitative and quantitative analysis. Pazopanib as a second-line treatment resulted in a PRR of 23 % (95 % CI, 17-31 %; I(2) = 52.6 %) and a DCR of 73 % (95 % CI, 65-80 %; I(2) = 0.00 %). The meta-analysis with fixed-effect model revealed that PFS was 6.5 months (95 % CI, 5.6-7.5 months; I(2) = 86.2 %). CONCLUSIONS In conclusion, the effectiveness and indication of pazopanib for use in the second-line setting has not yet been examined in-depth; however, this meta-analysis has shown that the treatment effects in terms of PRR, DCR, and PFS may be similar to other well-studied second-line targeted therapies. Rigorous comparative phase III trials testing this hypothesis are required.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, 117 Shatien Rd, Taichung, 43303, Taiwan.
- Department of Biomedical Informatics, Asia University, Taichung, 41354, Taiwan.
| | - Jung-Tsung Kuo
- Division of Biostatistics, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
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21
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Third-line Targeted Therapy in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol 2016; 71:204-209. [PMID: 27318422 DOI: 10.1016/j.eururo.2016.05.049] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/31/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of third-line targeted therapy (TTT) in metastatic renal cell carcinoma (mRCC) is not well characterized and varies due to the lack of robust data to guide treatment decisions. This study examined the use of third-line therapy in a large international population. OBJECTIVE To evaluate the use and efficacy of targeted therapy in a third-line setting. DESIGN, SETTING, AND PARTICIPANTS Twenty-five international cancer centers provided consecutive data on 4824 mRCC patients who were treated with an approved targeted therapy. One thousand and twelve patients (21%) received TTT and were included in the analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were analyzed for overall survival (OS) and progression-free survival using Kaplan-Meier curves, and were evaluated for overall response. Cox regression analyses were used to determine the statistical association between OS and the six factors included in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model. Subgroup analysis was performed on patients stratified by their IMDC prognostic risk status. RESULTS AND LIMITATIONS Everolimus was the most prevalent third-line therapy (27.5%), but sunitinib, sorafenib, pazopanib, temsirolimus, and axitinib were all utilized in over ≥9% of patients. Patients receiving any TTT had an OS of 12.4 mo, a progression-free survival of 3.9 mo, and 61.1% of patients experienced an overall response of stable disease or better. Patients not receiving TTT had an OS of 2.1 mo. Patients with favorable- (7.2%) or intermediate-risk (65.3%) disease had the highest OS with TTT, 29.9 mo and 15.5 mo, respectively, while poor-risk (27.5%) patients survived 5.5 mo. Results are limited by the retrospective nature of the study. CONCLUSIONS TTT remains highly heterogeneous. The IMDC prognostic criteria can be used to stratify third-line patients. TTT use in favorable- and intermediate-risk patients was associated with the greatest OS. PATIENT SUMMARY Patients with favorable- and intermediate-prognostic criteria disease treated with third-line targeted therapy have an associated longer overall survival compared with those with poor risk disease.
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22
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Incorvaia L, Bronte G, Bazan V, Badalamenti G, Rizzo S, Pantuso G, Natoli C, Russo A. Beyond evidence-based data: scientific rationale and tumor behavior to drive sequential and personalized therapeutic strategies for the treatment of metastatic renal cell carcinoma. Oncotarget 2016; 7:21259-71. [PMID: 26872372 PMCID: PMC5008283 DOI: 10.18632/oncotarget.7267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
The recent advances in identification of the molecular mechanisms related to tumorigenesis and angiogenesis, along with the understanding of molecular alterations involved in renal cell carcinoma (RCC) pathogenesis, has allowed the development of several new drugs which have revolutionized the treatment of metastatic renal cell carcinoma (mRCC).This process has resulted in clinically significant improvements in median overall survival and an increasing number of patients undergoes two or even three lines of therapy. Therefore, it is necessary a long-term perspective of the treatment: planning a sequential and personalized therapeutic strategy to improve clinical outcome, the potential to achieve long-term response, and to preserve quality of life (QOL), minimizing treatment-related toxicity and transforming mRCC into a chronically treatable condition.Because of the challenges still encountered to draw an optimal therapeutic sequence, the main focus of this article will be to propose the optimal sequencing of existing, approved, oral targeted agents for the treatment of mRCC using evidence-based data along with the knowledge available on the tumor behavior and mechanisms of resistance to anti-angiogenic treatment to provide complementary information and to help the clinicians to maximize the effectiveness of targeted agents in the treatment of mRCC.
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Affiliation(s)
- Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Giuseppe Bronte
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Viviana Bazan
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Sergio Rizzo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Gianni Pantuso
- Department of Surgical, Oncological and Oral Sciences, Section of Surgical Oncology, University of Palermo, Palermo, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, University “G. D'Annunzio”, Chieti, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
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23
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Iacovelli R, Verri E, Cossu Rocca M, Aurilio G, Cullurà D, Santoni M, de Cobelli O, Nolé F. Is there still a role for sorafenib in metastatic renal cell carcinoma? A systematic review and meta-analysis of the effectiveness of sorafenib over other targeted agents. Crit Rev Oncol Hematol 2016; 99:324-31. [DOI: 10.1016/j.critrevonc.2016.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 01/08/2023] Open
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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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Porta C, Giglione P, Paglino C. Targeted therapy for renal cell carcinoma: focus on 2nd and 3rd line. Expert Opin Pharmacother 2016; 17:643-55. [PMID: 26630127 DOI: 10.1517/14656566.2016.1127353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Second- and third-line treatments are more and more frequently administered to metastatic renal cell carcinoma (mRCC) patients. AREAS COVERED Here we discuss the various levels of evidence supporting presently available recommendations, trying to address a number of as yet unanswered issues, and also to take a glowing glance at the future. To do this, we interrogated the Medline database, as well as the proceedings of the main Oncological and Urological conferences for relevant studies. EXPERT OPINION Until recently, with regard to choosing the second line treatment after the failure of therapy with vascular endothelial growth factor receptors-tyrosine kinase inhibitors (VEGFR-TKIs), the continued inhibition of the VEGF/VEGR pathway, or else the switch to an mTOR inhibitor, is recommended. These two options are characterized by partly different targets, completely different toxicity profiles, but a comparable efficacy. This scenario will change soon, after the publication of two randomized, controlled, phase III trials in which cabozantinib and nivolumab proved to be superior as compared to everolimus. As regards third line treatment, where a sequence of two VEGFR-TKIs has been used beforehand, the choice is represented by the mTOR inhibitor everolimus, whilst if a VEGFR-TKI followed by everolimus has been chosen, a return to VEGF pathway inhibition is suggested.
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Affiliation(s)
- Camillo Porta
- a Medical Oncology , I.R.C.C.S. San Matteo University Hospital Foundation , Pavia , Italy.,b Italian Group of Nephro-Oncology/Gruppo Italiano di Oncologia Nefrologica (G.I.O.N.)
| | - Palma Giglione
- a Medical Oncology , I.R.C.C.S. San Matteo University Hospital Foundation , Pavia , Italy
| | - Chiara Paglino
- a Medical Oncology , I.R.C.C.S. San Matteo University Hospital Foundation , Pavia , Italy.,b Italian Group of Nephro-Oncology/Gruppo Italiano di Oncologia Nefrologica (G.I.O.N.)
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Sequential Therapy in Metastatic Renal Cell Carcinoma. J Kidney Cancer VHL 2016; 3:23-35. [PMID: 28326277 PMCID: PMC5345527 DOI: 10.15586/jkcvhl.2016.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/22/2016] [Indexed: 01/05/2023] Open
Abstract
The treatment of metastatic renal cell carcinoma (mRCC) has changed dramatically in the past decade. As the number of available agents, and related volume of research, has grown, it is increasingly complex to know how to optimally treat patients. The authors are practicing medical oncologists at the US Oncology Network, the largest community-based network of oncology providers in the country, and represent the leadership of the Network’s Genitourinary Research Committee. We outline our thought process in approaching sequential therapy of mRCC and the use of real-world data to inform our approach. We also highlight the evolving literature that will impact practicing oncologists in the near future.
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Axitinib in sequential therapy in metastatic renal cell carcinoma. Contemp Oncol (Pozn) 2016; 20:418-420. [PMID: 28373826 PMCID: PMC5371698 DOI: 10.5114/wo.2015.51823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/23/2015] [Indexed: 11/17/2022] Open
Abstract
Efficacy of new molecularly targeted drugs in the treatment of renal cell carcinoma (RCC), confirmed in clinical studies in relation to survival and prolongation of time to progression, has became a big chance for patients with metastatic renal cell cancer. Axitinib is a potent and selective receptor tyrosine kinase for vascular endothelial growth factor (VEGFR-1, -2, -3), platelet-derived growth factor β (PDGRF-β) and c-KIT. This is a case report of a 57-year old female patient with a history of left nephrectomy due to clear cell renal cell carcinoma. The patient had received three prior systemic treatments (interferon - sorafenib - everolimus). After consecutive progression the patient was qualified to 4th line therapy - axitinib at a dose of 5 mg twice daily. Partial response to treatment was achieved. After 6 months therapy was stopped due to the disease progression. The total time to progression was 37.5 months. The total survival time from the disease diagnosis was 45 months. Based on literature date and own experience we showed that sequential treatment RCC is associated with improved survival. In summary, axitinib may be an effective drug after failure of tyrosine-kinase inhibitor (TKI) therapy in previous lines of therapy.
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Clinical Outcome of Third-Line Pazopanib in a Patient with Metastatic Renal Cell Carcinoma. Case Rep Oncol Med 2015; 2015:629046. [PMID: 26798533 PMCID: PMC4698998 DOI: 10.1155/2015/629046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/15/2015] [Accepted: 11/30/2015] [Indexed: 12/02/2022] Open
Abstract
Background. Renal cell carcinoma accounts for about 2-3% of all malignant tumors. The prevalence of brain metastases from RCC is less than 20% of cases. Traditionally, whole brain radiotherapy as well as the latest stereotactic radiosurgery improves both survival and local tumor control. These treatments also allow stabilization of clinical symptomatology. However, validated treatment guidelines for RCC patients with brain metastases are not yet available on account of the frequent exclusion of such patients from clinical trials. Moreover, limited data about the sequential use of three therapies, changing the class of agent, have been published up to now. Case Report. We report the case of a patient with metastatic RCC who developed disease progression after sunitinib and everolimus as first-line and second-line therapy, respectively. Thus, he underwent a multimodality treatment with pazopanib, as third-line therapy, to control systemic disease and radiosurgery directed on the new brain metastasis. To date, the patient is still receiving pazopanib, with progression-free survival and overall survival of 43 and 103 months, respectively. Conclusion. In a context characterized by different emerging options, with no general consensus on the optimal treatment strategy, the use of pazopanib in pretreated patients could be a suitable choice.
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Ralla B, Erber B, Goranova I, von der Aue L, Floercken A, Hinz S, Kempkensteffen C, Magheli A, Miller K, Busch J. Efficacy of fourth-line targeted therapy in patients with metastatic renal cell carcinoma: a retrospective analysis. World J Urol 2015; 34:1147-54. [PMID: 26676614 DOI: 10.1007/s00345-015-1740-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/27/2015] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Evidence for sequencing targeted therapy (TT) in patients with metastatic renal cell carcinoma (mRCC) beyond third line is limited. Treatment decisions for these sequence options are largely based on individual preferences and experience. The aim of this study was to describe the efficacy and toxicity of fourth-line TT. MATERIALS AND METHODS We retrospectively reviewed patients treated with fourth-line TT for mRCC after failure of previous treatment lines at a German academic high-volume center. Out of 406 patients treated in first line, 56 patients (14.8 %) were identified with more than three lines of TT. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards models were applied to explore predictors of PFS and OS in uni- and multivariable analysis. RESULTS For the fourth-line treatment, disease control rate was 35.7 %. Median OS from beginning of first-line therapy was 47.4 months (IQR 31.0-76.5). Primary resistance at first-line TT, metastatic disease at initial diagnosis and an intermediate MSKCC score were independent predictors of shorter OS from start of first-line TT. Median OS from the time of initiation of fourth-line therapy was 10.5 months (IQR 5.6-22.6). The corresponding median PFS for fourth-line TT was 3.2 months (IQR 1.6-8.0) and was not correlated with treatment response in first-line TT. The rate of toxicity-induced treatment termination was 16.1 %. Limitations are the retrospective and unicentric design with a limited number of patients. CONCLUSIONS Patients might benefit from subsequent treatment lines independently from treatment response in first line.
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Affiliation(s)
- Bernhard Ralla
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany.
| | - Barbara Erber
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Irena Goranova
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Luise von der Aue
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Anne Floercken
- Department of Hematology, Oncology and Tumor Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Carsten Kempkensteffen
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Ahmed Magheli
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité Universitaetsmedizin Berlin, Charité Platz 1, 10117, Berlin, Germany
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Pérez-Valderrama B, Arranz Arija JA, Rodríguez Sánchez A, Pinto Marín A, Borrega García P, Castellano Gaunas DE, Rubio Romero G, Maximiano Alonso C, Villa Guzmán JC, Puertas Álvarez JL, Chirivella González I, Méndez Vidal MJ, Juan Fita MJ, León-Mateos L, Lázaro Quintela M, García Domínguez R, Jurado García JM, Vélez de Mendizábal E, Lambea Sorrosal JJ, García Carbonero I, González del Alba A, Suárez Rodríguez C, Jiménez Gallego P, Meana García JA, García Marrero RD, Gajate Borau P, Santander Lobera C, Molins Palau C, López Brea M, Fernández Parra EM, Reig Torras O, Basterretxea Badiola L, Vázquez Estévez S, González Larriba JL. Validation of the International Metastatic Renal-Cell Carcinoma Database Consortium (IMDC) prognostic model for first-line pazopanib in metastatic renal carcinoma: the Spanish Oncologic Genitourinary Group (SOGUG) SPAZO study. Ann Oncol 2015; 27:706-11. [PMID: 26658889 DOI: 10.1093/annonc/mdv601] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with metastatic renal carcinoma (mRCC) treated with first-line pazopanib were not included in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model. SPAZO (NCT02282579) was a nation-wide retrospective observational study designed to assess the effectiveness and validate the IMDC prognostic model in patients treated with first-line pazopanib in clinical practice. PATIENTS AND METHODS Data of 278 patients, treated with first-line pazopanib for mRCC in 34 centres in Spain, were locally recorded and externally validated. Mean age was 66 years, there were 68.3% male, 93.5% clear-cell type, 74.8% nephrectomized, and 81.3% had ECOG 0-1. Metastatic sites were: lung 70.9%, lymph node 43.9%, bone 26.3%, soft tissue/skin 20.1%, liver 15.1%, CNS 7.2%, adrenal gland 6.5%, pleura/peritoneum 5.8%, pancreas 5%, and kidney 2.2%. After median follow-up of 23 months, 76.4% had discontinued pazopanib (57.2% due to progression), 47.9% had received second-line targeted therapy, and 48.9% had died. RESULTS According to IMDC prognostic model, 19.4% had favourable risk (FR), 57.2% intermediate risk (IR), and 23.4% poor risk (PR). No unexpected toxicities were recorded. Response rate was 30.3% (FR: 44%, IR: 30% PR: 17.3%). Median progression-free survival (whole population) was 11 months (32 in FR, 11 in IR, 4 in PR). Median and 2-year overall survival (whole population) were 22 months and 48.1%, respectively (FR: not reached and 81.6%, IR: 22 and 48.7%, PR: 7 and 18.8%). These estimations and their 95% confidence intervals are fully consistent with the outcomes predicted by the IMDC prognostic model. CONCLUSION Our results validate the IMDC model for first-line pazopanib in mRCC and confirm the effectiveness and safety of this treatment.
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Affiliation(s)
- B Pérez-Valderrama
- Department of Medical Oncology, Virgen del Rocío University Hospitals, Sevilla
| | - J A Arranz Arija
- Department of Medical Oncology, Gregorio Marañón General University Hospital, Madrid
| | | | - A Pinto Marín
- Department of Medical Oncology, La Paz University Hospital, Madrid
| | - P Borrega García
- Department of Medical Oncology, San Pedro de Alcántara Hospital, Cáceres
| | | | - G Rubio Romero
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid
| | - C Maximiano Alonso
- Department of Medical Oncology, Puerta de Hierro University Hospital, Majadahonda (Madrid)
| | - J C Villa Guzmán
- Department of Medical Oncology, General University Hospital of Ciudad Real, Ciudad Real
| | | | | | - M J Méndez Vidal
- Department of Medical Oncology, Reina Sofía University Hospital, Córdoba
| | - M J Juan Fita
- Department of Medical Oncology, Valencian Institute of Oncology, Valencia
| | - L León-Mateos
- Department of Medical Oncology, Santiago University Hospital Complex, Santiago de Compostela
| | - M Lázaro Quintela
- Department of Medical Oncology, University Hospital Complex of Vigo, Vigo
| | - R García Domínguez
- Department of Medical Oncology, Clinic University Hospital of Salamanca, Salamanca
| | - J M Jurado García
- Department of Medical Oncology, San Cecilio University Hospital, Granada
| | | | | | | | - A González del Alba
- Department of Medical Oncology, Son Espases University Hospital, Palma de Mallorca
| | - C Suárez Rodríguez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona
| | - P Jiménez Gallego
- Department of Medical Oncology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria
| | - J A Meana García
- Department of Medical Oncology, University Hospital of Alicante, Alicante
| | - R D García Marrero
- Department of Medical Oncology, University Hospital of Canarias, San Cristóbal de La Laguna (Santa Cruz de Tenerife)
| | - P Gajate Borau
- Department of Medical Oncology, Quirón University Hospital, Madrid
| | - C Santander Lobera
- Department of Medical Oncology, Miguel Servet University Hospital, Zaragoza
| | - C Molins Palau
- Department of Medical Oncology, Doctor Peset University Hospital, Valencia
| | - M López Brea
- Department of Medical Oncology, Marqués de Valdecilla University Hospital, Santander
| | - E M Fernández Parra
- Department of Medical Oncology, Nuestra Señora de Valme University Hospital, Sevilla
| | - O Reig Torras
- Department of Medical Oncology, Clinic University Hospital of Barcelona, Barcelona
| | | | - S Vázquez Estévez
- Department of Medical Oncology, Lucus Augusti University Hospital, Lugo
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Li H, Samawi H, Heng DY. The use of prognostic factors in metastatic renal cell carcinoma. Urol Oncol 2015; 33:509-16. [DOI: 10.1016/j.urolonc.2015.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/28/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022]
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Vrdoljak E, Torday L, Szczylik C, Kharkevich G, Bavbek S, Sella A. Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe. Expert Opin Pharmacother 2015; 17:93-104. [PMID: 26619144 DOI: 10.1517/14656566.2016.1107043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries. AREAS COVERED The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC. EXPERT OPINION This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available.
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Affiliation(s)
- E Vrdoljak
- a University Hospital Split , Department of Oncology , Split , Croatia
| | - L Torday
- b University of Szeged , Department of Oncotherapy , Szeged , Hungary
| | - C Szczylik
- c Central Clinical Hospital , Department of Oncology, Military Institute of Medicine , Warsaw , Poland
| | - G Kharkevich
- d NN Blokhin Russian Cancer Research Center , Biotherapy Department , Moscow , Russia
| | - S Bavbek
- e VKV American Hospital , Div. Medical Oncology , Istanbul , Turkey
| | - A Sella
- f Assaf Harofeh Centre Zerifin, Department of Oncology , Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel
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Alesini D, Mosillo C, Naso G, Cortesi E, Iacovelli R. Clinical experience with everolimus in the second-line treatment of advanced renal cell carcinoma. Ther Adv Urol 2015; 7:286-94. [PMID: 26425143 PMCID: PMC4549702 DOI: 10.1177/1756287215591764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approved for the treatment of metastatic renal cell carcinoma (mRCC) after failure of first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor (TKI). In this narrative review, we aim to report the available evidence about the use of everolimus as second-line therapy for mRCC. A literature search was performed using PubMed/MEDLINE and abstracts from major conferences on clinical oncology as sources. We report data from prospective as well as retrospective and real world data studies and we analyze the safety and efficacy profile of everolimus as second-line therapy for mRCC. Although different drugs are currently available for the second-line treatment of mRCC, everolimus represents a feasible and safe option in this setting, especially for patients who have experienced high-grade toxicity or are still carrying TKI-related toxicities from first-line treatment.
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Affiliation(s)
- Daniele Alesini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Claudia Mosillo
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Naso
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Enrico Cortesi
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Roberto Iacovelli
- Division of Medical Oncology, Genitourinary Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Rothermundt C, Bailey A, Cerbone L, Eisen T, Escudier B, Gillessen S, Grünwald V, Larkin J, McDermott D, Oldenburg J, Porta C, Rini B, Schmidinger M, Sternberg C, Putora PM. Algorithms in the First-Line Treatment of Metastatic Clear Cell Renal Cell Carcinoma--Analysis Using Diagnostic Nodes. Oncologist 2015; 20:1028-35. [PMID: 26240132 DOI: 10.1634/theoncologist.2015-0145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With the advent of targeted therapies, many treatment options in the first-line setting of metastatic clear cell renal cell carcinoma (mccRCC) have emerged. Guidelines and randomized trial reports usually do not elucidate the decision criteria for the different treatment options. In order to extract the decision criteria for the optimal therapy for patients, we performed an analysis of treatment algorithms from experts in the field. MATERIALS AND METHODS Treatment algorithms for the treatment of mccRCC from experts of 11 institutions were obtained, and decision trees were deduced. Treatment options were identified and a list of unified decision criteria determined. The final decision trees were analyzed with a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees. The most common treatment recommendations were determined, and areas of discordance were identified. RESULTS The analysis revealed heterogeneity in most clinical scenarios. The recommendations selected for first-line treatment of mccRCC included sunitinib, pazopanib, temsirolimus, interferon-α combined with bevacizumab, high-dose interleukin-2, sorafenib, axitinib, everolimus, and best supportive care. The criteria relevant for treatment decisions were performance status, Memorial Sloan Kettering Cancer Center risk group, only or mainly lung metastases, cardiac insufficiency, hepatic insufficiency, age, and "zugzwang" (composite of multiple, related criteria). CONCLUSION In the present study, we used diagnostic nodes to compare treatment algorithms in the first-line treatment of mccRCC. The results illustrate the heterogeneity of the decision criteria and treatment strategies for mccRCC and how available data are interpreted and implemented differently among experts. IMPLICATIONS FOR PRACTICE The data provided in the present report should not be considered to serve as treatment recommendations for the management of treatment-naïve patients with multiple metastases from metastatic clear cell renal cell carcinoma outside a clinical trial; however, the data highlight the different treatment options and the criteria used to select them. The diversity in decision making and how results from phase III trials can be interpreted and implemented differently in daily practice are demonstrated.
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Affiliation(s)
- Christian Rothermundt
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alexandra Bailey
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Linda Cerbone
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Tim Eisen
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bernard Escudier
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Viktor Grünwald
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - James Larkin
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - David McDermott
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan Oldenburg
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Camillo Porta
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Brian Rini
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Manuela Schmidinger
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Cora Sternberg
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul M Putora
- Division of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Department of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom; Gustave Roussy, Villejuif, France; Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany; The Royal Marsden Hospital, London, United Kingdom; Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway; Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy; Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken, Wien, Austria; Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Khaled H, Azim HA, Barsoum E, Chahine G, Shamseddine A, Metaal GA, Omar A, Jazeih AR, Haggag R, Badran A. A multicenter, phase II study of the RAF-kinase inhibitor sorafenib in patients with advanced renal cell carcinoma. Mol Clin Oncol 2015; 3:1099-1102. [PMID: 26623058 DOI: 10.3892/mco.2015.603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/25/2015] [Indexed: 11/06/2022] Open
Abstract
The treatment of advanced renal cell carcinoma (RCC) has advanced significantly over the last two decades. This multicenter study was designed with the primary objective to evaluate the efficacy and safety of sorafenib as first-line treatment in patients with advanced or metastatic RCC in the Middle East, who were considered to be ineligible for other approved first-line therapies. A total of 75 eligible patients from 8 centers in the Middle East were included in this study. The patients comprised 48 men and 27 women, with a median age of 52 years (range, 19-78 years). A total of 50 patients had clear cell carcinoma, 17 had papillary carcinoma and 8 had other pathological subtypes. At enrollment, 55 of the 75 patients had undergone previous nephrectomy. A total of 67 patients presented with metastatic disease, while 8 patients had regional residual lesions or local recurrence. The patients were treated with 400 mg oral sorafenib twice daily on a continuous basis as a single agent. Treatment was discontinued upon disease progression, prohibitive toxicity, surgical complications, loss to follow-up, or refusal to continue therapy. The median treatment duration was 21 weeks (range, 1-137 weeks). Sorafenib was tolerated by the majority of the patients. Grade 3/4 hand-foot syndrome occurred in 17 patients; diarrhea, elevated liver enzymes and fatigue were observed in 3 patients each; and grade 3/4 vomiting, hypertension and anemia, in 1 patient each. Of the 75 patients included in this study, 60 were evaluable for response. One patient achieved a complete response for 91 weeks and 6 patients exhibited a partial response (median duration of 23 weeks) with an overall response rate of 11.7%. Disease stabilization occurred in 37 patients (61.7%). Thus, disease control was achieved in 44 of the 60 patientrs (73%). At a median follow-up period of 53.5 weeks (range, 8.5-192 weeks), an intention-to-treat analysis demonstrated a median time-to-disease progression of 25.7 weeks, with a median overall survival of 54.8 weeks. In conclusion, sorafenib was found to be tolerable and effective as first-line therapy in patients with advanced RCC.
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Affiliation(s)
- Hussein Khaled
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Hamdy Abdel Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo 11796, Egypt
| | - Emad Barsoum
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - George Chahine
- Department of Hematology-Oncology, Hôtel-Dieu de France Hospital, Beirut 1107 2020, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Gamal Abdel Metaal
- Department of Medical Oncology, Maadi Military Hospital, Cairo 11796, Egypt
| | - Abbas Omar
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria 21131, Egypt
| | - Abdul Rahman Jazeih
- Department of Oncology, National Guard Hospital, Riyadh 11564, Kingdom of Saudi Arabia
| | - Rasha Haggag
- Department of Medical Oncology, Zagazig University, Sharkia 44519, Egypt
| | - Atef Badran
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
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Iacovelli R, Santini D, Rizzo M, Felici A, Santoni M, Verzoni E, Masini C, Massari F, Calvani N, Mosca A, Procopio G. Bone metastases affect prognosis but not effectiveness of third-line targeted therapies in patients with metastatic renal cell carcinoma. Can Urol Assoc J 2015; 9:263-7. [PMID: 26316911 PMCID: PMC4537338 DOI: 10.5489/cuaj.2377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment of metastatic renal cell carcinoma (mRCC) has improved with the use of targeted therapies, but bone metastases continue to be negative prognostic factor. METHODS Patients with mRCC treated with everolimus (EV) or sorafenib (SO) after two previous lines of targeted therapies were included in the analysis. Overall survival (OS) and progression-free survival (PFS) were assessed based on the presence of bone metastases and type of therapy; they were also adjusted based on prognostic criteria. RESULTS Of the 233 patients with mRCC, 76 had bone metastases. Of the 233 patients, EV and SO were administered in 143 and 90 patients, respectively. Median OS was 10.4 months in patients with BMs and 17.4 months in patients without bone metastases (p = 0.002). EV decreased the risk of death by 18% compared to SO (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.74-0.91; p < 0.001), with comparable effects in patients with or without bone metastases. In the same manner, EV decreased the risk of progression by 12% compared to SO (adjusted HR 0.88, 95% CI 0.82-0.96; p = 0.002), but this difference was not significant in patients without bone metastases. The major limitations of the study are its retrospective nature, the heterogeneity of the methods to detect bone metastases, and the lack of data about patients treated with bisphosphonates. CONCLUSIONS The relative benefit of targeted therapies in mRCC is not affected by the presence of bone metastases, but patients without bone metastases have longer response to therapy and overall survival.
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Affiliation(s)
- Roberto Iacovelli
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Mimma Rizzo
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Felici
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Matteo Santoni
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Elena Verzoni
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Cristina Masini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Francesco Massari
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Nicola Calvani
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Alessandra Mosca
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Procopio
- Fondazione IRCCS Istituto Nazionale Tumori, Division of Medical Oncology, Rome, Italy
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Tokio Rationale and Protocol: A Phase II Study to Evaluate the Activity and Safety of Third-line Tyrosine Kinase Inhibitor after 2 Tyrosine Kinase Inhibitors in Patients with Metastatic Renal Cell Carcinoma. TUMORI JOURNAL 2015; 101:701-3. [DOI: 10.5301/tj.5000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 01/04/2023]
Abstract
Aims and Background The introduction of agents targeting vascular endothelial growth factor has radically changed the approach to metastatic renal cell carcinoma (mRCC): sunitinib and pazopanib are now the standard first-line therapy in mRCC. At sunitinib failure, second-line axitinib or everolimus or sorafenib should be considered to improve the clinical outcome. No data are available for a third-line tyrosine kinase inhibitor (TKI) after 2 previous lines of therapy with TKIs. At pazopanib failure, no prospective data are available. Study Design The TOKIO study was designed to evaluate progression-free survival, safety, and efficacy of third-line therapy with TKI in 44 patients already treated with 2 previous lines of TKIs in 10 Italian centers, and relapsed from sunitinib-axitinib (group A) or pazopanib-sorafenib (group B). Standard treatment is sorafenib in group A and sunitinib in group B, administered until disease progression or unacceptable toxicity. Secondary endpoints include the evaluation of overall survival, safety, and quality of life.
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Thiery-Vuillemin A, Theodore C, Jacobasch L, Schmitz J, Papandreou C, Guillot A, Emmanouilides C, Slimane K, Kelkouli N, Kim S, Nguyen Tan Hon T. Efficacy and Safety of Sequential Use of Everolimus in Patients With Metastatic Renal Cell Carcinoma Previously Treated With Bevacizumab With or Without Interferon Therapy: Results From the European AVATOR Study. Clin Genitourin Cancer 2015; 13:231-8. [DOI: 10.1016/j.clgc.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023]
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Iacovelli R, Albiges L, Escudier B. Emerging tyrosine kinase inhibitors for the treatment of renal cancer. Expert Opin Emerg Drugs 2015; 20:379-92. [DOI: 10.1517/14728214.2015.1047761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ciccarese C, Modena A, Tortora G, Massari F. Kidney cancer and 2014: is innovation really over? Future Oncol 2015; 11:1437-49. [DOI: 10.2217/fon.15.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT 2014 has been a year of significant innovations on kidney cancer treatments, the most relevant of which will be shown below. In particular, we analyzed the consolidated knowledge regarding the role of surgery in localized and advanced renal cell carcinoma and the targeted therapies already approved for metastatic renal cell carcinoma. Furthermore, we examined the outstanding issues, with particular reference to the choice of the second-line and the role of adjuvant and neoadjuvant treatments. Finally, we outlined the future therapeutic perspectives and those definitely abandoned.
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Affiliation(s)
- Chiara Ciccarese
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale LA Scuro 10, 37124 Verona, Italy
| | - Alessandra Modena
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale LA Scuro 10, 37124 Verona, Italy
| | - Giampaolo Tortora
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale LA Scuro 10, 37124 Verona, Italy
| | - Francesco Massari
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale LA Scuro 10, 37124 Verona, Italy
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Bergmann L, Kube U, Doehn C, Steiner T, Goebell PJ, Kindler M, Herrmann E, Janssen J, Weikert S, Scheffler MT, Schmitz J, Albrecht M, Staehler M. Everolimus in metastatic renal cell carcinoma after failure of initial anti-VEGF therapy: final results of a noninterventional study. BMC Cancer 2015; 15:303. [PMID: 25925846 PMCID: PMC4413536 DOI: 10.1186/s12885-015-1309-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/01/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Data are limited regarding routine use of everolimus after initial vascular endothelial growth factor (VEGF)-targeted therapy. The aim of this prospective, noninterventional, observational study was to assess efficacy and safety of everolimus after initial VEGF-targeted treatment in patients with metastatic renal cell carcinoma (mRCC) in routine clinical settings. METHODS Everolimus was administered per routine clinical practice. Patients with mRCC of any histology from 116 active sites in Germany were included. The main objective was to determine everolimus efficacy in time to progression (TTP). Progression-free survival (PFS), treatment duration, tumor response, adherence to everolimus regimen, treatment after everolimus, and safety were also assessed. RESULTS In the total population (N = 334), median follow-up was 5.2 months (range, 0-32 months). Median treatment duration (safety population, n = 318) was 6.5 months (95% confidence interval [CI], 5-8 months). Median TTP and median PFS were similar in populations investigated. In patients who received everolimus as second-line treatment (n = 211), median (95% CI) TTP was 7.1 months (5-9 months) and median PFS was 6.9 months (5-9 months). Commonly reported adverse events (safety population, n = 318) were dyspnea (17%), anemia (15%), and fatigue (12%). Limitations of the noninterventional design should be considered. CONCLUSIONS This study reflects routine clinical use of everolimus in a large sample of patients with mRCC. Favorable efficacy and safety were seen for everolimus after previous therapy with one VEGF-targeted agent. Results of this study confirm everolimus as one of the standard options in second-line therapy for patients with mRCC. Novartis study code, CRAD001LD27: VFA registry for noninterventional studies ( http://www.vfa.de/de/forschung/nisdb/).
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Affiliation(s)
- Lothar Bergmann
- Medical Clinic II, J. W., Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt/Main, 60590, Germany.
| | - Ulrich Kube
- Private Practice for Urology, Goethestrasse 5, 09119, Chemnitz, Germany.
| | | | - Thomas Steiner
- Department of Urology, Hospital Erfurt, Nordhaeusertrasse 74, 99089, Erfurt, Germany.
| | - Peter J Goebell
- Department of Urology, University Hospital Erlangen, Rathsberger Strasse 57, 91054, Erlangen, Germany.
| | - Manfred Kindler
- Private Practice for Oncology, Landsberger Allee 277a, 13055, Berlin, Germany.
| | - Edwin Herrmann
- Department of Urology, University Hospital Muenster, Albert Schweitzer Campus 1, Gebaeude A1, 48149, Muenster, Germany.
| | - Jan Janssen
- Private Practice for Oncology, Kuhlenstrasse 53d, 26655, Westerstede, Germany.
| | - Steffen Weikert
- Department of Urology, Vivantes Humboldt-Hospital and Charité-University Medicine, Am Nordgraben 2, 13509, Berlin, Germany.
| | - Michael T Scheffler
- Private Practice for Urology, Friedrich Staude Strasse 2, 08060, Zwickau, Germany.
| | - Joerg Schmitz
- St. Johannes-Hospital, Springufer 7, 59755, Arnsberg, Germany.
| | - Michael Albrecht
- Novartis Pharma GmbH, Roonstrasse 25, 90429, Nuremberg, Germany.
| | - Michael Staehler
- Department of Urology, University Hospital Munich-Grosshadern, Marchioninistrasse, 15, 81377, Germany.
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Iacovelli R, Santoni M, Verzoni E, Grassi P, Testa I, de Braud F, Cascinu S, Procopio G. Everolimus and Temsirolimus Are Not the Same Second-Line in Metastatic Renal Cell Carcinoma. A Systematic Review and Meta-Analysis of Literature Data. Clin Genitourin Cancer 2015; 13:137-41. [DOI: 10.1016/j.clgc.2014.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Elaidi R, Harbaoui A, Beuselinck B, Eymard JC, Bamias A, De Guillebon E, Porta C, Vano Y, Linassier C, Debruyne P, Gross-Goupil M, Ravaud A, Aitelhaj M, Marret G, Oudard S. Outcomes from second-line therapy in long-term responders to first-line tyrosine kinase inhibitor in clear-cell metastatic renal cell carcinoma. Ann Oncol 2015; 26:378-85. [DOI: 10.1093/annonc/mdu552] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vallet S, Pahernik S, Höfner T, Tosev G, Hadaschik B, Duensing S, Sedlaczek O, Hohenfellner M, Jäger D, Grüllich C. Efficacy of targeted treatment beyond third-line therapy in metastatic kidney cancer: retrospective analysis from a large-volume cancer center. Clin Genitourin Cancer 2014; 13:e145-52. [PMID: 25596830 DOI: 10.1016/j.clgc.2014.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/09/2014] [Accepted: 12/22/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/BACKGROUND Currently, 7 agents are approved for the first- and second-line therapy for metastatic renal cell carcinoma. In contrast, data supporting their use beyond second line are limited. Here we summarize our experience in patients treated with more than 4 lines of therapy. METHODS We retrospectively assessed the outcome of 24 patients treated at our institution with at least 4 lines of therapy. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier estimates. RESULTS Median OS from the initiation of first-line therapy for the whole cohort is 64.7 months. Up to 96% of the patients received a tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitor (mTOR-I) within the first 3 lines of treatment. In the fourth or following lines, patients were treated with TKI, mTOR-I, bevacizumab/interferon, or experimental drugs. Seven patients continued treatment with a sixth-line agent; one has been treated up to the ninth line. Sixteen percent of the patients receiving fourth-line therapy and 13% receiving fifth-line therapy experienced a partial remission, which was independent from response to previous therapies. Median OS from fourth and fifth line was 30.8 and 26.2 months, respectively. Median PFS for fourth-line therapy was 5.8 months. No significant difference in PFS was observed for patients with disease that responded or did not respond to first-line therapy. CONCLUSION Despite the limitations of a retrospective analysis, our study suggests that selected patients benefit from multiple lines of treatment, independent of response to first-line therapy. However, the optimal sequence of treatment with regard to later lines remains to be determined.
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Affiliation(s)
- Sonia Vallet
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Sascha Pahernik
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Höfner
- Department of Urology, Theresienkrankenhaus, and St. Hedwig-Klinik GmbH, Mannheim, Germany
| | - Georgi Tosev
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Hadaschik
- Department of Urology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Duensing
- Department of Urology, Section of Molecular Urooncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Sedlaczek
- Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
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Heng DY, Signorovitch J, Swallow E, Li N, Zhong Y, Qin P, Zhuo DY, Wang X, Park J, Stergiopoulos S, Kollmannsberger C. Comparative Effectiveness of Second-Line Targeted Therapies for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis of Real-World Observational Studies. PLoS One 2014; 9:e114264. [PMID: 25493562 PMCID: PMC4262396 DOI: 10.1371/journal.pone.0114264] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/05/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The optimal sequencing of targeted therapies for metastatic renal cell carcinoma (mRCC) is unknown. Observational studies with a variety of designs have reported differing results. The objective of this study is to systematically summarize and interpret the published real-world evidence comparing sequential treatment for mRCC. METHODS A search was conducted in Medline and Embase (2009-2013), and conference proceedings from American Society of Clinical Oncology (ASCO), ASCO Genitourinary Cancers Symposium (ASCO-GU), and European Society for Medical Oncology (ESMO) (2011-2013). We systematically reviewed observational studies comparing second-line mRCC treatment with mammalian target of rapamycin inhibitors (mTORi) versus vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI). Studies were evaluated for 1) use of a retrospective cohort design after initiation of second-line therapy, 2) adjustment for patient characteristics, and 3) use of data from multiple centers. Meta-analyses were conducted for comparisons of overall survival (OS) and progression-free survival (PFS). RESULTS Ten studies reported OS and exhibited significant heterogeneity in estimated second-line treatment effects (I2 = 68%; P = 0.001). Four of these were adjusted, multicenter, retrospective cohort studies, and these showed no evidence of heterogeneity (I2 = 0%; P = 0.61) and a significant association between second-line mTORi (>75% everolimus) and longer OS compared to VEGF TKI (>60% sorafenib) (HR = 0.82, 95% CI: 0.68 to 0.98) in a meta-analysis. Seven studies comparing PFS showed significant heterogeneity overall and among the adjusted, multicenter, retrospective cohort studies. Real-world observational data for axitinib outcomes was limited at the time of this study. CONCLUSIONS Real-world studies employed different designs and reported heterogeneous results comparing the effectiveness of second-line mTORi and VEGF TKI in the treatment of mRCC. Within the subset of adjusted, multicenter observational studies, second-line use of mTORi was associated with significantly prolonged survival compared with second-line use of VEGF TKI.
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Affiliation(s)
- Daniel Y. Heng
- Department of Medical Oncology, Tom Baker Cancer Center, Alberta Health Services Cancer Care, University of Calgary, Calgary, Canada
| | | | - Elyse Swallow
- Analysis Group, Inc., Boston, Massacusetts, United States of America
| | - Nanxin Li
- Analysis Group, Inc., Boston, Massacusetts, United States of America
| | - Yichen Zhong
- Analysis Group, Inc., Boston, Massacusetts, United States of America
| | - Paige Qin
- Analysis Group, Inc., Boston, Massacusetts, United States of America
| | - Daisy Y. Zhuo
- Analysis Group, Inc., Boston, Massacusetts, United States of America
| | - Xufang Wang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Jinhee Park
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Sotirios Stergiopoulos
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
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Iacovelli R, Farcomeni A, Sternberg CN, Cartenì G, Milella M, Santoni M, Cerbone L, Di Lorenzo G, Verzoni E, Ortega C, Sabbatini R, Ricotta R, Messina C, Lorusso V, Atzori F, De Vincenzo F, Sacco C, Boccardo F, Valduga F, Massari F, Baldazzi V, Cinieri S, Mosca A, Maria Ruggeri E, Berruti A, Procopio G. Prognostic factors in patients receiving third line targeted therapy for metastatic renal cell carcinoma. J Urol 2014; 193:1905-10. [PMID: 25433306 DOI: 10.1016/j.juro.2014.11.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Several prognostic models have been proposed for metastatic renal cell carcinoma but none has been validated in patients who receive third line targeted agents. We evaluated prognostic factors in patients with metastatic renal cell carcinoma who received a third line targeted agent. MATERIALS AND METHODS We retrospectively reviewed data on 2,065 patients with clear cell metastatic renal cell carcinoma who were treated with targeted therapy at a total of 23 centers in Italy. Included in final analysis were 281 patients treated with 3 targeted agents. Overall survival was the main outcome. Cox proportional hazards regression followed by bootstrap validation was used to identify independent prognostic factors. RESULTS Three clinical characteristics (ECOG performance status greater than 1, metastasis at diagnosis and liver metastasis) and 2 biochemical factors (hemoglobin less than the lower limit of normal and neutrophil count greater than the upper limit of normal, respectively) were prognostic. Patients were classified into 3 risk categories, including low-zero or 1, intermediate-2 and high risk-more than 2 risk factors. Median overall survival was 19.7, 10.1 and 5.5 months, and 1-year overall survival was 71%, 43% and 15%, respectively. The major limitation was the retrospective nature of this study and absent external validation. CONCLUSIONS This nomogram included clinical and biochemical prognostic factors. In clinical trials it may be useful to select patients and define the prognosis.
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Affiliation(s)
- Roberto Iacovelli
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza-University of Rome, Rome, Italy
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | - Matteo Santoni
- Department of Medical Oncology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Linda Cerbone
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Giuseppe Di Lorenzo
- Medical Oncology, Genitourinary Cancer Section, University Federico II, Naples, Italy
| | - Elena Verzoni
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Ortega
- Fondazione del Piemonte per l'Oncologia IRCC, Candiolo, Italy
| | - Roberto Sabbatini
- Oncology Division, Department of Oncology and Hematology, University of Modena e Reggio Emilia, Modena, Italy
| | - Riccardo Ricotta
- Falck Division of Oncology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Vito Lorusso
- National Cancer Research Center, Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Atzori
- Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy
| | - Fabio De Vincenzo
- Oncology and Hematology Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Cosimo Sacco
- Oncology Unit, St Maria della Misericordia Hospital, Udine, Italy
| | - Francesco Boccardo
- University and IRCCS AOU-San Martino-IST, National Cancer Research Institute, Genoa, Italy
| | | | - Francesco Massari
- Medical Oncology, "G.B. Rossi" Academic Hospital, University of Verona, Verona, Italy
| | - Valentina Baldazzi
- Department of Medical Oncology; Santa Maria Annunziata Hospital, Florence, Italy
| | - Saverio Cinieri
- Medical Oncology and Breast Unit Department, Sen A. Perrino Hospital, Brindisi, Italy
| | - Alessandra Mosca
- Medical Oncology, Maggiore della Carità University Hospital, Novara, Italy
| | | | | | - Giuseppe Procopio
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Barni S, Petrelli F. PISCES trial: the end does not always justify the means. J Clin Oncol 2014; 32:3782-3. [PMID: 25267749 DOI: 10.1200/jco.2014.56.8832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Signorovitch JE, Vogelzang NJ, Pal SK, Lin PL, George DJ, Wong MK, Liu Z, Wang X, Culver K, Scott JA, Jonasch E. Comparative effectiveness of second-line targeted therapies for metastatic renal cell carcinoma: synthesis of findings from two multi-practice chart reviews in the United States. Curr Med Res Opin 2014; 30:2343-53. [PMID: 25105304 DOI: 10.1185/03007995.2014.949645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Second-line targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin (mTOR) inhibitors and tyrosine kinase inhibitors (TKIs). This study compares the effectiveness of these therapies in a multi-practice chart review and synthesizes the findings with those of a similarly designed study. METHODS Medical oncologists/hematologists (N = 36) were recruited to review charts for patients aged ≥18 years, received a first-line TKI and initiated second-line targeted therapy in 2010 or later. The primary outcome was time from second-line initiation to treatment failure (TTF; discontinuation, physician-assessed progression, or death, whichever occurred first). TTF was compared among patients receiving second-line everolimus (EVE), temsirolimus (TEM), or TKI as a class, using a Cox proportional hazards model adjusting for type of initial TKI and response, histological subtype, performance status, and sites of metastasis. Hazard ratios (HRs) for TTF were pooled, in a meta-analysis, with previously reported HRs for progression-free survival from a chart review with a similar design. RESULTS A total of 138, 64 and 79 patients received second-line therapy with EVE, TEM or a TKI, respectively. Adjusting for baseline characteristics, EVE was associated with numerical, but not statistically significant, reductions of 28% (HR = 0.72; 95% CI [0.45-1.16]) and 26% (HR = 0.74; 95% CI [0.48-1.15]) in the hazard of TTF compared to TEM and TKI, respectively. After pooling the HRs from both studies, EVE was associated with significantly reduced hazards of TTF compared to TEM and TKI (HR = 0.73; 95% CI [0.57-0.93]; and HR = 0.75; 95% CI [0.57-0.98], respectively). LIMITATIONS LIMITATIONS include retrospective analyses with possible missing or erroneous chart data, confounding of unobserved factors due to non-randomization, and limited data for axitinib during the study period. CONCLUSIONS In pooled results from two independent multi-practice chart reviews of second-line mRCC treatment, EVE was associated with significantly reduced hazards of treatment failure compared to TEM and to TKIs as a class.
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Procopio G, Derosa L, Gernone A, Morelli F, Sava T, Zustovich F, De Giorgi U, Ferrari V, Sabbatini R, Gasparro D, Felici A, Burattini L, Calvani N, Lo Re G, Banna G, Pia Brizzi M, Rizzo M, Ciuffreda L, Iacovelli R, Ferraù F, Taibi E, Bracarda S, Porta C, Galligioni E, Contu A. Sorafenib as first- or second-line therapy in patients with metastatic renal cell carcinoma in a community setting. Future Oncol 2014; 10:1741-50. [DOI: 10.2217/fon.14.48] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Aim: The Italian Retrospective Analysis of Sorafenib as First or Second Target Therapy study assessed the efficacy and safety of sorafenib in metastatic renal cell carcinoma patients treated in the community. Patients & methods: Patients receiving first- or second-line single-agent sorafenib between January 2008 and December 2010 were eligible. Retrospective data collection started in 2012 and covers at least 1-year follow-up. The primary end point was overall survival (OS). Results: Median OS was 17.2 months (95% CI: 15.5–19.6): 19.9 months (95% CI: 15.9–25.3) in patients treated with first-line sorafenib and 16.3 months (95% CI: 13.1–18.2) with second-line sorafenib. Overall median (95% CI) progression-free survival was 5.9 months (95% CI: 4.9–6.7): 6.6 (95% CI: 4.9–9.3) and 5.3 months (95% CI: 4.3–6.0) in first- and second-line patients, respectively. Conclusion: The efficacy and safety of sorafenib in routine community practice was generally good, especially in relation to OS in patients treated in the second line, where results were similar to those seen in recent prospective clinical trials.
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Affiliation(s)
- Giuseppe Procopio
- S.C. Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milano, Italy
| | - Lisa Derosa
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Via Roma 67, 56100 Pisa, Italy
| | - Angela Gernone
- U.O. Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Franco Morelli
- U.O.C. Oncologia, Casa Sollievo della Sofferenza, Viale Cappucini 1, 71013 San Giovanni Rotondo (FG), Italy
| | - Teodoro Sava
- Oncologia Medica d.O., Azienda Ospedaliera Universitaria Integrata Verona, Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Fable Zustovich
- Oncologia Medica 1, Istituto Oncologico Veneto – IRCCS, Via Gattamelata 64, 35127 Padova, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo, per lo Studio e la Cura dei Tumori (I.R.S.T.), Via Piero Maroncelli 40, 47014 Meldola (FC), Italy
| | - Vittorio Ferrari
- U.O. Oncologia Medica, Spedali Civili Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Roberto Sabbatini
- Medical Oncology Division, Azienda Ospedaliero Universitaria, Policlinico di Modena, 41125 Modena, Italy
| | - Donatello Gasparro
- Azienda Ospedaliero-Universitaria di Parma, Dipartimento Onco-Ematogico, Oncologia Medica, Via Gramsci 14, 40126 Parma, Italy
| | - Alessandra Felici
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Luciano Burattini
- Oncologia Clinica, Ospedali Riuniti, Via Conca 71, 60100 Ancona, Italy
| | - Nicola Calvani
- Medical Oncology Division & Breast Unit, Sen. Antonio Perrino Hospital, S.S. 7, 72100 Brindisi, Italy
| | - Giovanni Lo Re
- Divisine di Oncologia, Azienda Ospedaliera Santa Maria degli Angeli, Via Montereale 24, 33170 Pordenone, Italy
| | - Giuseppe Banna
- Division of Medical Oncology, Cannizzaro Hospital, Via Messina 829, 95126, Catania, Italy
| | - Maria Pia Brizzi
- Department of Oncology, Medical Oncology, A.O.U. San Luigi, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Mimma Rizzo
- A.O.R.N. “A. Cardarelli”, U.O.S.C. Oncologia, Via A. Cardarelli 9, 80131 Napoli, Italy
| | - Libero Ciuffreda
- Direttore S.C. Oncologia Medica 1, Dipartimento Oncologia ed Ematologia, A.O.Citta’ della Salute e della Scienza – Ospedale Molinette, C.so Bramante 88, 10126 Torino, Italy
| | - Roberto Iacovelli
- Oncology Unit B, Department of Radiology, Oncology & Human-Pathology, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, “S.Vincenzo” Hospital, C.da Sirina, 98039 Taormina, Italy
| | - Eleonora Taibi
- Humanitas Centro Catanese di Oncologia S.p.A, Via V. E. Da Bormida 64, 95126 Catania (CT), Italy
| | - Sergio Bracarda
- Dipartimento Oncologico UOC, Ospedale S. Donato USL 8Toscana, Via Pietro Nenni 20, 52100 Arezzo, Italy
| | - Camillo Porta
- Medical Oncology, IRCCS San Matteo, University Hospital Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Enzo Galligioni
- Dipartimento di Oncologia, Azienda Provinciale per i Servizi Sanitari, Trento, Ospedale S.Chiara, 38122 Trento, Italy
| | - Antonio Contu
- SC di Oncologia Medica, ASL n°1, Via De Nicola 14, 07100 Sassari, Italy
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Martin-Liberal J, Gil-Martín M, Sáinz-Jaspeado M, Gonzalo N, Rigo R, Colom H, Muñoz C, Tirado OM, García del Muro X. Phase I study and preclinical efficacy evaluation of the mTOR inhibitor sirolimus plus gemcitabine in patients with advanced solid tumours. Br J Cancer 2014; 111:858-65. [PMID: 25003665 PMCID: PMC4150275 DOI: 10.1038/bjc.2014.370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/21/2014] [Accepted: 06/07/2014] [Indexed: 01/10/2023] Open
Abstract
Background: We conducted a phase I study in patients with advanced solid tumours to identify the recommended dose, assess pharmacokinetics (PK), pharmacodynamic activity and preclinical antitumour efficacy of the combination of sirolimus and gemcitabine. Methods: Nineteen patients were treated with sirolimus 2 or 5 mg daily and gemcitabine 800 or 1000 mg m−2 on days 1 and 8. Dose escalation depended on dose-limiting toxicity (DLT) rate during the first 3-week period. Paired skin biopsies were evaluated for phosphorylated S6 (pS6) as marker of mTOR (mammalian target of rapamycin) inhibition. Pharmacokinetics and preclinical evaluation of efficacy using two different sarcoma cell lines and leiomyosarcoma xenografts were also conducted. Results: Three DLTs were observed: grade 3 transaminitis, grade 3 thrombocytopenia and grade 4 thrombocytopenia. Common treatment-related adverse events included anaemia, neutropenia, thrombocytopenia and transaminitis. Pharmacodynamic analyses demonstrated mTOR inhibition with sirolimus 5 mg and PK showed no influence of sirolimus concentrations on gemcitabine clearance. In vitro and in vivo studies suggested mTOR pathway hyperactivation by gemcitabine that was reversed by sirolimus. Tumour growth in leiomyosarcoma xenografts was dramatically inhibited by the treatment. Conclusions: Recommended dose was sirolimus 5 mg per 24 h plus gemcitabine 800 mg m−2. Antitumour activity in preclinical sarcoma models and mTOR signalling inhibition were observed. A phase II study is currently ongoing.
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Affiliation(s)
| | - M Gil-Martín
- Institut Català d'Oncologia L'Hospitalet, Genitourinary Tumors, Sarcoma and Melanoma Unit, Avda Gran Via 199, L'Hospitalet, 08908 Barcelona, Spain
| | - M Sáinz-Jaspeado
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Dag Hammarskjöldsv 20, 751 85 Uppsala, Sweden
| | - N Gonzalo
- Institut Català d'Oncologia L'Hospitalet, Laboratori de Farmacocinètica, Avda Gran Via 199, L'Hospitalet, 08908 Barcelona, Spain
| | - R Rigo
- Hospital de Bellvitge, Àrea de Bioquímica i Biologia Molecular, Feixa Llarga s/n, L'Hospitalet, 08907 Barcelona, Spain
| | - H Colom
- Universitat de Barcelona, Facultat de Farmàcia, Avda de Joan XXIII 31, 08028 Barcelona, Spain
| | - C Muñoz
- Institut Català d'Oncologia L'Hospitalet, Laboratori de Farmacocinètica, Avda Gran Via 199, L'Hospitalet, 08908 Barcelona, Spain
| | - O M Tirado
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Laboratori d'Oncología Molecular, Sarcoma Research Group, Avda Gran Via 199, L'Hospitalet, 08908 Barcelona, Spain
| | - X García del Muro
- Institut Català d'Oncologia L'Hospitalet, Genitourinary Tumors, Sarcoma and Melanoma Unit, Avda Gran Via 199, L'Hospitalet, 08908 Barcelona, Spain
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