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Dupuis HGA, Chebbi A, Surlemont L, Rigal O, Di Fiore F, Pfister C, Nouhaud FX. Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma. Transl Androl Urol 2021; 10:2418-2426. [PMID: 34295728 PMCID: PMC8261413 DOI: 10.21037/tau-20-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/17/2021] [Indexed: 12/09/2022] Open
Abstract
Background immunotherapy became the first line treatment of metastatic renal cell carcinoma (mRCC). Nevertheless, a better understanding of the specificities of targeted therapies (TT) in the elderly population could be helpful in order to improve the management of mRCC in this population. The aim of this retrospective study was to assess efficacy and safety of sunitinib and sorafenib used as first-line TT in 70 years older patients compared to younger patients. Methods Data were retrospectively collected for all consecutive mRCC patients receiving first line TT treatment by sunitinib or sorafenib for mRCC from January 2006 to November 2017. Patients were divided into two groups according to the age using a cut-off at 70 years old. Median progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared using log-rank test. Results In total, 147 patients were included; 94 (63.9%) were <70 and 53 (36.1%) were 70 years old or more. First line TT used was sunitinib in 123 (83.7%) patients or sorafenib in 24 (16.3%) patients. Median PFS was 8 months for elderly patients vs. 6 in younger group (P=0.68). Median OS were 26 vs. 36 months (P=0.08). Severe induced toxicity was more frequent among elderly patients: 34 (64.2%) vs. 46 patients (48.9%) (P=0.07). Rate of treatment discontinuation due to toxicity was 22 patients (23.4%) in younger group vs. 28 patients (52.8%) in the elderly group (P=0.0005). Results were similar in the 2 groups regarding the type of toxicities. Conclusions Our results suggest similar efficacy of anti-vascular endothelial growth factor (VEGF) agents as first-line treatment for mRCC among younger and older patients with an age cut-off of 70 years. Safety results suggest that these drugs can be safely used for older patients with a need of caution regarding toxicity prevention.
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Affiliation(s)
| | - Ala Chebbi
- Urology Department, Rouen University Hospital, Rouen, France
| | - Louis Surlemont
- Urology Department, Rouen University Hospital, Rouen, France
| | - Olivier Rigal
- Medical Oncology Unit, Henri Becquerel Center, Rouen, France
| | | | - Christian Pfister
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
| | - François-Xavier Nouhaud
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
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2
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Internò V, De Santis P, Stucci LS, Rudà R, Tucci M, Soffietti R, Porta C. Prognostic Factors and Current Treatment Strategies for Renal Cell Carcinoma Metastatic to the Brain: An Overview. Cancers (Basel) 2021; 13:cancers13092114. [PMID: 33925585 PMCID: PMC8123796 DOI: 10.3390/cancers13092114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Renal cell carcinoma (RCC) is one of primary cancers that frequently metastasize to the brain. Brain metastasis derived from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema. Moreover, it confers a grim prognosis in a great percentage of cases with a median overall survical (mOS) around 10 months. The well-recognized prognostic factors for brain metastatic renal cell carcinoma (BMRCC) are Karnofsky Performance Status (KPS), the number of brain metastasis (BM), the presence of a sarcomatoid component and the presence of extracranial metastasis. Therapeutic strategies are multimodal and include surgical resection, radiotherapy, such as stereotactic radiosurgery due to the radioresistance of RCC and systemic strategies with tyrosin kinase inhibitors (TKI) or Immune checkpoint inhibitors (ICI) whose efficacy is not well-established in this setting of patients due to their exclusion from most clinical trials. To date, in case of positive prognostic factors and after performing local radical therapies, such as complete resection of BM or stereotactic radiosurgery (SRS), the outcome of these patients significantly improves, up to 33 months in some patients. As a consequence, tailored clinical trials designed for BMRCC are needed to define the correct treatment strategy even in this poor prognostic subgroup of patients.
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Affiliation(s)
- Valeria Internò
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70122 Bari, Italy; (P.D.S.); (L.S.S.); (M.T.); (C.P.)
- Aldo Moro Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, 70121 Bari, Italy
- Correspondence: ; Tel.: +39-080-547-8674; Fax: +39-080-547-8831
| | - Pierluigi De Santis
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70122 Bari, Italy; (P.D.S.); (L.S.S.); (M.T.); (C.P.)
- Aldo Moro Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, 70121 Bari, Italy
| | - Luigia Stefania Stucci
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70122 Bari, Italy; (P.D.S.); (L.S.S.); (M.T.); (C.P.)
- Aldo Moro Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, 70121 Bari, Italy
| | - Roberta Rudà
- Department of Neurology, Castelfranco Veneto and Treviso Hospital, 31033 Castelfranco Veneto, Italy;
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10122 Turin, Italy;
| | - Marco Tucci
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70122 Bari, Italy; (P.D.S.); (L.S.S.); (M.T.); (C.P.)
- National Cancer Research Center, Tumori Institute IRCCS Giovanni Paolo II, 70121 Bari, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, 10122 Turin, Italy;
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70122 Bari, Italy; (P.D.S.); (L.S.S.); (M.T.); (C.P.)
- Aldo Moro Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, 70121 Bari, Italy
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3
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Neuzillet Y, Albrand G, Caillet P, Paillaud E, Mongiat-Artus P. [Specificity of the management of metastatic renal cancer in the older patient]. Prog Urol 2020; 29:874-895. [PMID: 31771770 DOI: 10.1016/j.purol.2019.08.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/19/2019] [Indexed: 01/27/2023]
Abstract
AIM To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients. METHOD Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment. RESULTS The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways. CONCLUSION The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - G Albrand
- Service UCOG-IR, pavillon 1C Louis-Lortet, hospices civils de Lyon, centre hôpitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, unité d'oncogériatrie, hôpital européen Georges-Pompidou, université de Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - E Paillaud
- Service de gériatrie, unité d'oncogériatrie, hôpital européen Georges-Pompidou, université de Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Mongiat-Artus
- Inserm UMR, S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université de Paris-7-Denis-Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France
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4
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Current systemic therapies for metastatic renal cell carcinoma in older adults: A comprehensive review. J Geriatr Oncol 2017; 9:265-274. [PMID: 29249644 DOI: 10.1016/j.jgo.2017.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/24/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022]
Abstract
Physiological changes that occur during the aging process may impact drug metabolism and availability, consequently affecting treatment efficacy and tolerability. Despite being a disease of older adults, there is little data to guide treatment decisions for older patients with metastatic renal cell carcinoma (mRCC). The recent approval of many new agents for this disease poses a clinical challenge: how to best utilize these drugs in a population (older adults) who has been generally under-represented in clinical studies. Additionally, the presence of comorbid conditions, polypharmacy, frailty, and lack of social support place this group of patients in a very unique situation. In order to avoid under-treatment, international societies' guidelines recommend routine use of geriatric tools to assess patients' suitability for systemic treatments. Here we provide a thorough review of age-related metabolic differences, safety and efficacy data for each drug approved for mRCC, and cover specific considerations for the management of older adults with this disease.
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5
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Williet N, Clavel L, Bourmaud A, Verot C, Bouarioua N, Roblin X, Merle P, Phelip JM. Tolerance and outcomes of sorafenib in elderly patients treated for advanced hepatocellular carcinoma. Dig Liver Dis 2017; 49:1043-1049. [PMID: 28712860 DOI: 10.1016/j.dld.2017.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Use of sorafenib remains debated in elderly patients treated for advanced hepatocellular carcinoma (HCC). METHODS This was a bicentric retrospective study including all patients ≥75years and treated with sorafenib for advanced HCC between January 2010 and March 2014. RESULTS Of the 51 patients included (median age: 78 years, range: 75-92; performance status (PS) 0-1: 98%; cirrhosis: 88.2%; Child-Pugh A: 95.6%) all experienced at least one adverse event (AE). About 2/3 of them (66.7%) had grade 3-4 toxicities, including fatigue (43.1%), hand foot skin syndrome (11.8%), anorexia (9.8%) or diarrhea (9.8%). After adjustment for arterial hypertension, heart failure, other(s) cardiovascular history(ies), and sorafenib dose at baseline, only patients ≥80 years were associated with severe AE (OR: 13.3; p=0.009). Discontinuation for toxicity was reported in 31 (60.8%) patients, mainly within the 3rd months, especially in those who had PS ≥1 at baseline (OR: 10.4; p=0.01), or other cardiovascular histories (OR: 30.9; p=0.016). In this setting, overall survival was significantly reduced (HR: 4.5; p<0.0001). CONCLUSION Tolerance of Sorafenib seems to be low in elderly, especially for patients aged ≥80 years or with PS ≥1. Starting with reduced dose of sorafenib does not seem to impact results. Some of these patients may truly benefit from the treatment in terms of survival.
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Affiliation(s)
- Nicolas Williet
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France.
| | - Léa Clavel
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Center, Saint Priest en Jarez, France; Inserm, Clinical Investigation Center 1408, Saint-Etienne, France
| | - Céline Verot
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - Nadia Bouarioua
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - Xavier Roblin
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - Philippe Merle
- Hepatology Unit, Hospital Group of North Lyon, Civic Hospice of Lyon, Claude Bernard Lyon 1 University, Research center for oncology of Lyon; INSERM 1052, Lyon Cedex 03, France
| | - Jean-Marc Phelip
- Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France; University Jean Monnet, LINA EA 4624, France
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6
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van den Brom R, van Es S, Leliveld A, Gietema J, Hospers G, de Jong I, de Vries E, Oosting S. Balancing treatment efficacy, toxicity and complication risk in elderly patients with metastatic renal cell carcinoma. Cancer Treat Rev 2016; 46:63-72. [DOI: 10.1016/j.ctrv.2016.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/15/2022]
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7
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Bretagne M, Boudou-Rouquette P, Huillard O, Thomas-Schoemann A, Chahwakilian A, Orvoen G, Arrondeau J, Tlemsani C, Cessot A, Cabanes L, Blanchet B, Coriat R, Alexandre J, Goldwasser F. [Tyrosine kinase inhibiting the VEGF pathway and elderly people: Tolerance, pre-treatment assessment and side effects management]. Bull Cancer 2016; 103:259-72. [PMID: 26832420 DOI: 10.1016/j.bulcan.2015.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
Angiogenesis inhibition is a major antitumor strategy that has emerged during the last decade. Oral tyrosine kinase inhibitors (TKI) targeting the VEGF receptor, including sunitinib, sorafenib, axitinib, regorafenib, pazopanib, and vandetanib reduce tumor growth and metastasis. These agents are approved for the treatment of metastatic diseases in first or second-line. They display a narrow therapeutic index. However, data in the elderly and/or in patients with multiple illnesses remain scarce. This population is classically excluded from clinical trials. The aim of this review is to provide an overview of existing literature regarding antiangiogenic TKI tolerance in the elderly (>70 years old). We also highlight key points of the pre-therapeutic evaluation and summarize the management of common toxicities.
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Affiliation(s)
- Marie Bretagne
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Pascaline Boudou-Rouquette
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France.
| | - Olivier Huillard
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Audrey Thomas-Schoemann
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, laboratoire de pharmacologie et toxicologie, Paris, France
| | - Anne Chahwakilian
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gériatrie, Paris, France
| | - Galdric Orvoen
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gériatrie, Paris, France
| | - Jennifer Arrondeau
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Camille Tlemsani
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Anatole Cessot
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - Laure Cabanes
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de cardiologie, Paris, France
| | - Benoit Blanchet
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, laboratoire de pharmacologie et toxicologie, Paris, France
| | - Romain Coriat
- Hôpitaux universitaires Paris centre, université Paris Descartes, hôpital Broca, hôpital Cochin-Port-Royal, service de gastro-entérologie, Paris, France
| | - Jérôme Alexandre
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
| | - François Goldwasser
- Hôpitaux universitaires Paris centre, université Paris Descartes, CERIA, Center for Research on Angiogenesis Inhibitors, ARIANE, hôpital Broca, hôpital Cochin-Port-Royal, service d'oncologie médicale, Paris, France
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8
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Zanardi E, Grassi P, Cavo A, Verzoni E, Maggi C, De Braud F, Boccardo F, Procopio G. Treatment of elderly patients with metastatic renal cell carcinoma. Expert Rev Anticancer Ther 2016; 16:323-34. [PMID: 26654225 DOI: 10.1586/14737140.2016.1131613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of developing renal cell carcinoma (RCC) increases with age, and given the constant gain in life expectancy of the general population, both localized RCC and metastatic RCC (mRCC) are more frequently observed in the elderly population. The elderly are a heterogeneous group of patients often characterized by the presence of comorbidities, different compliance to treatment and polypharmacy. Here we review the available data with the aim to analyze the safety and efficacy of new targeted therapies (TTs) in elderly mRCC patients. TTs seem to be effective in both older and younger patients, but elderly patients appear to show reduced tolerance to treatments compared to younger patients. Prospective trials are needed to better understand how to manage mRCC in elderly patients.
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Affiliation(s)
- Elisa Zanardi
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Paolo Grassi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Alessia Cavo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Elena Verzoni
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Claudia Maggi
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Filippo De Braud
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Francesco Boccardo
- a Academic Unit of Medical Oncology , IRCCS San Martino University Hospital-IST National Cancer Research Institute , Genoa , Italy.,b Department of Medicine , School of Medicine, University of Genoa , Genoa , Italy
| | - Giuseppe Procopio
- c Department of Medical Oncology 1 , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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9
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Puente J, García Del Muro X, Pinto Á, Láinez N, Esteban E, Arranz JÁ, Gallardo E, Méndez MJ, Maroto P, Grande E, Suárez C. Expert Recommendations for First-Line Management of Metastatic Renal Cell Carcinoma in Special Subpopulations. Target Oncol 2015; 11:129-41. [PMID: 26706236 DOI: 10.1007/s11523-015-0408-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The availability of agents targeting the vascular endothelial growth factor or mammalian target of rapamycin [mTOR] pathways has provided new treatment options for patients with metastatic renal cell carcinoma (RCC). Based on the results of pivotal randomized clinical trials, specific recommendations have been established for management of these patients in first- and second-line settings. However, certain subgroups of patients may be excluded or under-represented in clinical trials, including patients with poor performance status, brain metastases, and cardiac or renal comorbidities, elderly patients, and those with non-clear cell histology. For these subpopulations, management recommendations have emerged from expanded access programs (EAPs), small phase II studies, retrospective analysis of clinical data, and expert opinion. This paper describes recommendations from an expert panel for the treatment of metastatic RCC in these subpopulations. The efficacy of targeted agents appears to be inferior in these patient subgroups relative to the general RCC population. Tyrosine kinase inhibitors (TKIs) and mTOR inhibitors can be administered safely to elderly patients and those with poor performance status, although dose and schedule modifications are often needed, and close monitoring and management of adverse events is essential. In addition to local surgical treatment and radiotherapy for brain metastases, systemic treatment with a TKI should be offered as part of multidisciplinary care.While there are currently no data from randomized trials, sunitinib has the greatest body of evidence, and it should be considered the first choice in patients with a good prognosis. Patients with an acute cardiac event within the previous 6 months, New York Heart Association grade III heart failure, or uncontrolled high blood pressure should not be treated with TKIs. In patients with mild or moderate renal failure, there are no contraindications to TKI treatment. TKIs can be administered to patients undergoing dialysis, but other, less nephrotoxic agents and other alternatives should always be considered.In managing RCC among patients with non-clear cell histology, sunitinib seems to be more effective than everolimus for the papillary subtype, but there are no clear data to guide treatment for other subtypes. In conclusion, individualized treatment approaches are needed to manage RCC in subpopulations that are underrepresented in registration clinical trials.
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Affiliation(s)
- Javier Puente
- Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Álvaro Pinto
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Nuria Láinez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Ángel Arranz
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Enrique Gallardo
- Department of Medical Oncology, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - María José Méndez
- Department of Medical Oncology, Hospital Reina Sofía, Córdoba, Spain
| | - Pablo Maroto
- Department of Medical Oncology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Grande
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Suárez
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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10
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Guo F, Han T, Liu Z, Song X, Zhang Q, Kong X, Li C, Li Z, Li C, Qu S, Zheng Z, Piao Y, Han Y, Xie X. Prognostic analysis of Chinese patients with metastasis renal cell cancer receiving sorafenib: results from a multicenter long-term follow-up retrospective study. Onco Targets Ther 2015; 8:1581-8. [PMID: 26170693 PMCID: PMC4489821 DOI: 10.2147/ott.s84994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The effects of sorafenib for Chinese patients with metastatic renal cell cancer (mRCC) were evaluated to figure out the relationship between clinical variables and prognosis. The data were analyzed retrospectively from six comprehensive cancer centers in Northeast China. All cases were diagnosed as mRCC histopathologically without exception. Patients were taken 400 mg sorafenib orally twice daily until progression of disease or intolerable toxic reaction occurred. Overall survival (OS), progression-free survival (PFS), and the influence of clinical variables on survival were appointed as main outcome measures. Clinical data were analyzed using SPSS statistical software. P<0.05 was considered as statistically significant. A total of 131 patients were available for survival analysis. The median follow-up periods were 16.9 months, and the median OS and PFS were 16.1 months and 10.5 months, respectively. Univariate analysis showed that Eastern Cooperative Oncology Group performance status (ECOG PS), metastatic sites, and previous therapy were significantly associated with OS, whereas PFS was merely associated with ECOG PS and previous therapy. The multivariate analysis suggested that ECOG PS, metastatic sites, and previous therapy were the independent prognostic factors for OS, and ECOG PS and previous therapy as the independent prognostic factors for PFS. In the subgroup analysis for patients with visceral metastasis, the prognosis of patients with lung metastasis alone was better than those cases with liver metastasis alone or multiple organs metastasis. In our study, sorafenib shows a higher curative activity for patients with mRCC in Northeast China. ECOG PS, metastatic lesions, and previous therapy may be important parameters for OS and PFS prediction. Lung metastases alone may be a more sensitive indicator for sorafenib than other organ metastases.
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Affiliation(s)
- Fang Guo
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Tao Han
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Zhaozhe Liu
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Xishuang Song
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, People's Republic of China
| | - Qifu Zhang
- Department of Urology, Jilin Oncology Hospital, China-Japan Union Hospital of Jilin University, Jilin City, Jilin Province, People's Republic of China
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital of Jilin University, Jilin City, Jilin Province, People's Republic of China
| | - Changfu Li
- Department of Urology, Heilongjiang Oncology Hospital, Heilongjiang City, Heilongjiang Province, People's Republic of China
| | - Zhenhua Li
- Department of Urology, First Affiliated Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Chengge Li
- Department of Health Statistics, Shenyang Medical College, Liaoning Province, People's Republic of China
| | - Shuxian Qu
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Zhendong Zheng
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Ying Piao
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
| | - Yaling Han
- Department of Cardiology, Institute of Cardiovascular Research of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Xiaodong Xie
- Department of Oncology, Cancer Center of People's Liberation Army, General Hospital of Shenyang Military Region, Shenyang City, People's Republic of China
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11
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Fishman MN, Tomshine J, Fulp WJ, Foreman PK. A systematic review of the efficacy and safety experience reported for sorafenib in advanced renal cell carcinoma (RCC) in the post-approval setting. PLoS One 2015; 10:e0120877. [PMID: 25830512 PMCID: PMC4382117 DOI: 10.1371/journal.pone.0120877] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/05/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sorafenib was FDA approved in 2005 for treatment of renal cell carcinoma (RCC) based on the results of the pivotal phase 3 clinical trial, TARGET (Treatment Approaches in Renal Cancer Global Evaluation Trial). Since that time, numerous clinical studies have been undertaken that substantially broaden our knowledge of the use of sorafenib for this indication. METHODS We systematically reviewed PubMed, Web of Science, Embase, Cochrane Library, and www.clinicaltrials.gov for prospective clinical studies using single agent sorafenib in RCC and published since 2005. Primary endpoints of interest were progression-free survival (PFS) and safety. PROSPERO International prospective register of systematic reviews #CRD42014010765. RESULTS We identified 30 studies in which 2182 patients were treated with sorafenib, including 1575 patients who participated in randomized controlled phase 3 trials. In these trials, sorafenib was administered as first-, second- or third-line treatment. Heterogeneity among trial designs and reporting of data precluded statistical comparisons among trials or with TARGET. The PFS appeared shorter in second- vs. first-line treatment, consistent with the more advanced tumor status in the second-line setting. In some trials, incidences of grade 3/4 hypertension or hand-foot skin reaction (HFSR) were more than double that seen in TARGET (4% and 6%, respectively). These variances may be attributable to increased recognition of HFSR, or potentially differences in dose adjustments, that could be consequences of increased familiarity with sorafenib usage. Several small studies enrolled exclusively Asian patients. These studies reported notably longer PFS than was observed in TARGET. However, no obvious corresponding differences in disease control rate and overall survival were seen. CONCLUSIONS Collectively, more recent experiences using sorafenib in RCC are consistent with results reported for TARGET with no marked changes of response endpoints or new safety signals observed.
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Affiliation(s)
- Mayer N. Fishman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Jin Tomshine
- Blue Ocean Pharma LLC, Annandale, New Jersey, United States of America
| | - William J. Fulp
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Pamela K. Foreman
- Blue Ocean Pharma LLC, Annandale, New Jersey, United States of America
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12
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Jäger D, Ma J, Mardiak J, Ye D, Korbenfeld E, Zemanova M, Ahn H, Guo J, Leonhartsberger N, Stauch K, Böckenhoff A, Yu J, Escudier B. Sorafenib Treatment of Advanced Renal Cell Carcinoma Patients in Daily Practice: The Large International PREDICT Study. Clin Genitourin Cancer 2015; 13:156-64.e1. [DOI: 10.1016/j.clgc.2014.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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13
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Improved overall survival after implementation of targeted therapy for patients with metastatic renal cell carcinoma: Results from the Danish Renal Cancer Group (DARENCA) study-2. Eur J Cancer 2014; 50:553-62. [DOI: 10.1016/j.ejca.2013.10.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/20/2013] [Accepted: 10/21/2013] [Indexed: 11/19/2022]
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14
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Escudier B. Sorafenib for the management of advanced renal cell carcinoma. Expert Rev Anticancer Ther 2014; 11:825-36. [DOI: 10.1586/era.11.55] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Zustovich F, Lombardi G, Farina P. Treating patients with metastatic renal carcinoma: an escape from Phase III. Expert Rev Anticancer Ther 2014; 12:919-27. [DOI: 10.1586/era.12.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Walko CM, Grande C. Management of common adverse events in patients treated with sorafenib: nurse and pharmacist perspective. Semin Oncol 2014; 41 Suppl 2:S17-28. [PMID: 24576655 DOI: 10.1053/j.seminoncol.2014.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sorafenib, a tyrosine kinase inhibitor, is indicated for the treatment of patients with unresectable hepatocellular carcinoma (HCC) and advanced renal cell carcinoma (RCC). Sorafenib is currently being evaluated in phase II and III trials in various malignancies as a single agent (locally advanced/metastatic radioactive iodine-refractory differentiated thyroid cancer [DTC]), as part of multimodality care (HCC), and in combination with chemotherapies (metastatic breast cancer). Grade 1 and 2 adverse events (AEs) that commonly occur during treatment (ie, dermatologic manifestations, diarrhea, fatigue, and hypertension) should be proactively managed. The goal is to allow patients to remain on their full dose of sorafenib for as long as their treatment is indicated. A combination of early recognition of and intervention for AEs, patient education, and an open dialogue between patients and their multidisciplinary healthcare team, with timely reporting of AEs, will allow for effective management of AEs and minimize the need for sorafenib dose reduction or discontinuation.
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Affiliation(s)
| | - Carolyn Grande
- Nurse Practitioner, Hospital of the University of Pennsylvania, Department of Otorhinolaryngology, Philadelphia, PA.
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17
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Lee SK, Kim DJ, Lee G, Kim GS, Kwak M, Fan R. Specific rare cell capture using micro-patterned silicon nanowire platform. Biosens Bioelectron 2013; 54:181-8. [PMID: 24274988 DOI: 10.1016/j.bios.2013.10.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 12/22/2022]
Abstract
We report on the rapid and direct quantification of specific cell captures using a micro-patterned streptavidin (STR)-functionalized silicon nanowire (SiNW) platform, which was prepared by Ag-assisted wet chemical etching and a photo-lithography process. This platform operates by high-affinity cell capture rendered by the combination of antibody-epithelial cell surface-binding, biotin-streptavidin binding, and the topologically enhanced cell-substrate interaction on a 3-dimensional SiNWs array. In this work, we developed a micro-patterned nanowire platform, with which we were able to directly evaluate the performance enhancement due to nanotopography. An excellent capture efficiency of ~96.6±6.7%, which is the highest value achieved thus far for the targeting specific A549 cells on a selective area of patterned SiNWs, is demonstrated. Direct comparison between the nanowire region and the planar region on the same substrate indicates dramatically elevated cell-capture efficiency on nanotopological surface identical surface chemistry (<2% cell-capture efficiency). An excellent linear response was seen for quantifying captured A549 cells with respect to loaded cells. This study suggests that the micro-patterned STR-functionalized SiNWs platform provides additional advantage for detecting rare cells populations in a more quantitative and specific manner.
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Affiliation(s)
- Sang-Kwon Lee
- Department of Physics, Chung-Ang University, Seoul 156-756, Republic of Korea.
| | - Dong-Joo Kim
- Basic Research Laboratory (BRL), Department of Semiconductor Science and Technology, Chonbuk National University, Jeonju 561-756, Republic of Korea
| | - GeeHee Lee
- Department of Physics, Chung-Ang University, Seoul 156-756, Republic of Korea
| | - Gil-Sung Kim
- Basic Research Laboratory (BRL), Department of Semiconductor Science and Technology, Chonbuk National University, Jeonju 561-756, Republic of Korea
| | - Minsuk Kwak
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA
| | - Rong Fan
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA; Yale Comprehensive Cancer Center, New Haven, CT 06520, USA
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18
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Verzoni E, de Braud F, Fabiani F, Grassi P, Testa I, Procopio G. Patient approach in advanced/metastatic renal cell carcinoma: focus on the elderly population and treatment-related toxicity. Future Oncol 2013; 9:1599-607. [DOI: 10.2217/fon.13.150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recent therapeutic advances have changed the treatment landscape of metastatic renal cell carcinoma. Unfortunately, the seven agents now available are not based on biomarkers that would indicate which one could provide the best benefit for every patient. We have reviewed the available information concerning the impact of each treatment on comorbidities or status that are frequently seen before commencing treatment for the advanced disease: elderly and patients with cardiovascular complications, metabolic and endocrinology disorders, and infections, as well as impaired organ function (kidney, liver and heart). Additional new drugs will be launched, but no predictive biomarkers are available. Head-to-head studies to evaluate the safety of the different drugs are rare. In this quite complex scenario, we believe that a decision-making approach focused on the patient may represent a suitable strategy.
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Affiliation(s)
- Elena Verzoni
- Department of Medical Oncology, Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Francesca Fabiani
- Department of Emergency–Urgency, San Giuseppe General Hospital, Viale G. Boccaccio, Empoli (Florence), Italy
| | - Paolo Grassi
- Department of Medical Oncology, Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Isabella Testa
- Department of Medical Oncology, Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
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19
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Nelson RA, Vogelzang N, Pal SK. A gap in disease-specific survival between younger and older adults with de novo metastatic renal cell carcinoma: results of a SEER database analysis. Clin Genitourin Cancer 2013; 11:303-10. [PMID: 23647940 DOI: 10.1016/j.clgc.2013.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/11/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Consistent with other data sets, our own institutional series suggests that survival in patients aged ≥ 75 years with metastatic renal cell carcinoma (mRCC) is inferior to that in patients < 75 years. We sought to confirm these trends through exploration of the Surveillance, Epidemiology and End Results (SEER) registry. PATIENTS AND METHODS We assessed disease-specific survival (DSS) in 6204 patients with clear cell, papillary, or chromophobe mRCC diagnosed between 1992 and 2009, with the a priori hypothesis that DSS was shorter in patients aged ≥ 75 years. Analyses were further stratified by the period of diagnosis, either between 1992 and 2004 (the "cytokine era") or 2005 to 2009 (the "targeted therapy" era). Univariate and multivariate analyses were conducted to determine the association between clinicopathologic characteristics and DSS. RESULTS DSS was shorter in patients aged ≥ 75 years than in patients aged < 75 years (9 vs. 16 months; P < .0001). In patients 18 to 74 years, DSS was superior in the targeted therapy era compared with the cytokine era (P < .0001). However, in patients ≥ 75 years, no difference in DSS was noted between these periods (P = .90). On multivariate analysis, age ≥ 75 years, female sex, diagnosis during the cytokine era, node-positive disease, and absence of cytoreductive nephrectomy were independently associated with DSS. CONCLUSION DSS appears to be inferior in older adults with mRCC (specifically, patients aged ≥ 75 years). Furthermore, in contrast to their younger counterparts, no improvement in DSS was seen in older adults in the transition from the cytokine era to the targeted therapy era.
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Affiliation(s)
- Rebecca A Nelson
- Division of Biostatistics, Department of Information Science, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
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20
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Montella L, Addeo R, Cennamo G, Vincenzi B, Palmieri R, Sperlongano P, Sperlongano R, Iodice P, Russo P, Del Prete S. Sorafenib in elderly patients with advanced hepatocellular carcinoma: a case series. Oncology 2013; 84:265-72. [PMID: 23428832 DOI: 10.1159/000345558] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 09/28/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The management of hepatocellular carcinoma (HCC) in elderly patients is significantly more complicated than in younger patients because of medical comorbidities, advanced status at diagnosis, reduced liver function and altered drug pharmacokinetics. Our objective was a revision of the charts of unselected elderly patients with HCC being treated with a reduced starting dose of sorafenib. METHODS Activity, adverse events and quality of life were evaluated during the treatment. Sixty patients (47 males and 13 females) aged more than 70 years old (range 70-90, median 76 years) were retrospectively reviewed. RESULTS One complete and one partial response were achieved in the series (overall response rate 3.3%). Stable disease accounted for 76.6% (46 out of 60 patients). The disease control rate (complete plus partial response plus stable disease) was 80%. Median time to progression (TTP) was 7.0 months (95% CI, 5.2-8.7 months) and median survival was 10.0 months (95% CI, 5.0-14.9 months). Thrombosis correlated to TTP. Full doses of sora-fenib were reached in 11 out of 60 patients (18.3%). The evaluation of quality of life did not show any significant change during the study. CONCLUSIONS Sorafenib at a reduced dose can be safely used in elderly HCC patients with maintenance of activity and increased tolerability.
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Affiliation(s)
- Liliana Montella
- Unit of Medical Oncology, San Giovanni di Dio Hospital, IT–80067 Frattamaggiore, Italy.
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21
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Procopio G, Bellmunt J, Dutcher J, Bracarda S, Knox J, Brueckner A, Molnar I, Escudier B, Hutson TE. Sorafenib tolerability in elderly patients with advanced renal cell carcinoma: results from a large pooled analysis. Br J Cancer 2013; 108:311-8. [PMID: 23322192 PMCID: PMC3566810 DOI: 10.1038/bjc.2012.543] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 11/08/2012] [Accepted: 11/10/2012] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Elderly patients tend to be underrepresented in renal cell carcinoma (RCC) clinical trials. The Sorafenib RCC Integrated Database includes data from six clinical trials and two expanded-access studies evaluating sorafenib monotherapy in >4600 patients with RCC. Using this database, sorafenib tolerability and treatment patterns were analysed according to age group (<55, 55-<65, 65-<75, or ≥ 75 years). METHODS Dosing patterns, and incidence, prevalence and cumulative incidence of drug-related adverse events (DRAEs) and fatal DRAEs were assessed. RESULTS Overall, 4684 patients were evaluable (<55 years, n=1126; 55-<65, n=1579; 65-<75, n=1382; ≥ 75, n=559). Treatment patterns were generally similar across subgroups, although sorafenib treatment duration was ∼30% shorter in the ≥ 75-years subgroup. There were no substantial differences in any-grade DRAEs with sorafenib between subgroups. Drug-related adverse events and dose modifications due to DRAEs tended to occur in months 0-3 and declined thereafter; there was no evidence of cumulative toxicity. Fatal DRAEs were rare (0.7% overall; 95% confidence interval, 0.5-1.0%). CONCLUSION Sorafenib was well tolerated regardless of age in a heterogeneous population of RCC patients.
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Affiliation(s)
- G Procopio
- Department of Medical Oncology 1, Fondazione IRCCS 'Istituto Nazionale Tumori', Milan, Italy.
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22
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Di Costanzo GG, Tortora R, De Luca M, Galeota Lanza A, Lampasi F, Tartaglione MT, Picciotto FP, Imparato M, Mattera S, Cordone G, Ascione A. Impact of age on toxicity and efficacy of sorafenib-targeted therapy in cirrhotic patients with hepatocellular carcinoma. Med Oncol 2013; 30:446. [PMID: 23307255 DOI: 10.1007/s12032-012-0446-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/27/2012] [Indexed: 12/17/2022]
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing worldwide and the proportion of older patients with HCC is expected to steadily rise in the next years. Sorafenib is the standard of care for patients with advanced HCC but there is a lack of detailed data on how older patients with cirrhosis tolerate this drug. Therefore, we aimed to evaluate the impact of age on the effects of sorafenib-targeted therapy in patients with HCC and cirrhosis. We analyzed a consecutive cohort of HCC patients not eligible for surgery or locoregional treatment, with Child-Pugh score ≤ 7, and an Eastern Cooperative Oncology Group performance status of 0-1, treated with sorafenib. Clinical outcomes and treatment-related adverse events (AEs) were compared between younger (< 70 years) and older (≥ 70 years) patients. Overall, 150 patients, 90 in the younger (median age 60 years) and 60 in the older (median age 72 years) group, were evaluated. Treatment duration was 4 months in both groups. The median time to progression and overall survival were longer in older than in younger group (12 vs. 8 months and 16 vs. 12 months, respectively), although the differences did not reach a statistical significance. Grade 3-4 AEs were more frequently observed in younger than in older group (15.7 vs. 9.2 %, respectively; p = .0146). In field practice, sorafenib treatment in elderly patients with cirrhosis and HCC resulted at least as effective and safe as in younger patients. However, severe AEs occurred more frequently in younger patients.
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23
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Management of adverse events of targeted therapies in normal and special patients with metastatic renal cell carcinoma. Cancer Metastasis Rev 2012; 31 Suppl 1:S19-27. [PMID: 22821550 DOI: 10.1007/s10555-012-9355-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Treatment options for metastatic renal cell carcinoma (mRCC) have evolved very rapidly, as reflected by the approval of the many drugs that have shown efficacy in phase III studies. Approved drugs include tyrosine kinase inhibitors (TKI) such as sunitinib, sorafenib and pazopanib, vascular endothelial growth factor inhibitors such as bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors such as temsirolimus and everolimus. These biological agents have toxicity profiles that differ from those accompanying current chemotherapeutic agents, but their novelty leads to a lack of exhaustive clinical data regarding related adverse events (AEs), whose symptoms may overlap with those of the chronic illnesses of patients with mRCC such as hypertension, hyperglycemia, and pneumonitis. Hypertension, hypothyroidism, hand-foot syndrome, and fatigue are AEs frequently associated with TKIs; whereas immunosuppression, stomatitis, metabolic alterations, and non-infectious pneumonitis are AEs of mTOR inhibitors. Recommendations for treating these adverse events in patients with mRCC are usually the same as those for the general population. Mild to moderate toxicities may be managed with supportive and pharmacologic interventions, but higher-grade toxicities usually require external specialist consultation, dose reductions, and treatment interruption or discontinuation. Some groups of patients with mRCC, such as frail, elderly patients, and patients with renal or liver dysfunction, require special management of AEs.
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Procopio G, Verzoni E, Testa I, Nicolai N, Salvioni R, Debraud F. Experience with sorafenib in the treatment of advanced renal cell carcinoma. Ther Adv Urol 2012; 4:303-13. [PMID: 23205057 PMCID: PMC3491759 DOI: 10.1177/1756287212457216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The molecular-targeted agent sorafenib is the first anticancer agent able to slow the progression of advanced/metastatic renal cell carcinoma, a tumor that was formerly refractory to conventional therapy. Experience from everyday clinical practice and investigations exploring the suitability of this agent for patients with harmful pathological conditions has extended the use of sorafenib to other settings of renal cell carcinoma and to particular risk populations. The aim of this review is to provide evidence on the most effective and safe use of sorafenib. The review pays particular attention to patients who have several comorbidities, such as impaired renal and cardiac function, and older patients whose frailty due to impaired organ function necessitates the most careful administration of targeted antineoplastic agents.
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Affiliation(s)
- Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via G. Venezian, Milan 1-20133, Italy
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25
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Edeline J, Vauléon E, Rioux-Leclercq N, Perrin C, Bensalah CVK, Laguerre B. Safety and Efficacy of Sorafenib in Renal Cell Carcinoma. CANCER GROWTH AND METASTASIS 2012. [DOI: 10.4137/cgm.s7526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article reviews data on sorafenib use in renal cell carcinoma. Mechanisms of actions and pharmacokinetics are briefly described. Major clinical trials are presented, summarizing efficacy and safety of sorafenib. Its place in current treatment of renal cell carcinoma is discussed. Sorafenib is likely to remain one of the mainstays of RCC treatment in coming years.
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Affiliation(s)
- Julien Edeline
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | - Elodie Vauléon
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
| | - Nathalie Rioux-Leclercq
- CHU Pontchaillou, Pathology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | - Christophe Perrin
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
- CNRS/UMR 6061, IFR140, Rennes1 University, France
| | | | - Brigitte Laguerre
- Eugene Marquis Comprehensive Cancer Center, Medical Oncology Department, Rennes, France
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26
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Zustovich F, Lombardi G, Nicoletto O, Pastorelli D. Second-line therapy for refractory renal-cell carcinoma. Crit Rev Oncol Hematol 2012; 83:112-22. [DOI: 10.1016/j.critrevonc.2011.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 04/26/2011] [Accepted: 08/26/2011] [Indexed: 01/06/2023] Open
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Early detection, prevention and management of cutaneous adverse events due to sorafenib: Recommendations from the Sorafenib Working Group. Crit Rev Oncol Hematol 2012; 82:378-86. [DOI: 10.1016/j.critrevonc.2011.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/11/2011] [Accepted: 08/17/2011] [Indexed: 11/18/2022] Open
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28
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Yuen JSP, Sim MY, Sim HG, Chong TW, Lau WKO, Cheng CWS, Ong RW, Huynh H. Combination of the ERK inhibitor AZD6244 and low-dose sorafenib in a xenograft model of human renal cell carcinoma. Int J Oncol 2012; 41:712-20. [PMID: 22641227 DOI: 10.3892/ijo.2012.1494] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/23/2012] [Indexed: 11/06/2022] Open
Abstract
Sorafenib, a multikinase inhibitor, is currently used as monotherapy for advanced renal cell carcinoma (RCC). However, adverse effects associated with its use have been experienced by some patients. In this study, we examined the antitumor and antiangiogenic activities of low-dose sorafenib in combination with the MEK inhibitor AZD6244 (sorafenib/AZD6244) in a preclinical model of RCC. Primary RCC 08-0910 and RCC 786-0 cells as well as patient-derived RCC models were used to study the antitumor and antiangiogenic activities of sorafenib/AZD6244. Changes of biomarkers relevant to angiogenesis and cell cycle were determined by western immunoblotting. Microvessel density, apoptosis and cell proliferation were analyzed by immunohistochemistry. Treatment of RCC 786-0 cells with sorafenib/AZD6244 resulted in G1 cell cycle arrest and blockade of serum-induced cell migration. Sorafenib/AZD6244 induced apoptosis in primary RCC 08-0910 cells at low concentrations. In vivo addition of AZD6244 to sorafenib significantly augmented the antitumor activity of sorafenib and allowed dose reduction of sorafenib without compromising its antitumor activity. Sorafenib/AZD6244 potently inhibited angiogenesis and phosphorylation of VEGFR-2, PDGFR-β and ERK, p90RSK, p70S6K, cdk-2 and retinoblastoma. Sorafenib/AZD6244 also caused upregulation of p27, Bad and Bim but downregulation of survivin and cyclin B1. These resulted in a reduction in cellular proliferation and the induction of tumor cell apoptosis. Our findings showed that AZD6244 and sorafenib complement each other to inhibit tumor growth. This study provides sound evidence for the clinical investigation of low-dose sorafenib in combination with AZD6244 in patients with advanced RCC.
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Affiliation(s)
- John Shyi Peng Yuen
- Department of Urology, Singapore General Hospital, Singapore, Republic of Singapore
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29
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Wada Y, Takahashi W, Kawano Y, Eto M. Current status of pharmacotherapy against metastatic renal cell carcinoma in Japan. Int J Urol 2012; 19:284-95. [DOI: 10.1111/j.1442-2042.2012.02962.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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30
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Procopio G. Role of sorafenib in renal cell carcinoma: focus on elderly patients. Expert Rev Anticancer Ther 2012; 11:1689-92. [PMID: 22050017 DOI: 10.1586/era.11.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mounting evidence suggests that, in order to optimize therapeutic benefits, it is important to consider the range of parameters and characteristics relevant to each individual patient. Of note, the six targeted therapies currently approved for the treatment of advanced/metastatic renal cell carcinoma have not been evaluated in all relevant settings and in all prognostic groups. Among different agents currently licensed for the treatment of renal cell carcinoma, sorafenib was the first therapy to show improvements in progression-free survival and overal survival in Phase III trials. This article will discuss the current role of sorafenib in the treatment of elderly patients with renal cell carcinoma.
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Affiliation(s)
- Giuseppe Procopio
- Fondazione Istituto Nazionale Tumori, Via G Venezian 1, 20133 Milan, Italy.
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Hurria A, Browner IS, Cohen HJ, Denlinger CS, deShazo M, Extermann M, Ganti AKP, Holland JC, Holmes HM, Karlekar MB, Keating NL, McKoy J, Medeiros BC, Mrozek E, O'Connor T, Petersdorf SH, Rugo HS, Silliman RA, Tew WP, Walter LC, Weir AB, Wildes T. Senior adult oncology. J Natl Compr Canc Netw 2012; 10:162-209. [PMID: 22308515 PMCID: PMC3656650 DOI: 10.6004/jnccn.2012.0019] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pal SK, Vanderwalde A, Hurria A, Figlin RA. Systemic therapies for metastatic renal cell carcinoma in older adults. Drugs Aging 2011; 28:635-49. [PMID: 21812499 PMCID: PMC5333645 DOI: 10.2165/11592880-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The introduction of targeted therapies has radically changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). However, multiple clinical dilemmas have emerged. For instance, limited data are available to juxtapose the safety and efficacy profile of targeted therapies between older and younger adults. Herein, pivotal trials of vascular endothelial growth factor (VEGF)- and mammalian target of rapamycin (mTOR)-directed therapies are assessed in the context of their implications in treating older adults with mRCC. In general, subset analyses from these pivotal studies suggest similar efficacy of targeted therapies amongst older adults. Aging is accompanied by a multitude of physiological changes, as well as an increased prevalence of co-morbidities. The age-related toxicity profiles of targeted agents for mRCC are detailed to provide a framework for the risks and benefits of these therapies in older adults. Ultimately, tools such as the Comprehensive Geriatric Assessment (CGA) that account for physiological (as opposed to chronological) age may prove useful in the evaluation and treatment of older adults with mRCC.
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Affiliation(s)
- Sumanta K. Pal
- Division of Genitourinary Malignancies, Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ari Vanderwalde
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Arti Hurria
- Department of Medical Oncology & Experimental Therapeutics, Cancer Control and Population Sciences Program, and Cancer and Aging Research Program, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Robert A. Figlin
- Department of Medicine, Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
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Toxicities of Targeted Therapy and Their Management in Kidney Cancer. Eur Urol 2011; 59:526-40. [DOI: 10.1016/j.eururo.2011.01.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 01/03/2011] [Indexed: 01/13/2023]
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Simoens S. Sorafenib for advanced renal cell carcinoma in real-life practice: a literature review. Health (London) 2011. [DOI: 10.4236/health.2011.32016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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