Outcomes of patients with metastatic clear-cell renal cell carcinoma treated with pazopanib after disease progression with other targeted therapies

AIM

The multi-tyrosine kinase inhibitor pazopanib prolongs progression-free survival (PFS) versus placebo in treatment-naive and cytokine-refractory metastatic clear-cell renal cell carcinoma (ccRCC). Outcomes and safety data with pazopanib after targeted therapy (TT) are limited.

METHODS

We retrospectively evaluated records of consecutive patients with metastatic ccRCC who had progressive disease (PD) after TT and received pazopanib from November 2009 through November 2011. Tumour response was assessed by a blinded radiologist using Response Evaluation Criteria In Solid Tumours (RECIST). PFS and overall survival (OS) were estimated by Kaplan-Meier methods.

RESULTS

Ninety-three patients were identified. Median number of prior TTs was 2 (range, 1-5). There were 68 events (PD or death). Among 85 evaluable patients, 13 (15%) had a partial response. Median PFS was 6.5 months (95% CI: 4.5-9.7); median OS was 18.1 months (95% CI: 10.26-NA). Common adverse events (AEs) included fatigue (44%), elevated transaminases (35%), diarrhoea (30%), hypothyroidism (18%), nausea/vomiting (17%), anorexia (14%) and hypertension exacerbation (14%); 91% of AEs were grade 1/2. Eleven patients (12%) discontinued therapy due to AEs. There were no treatment-related deaths.

CONCLUDING STATEMENT

Pazopanib demonstrated efficacy in patients with metastatic ccRCC after PD with other TTs. Toxicity overall was mild/moderate and manageable.

Everolimus-associated pneumonitis (EAP) in metastatic renal cell cancer patients (mRCC): A single-center experience

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Background: Pneumonitis is a known adverse effect (AE) of mammalian target of rapamycin-inhibitors, with a literature reported incidence for everolimus ranging from 4 to 45%. The goal of this review was to characterize the incidence, timing, management, and outcomes related to everolimus-associated pneumonitis (EAP).

Methods: Retrospective review of 86 mRCC patients (pts) with complete, evaluable records, given everolimus (E) between 4/2009 and 3/2010. We assessed baseline patient (pt) characteristics, previous therapies, time on E therapy, pt symptoms, physician management of AE, NCI-CTC pneumonitis grading, and survival outcomes. Radiologic CT indicated ground glass, inflammatory, and/or parenchymal opacities.

Results: (See table.) EAP occurred in 28% of pts on E therapy, confirmed radiologically. 8% of EAP patients reported no symptoms. In EAP pts, 58% reported cough, 75% dyspnea and/or SOB, 17% fever, 71% fatigue. The median number of symptoms/patient was 3. 46% of pts received steroids (median 21 days (3-120)), 38% received antibiotics, 25% received pulmonary consultation, and 8% required oxygen. In pts who developed EAP, providers discontinued E in 75%, held and dose reduced E in 8%, and continued E in 17%. The median NCI-CTC pneumonitis grade was 2 (1-3); there were no treatment-related deaths. The median time to EAP onset was 67 days (8-442). There was no statistically significant difference in outcomes between EAP pts and non-EAP pts.

Conclusions: EAP occurs often in mRCC pts treated with E. It is an important AE that can negatively affect pt symptoms, but did not adversely impact pt outcomes in our single-center experience.

[Table: see text]

[Table: see text]

Metastatic renal cell carcinoma treated with pazopanib after progression on other targeted agents: A single-institution experience

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Background: Pazopanib, a multityrosine kinase inhibitor (TKI), prolongs PFS compared to placebo in treatment-naive and cytokine refractory metastatic renal cell carcinoma (mRCC). No data has been reported about pazopanib salvage therapy after treatment with other targeted agents.

Methods: We retrospectively reviewed the records of 88 consecutive patients (pts) with mRCC (median age 62.7, M:F 63/25, 84% clear cell) who received salvage pazopanib between 11/09-8/10. All pts failed previous treatment with one or more targeted agents (median number of prior targeted agents was 2, range 1-5; median time on previous treatments was 632 days). 78% of pts had progressed on sunitinib, 40% on sorafenib, 20% on temsirolimus, 51% on everolimus, and 26% on bevacizumab. 26% received previous chemotherapy and 16% received previous cytokines in addition to targeted therapies. 58% failed both TKI/VEGF inhibitors and mTOR inhibitors. 57% had intermediate-risk disease and 43% had poor-risk disease by MSKCC criteria. All pts had follow-up at least every 3 months after initiating pazopanib.

Results: Median time to last follow-up was 114 days (range 30-278 days). 42% continued pazopanib at last follow- up. 25% had partial response (PR) by treating physician assessment. 50% failing 1-2 previous targeted therapies remained on pazopanib at last follow-up, compared to 27% of those failing more than 2 targeted therapies (p=0.04). 56% of pts with intermediate-risk disease by MSKCC criteria continued pazopanib at follow-up compared to 27% with poor-risk disease (p=0.002). 42% of those failing 1 prior targeted therapy achieved PR compared to 18% failing >1 prior targeted therapy (p=0.02). 35% discontinued pazopanib due to progressive disease (PD) (median time to PD 71 days, range 36-198 days), 10% discontinued due to adverse drug events, and 10% died of PD on treatment. There were no treatment related deaths.

Conclusions: In this retrospective study, pazopanib demonstrated clinically relevant activity in mRCC following PD with other targeted therapies. Mature survival data will be provided with final presentation.

No significant financial relationships to disclose.