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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Anaemia is a frequent complication in cancer patients and may be multifactorial in origin. Treatment with recombinant human erythropoietin (rHuEPO) is an alternative to red blood cell transfusion. The evidence from clinical trials has established that patients with chemotherapy-induced anaemia with a haemoglobin concentration below 10 g/dl benefit from epoetin therapy. The native glycoprotein hormone consists of 165 amino acids with three N-glycosylation and one O-glycosylation sites. Epoetin and darbepoetin bind to the EPO receptor to induce intracellular signalling by the same intracellular molecules as native EPO. There are some differences in the glycosylation pattern which lead to variations in the pharmacokinetics and pharmacodynamics profiles. Pharmacokinetic and therapeutic studies have examined the use of rHuEPO administered intravenously and subcutaneously and there is accumulating evidence that the latter route has several advantages in cancer patients. After subcutaneous administration, the bioavailability of epoetin is about 20-30% and has a plasma half-life of >24 h. Darbepoetin has a longer half-life after subcutaneous administration of 48 h. The general recommendations are based on evidence from trials in which epoetin was administered 150 U/kg thrice weekly. The recommended initial dose for darbepoetin alpha is 2.25 mug/kg per week. The most serious adverse effects are hypertension, bleeding and increased risk of thrombotic complications. Caution is advised when used in patients who are at high risk for thromboembolic events. In the management of anaemic cancer patients, physicians should closely follow the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO)/American Society of Hematology (ASH) guidelines.
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Affiliation(s)
- J M Jurado García
- Servicio de Oncología Médica, Hospital Clínico Universitario Virgen de La Victoria, Málaga, Spain.
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