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.

Nomogram for predicting development of brain metastasis in patients with inflammatory breast cancer

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Background: Inflammatory breast cancer (IBC) is associated with poor prognosis and high rates of distant metastasis. Brain metastasis is particularly important due to its morbidity and mortality. The purpose of this study was to construct a nomogram from clinicopathological factors that could predict the risk of occurrence of brain metastasis in patients with IBC.

Methods: We performed a retrospective analysis of 406 patients with IBC, who were seen at the University of Texas M. D. Anderson Cancer Center between 1991 and 2009. Data was collected from IBC registry. Patients were divided in a randomized manner into a training cohort (n = 206) and a validation (n = 200) cohort. A multivariate cox proportional hazards regression analysis of selected prognostic features was performed on the training cohort. The model estimated in the training cohort was cross-validated with the validation cohort. Based on this model a nomogram was constructed to assess 5- and 10-year risk of developing brain metastasis.

Results: A total of 115 (28%) patients developed brain metastasis. Univariate analysis identified menopausal status, progesterone receptor expression, number of distant metastasis, adjuvant taxane-based therapy and age at diagnosis as significant factors associated with brain metastasis (p < 0.05). Subsequent multivariate analysis showed menopausal status and number of metastasis were independently associated with development of brain metastasis (p < 0.05). Nomogram constructed using above model was evaluated for its ability to discriminate among likelihood of occurrence of brain metastasis in patients, using the validation set. The validation set showed good discrimination with the area under the receiver operating characteristic curve of 0.68.

Conclusions: We have formulated a distinct predictive tool to evaluate 5 and 10-year risk for developing brain metastasis in patients with IBC. This nomogram can be potentially helpful for designing risk adapted therapeutic trials. Identifying patients at high risk for brain metastasis in IBC can help personalize therapy, surveillance, and prognostication.

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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.