Two phase II trials (NCT00688753 and NCT00541008) reported efficacy data of sunitinib and everolimus in first-line treatment of metastatic papillary renal cell carcinoma (mpRCC). Although most patients receive sunitinib or a mammalian target of rapamycin (mTOR) inhibitor in first- and second-line treatment, the optimal strategy remained unknown.
In 23 centres of the Groupe d'Etude des Tumeurs Urogénitales group, after centralised pathological review, we analysed retrospectively progression-free survival (PFS) of patients with mpRCC treated in first-line treatment (PFS-1) with sunitinib or everolimus (primary end-point), PFS in second-line treatment (PFS-2), overall survival (OS), objective response rate, disease control rate (DCR), overall sequence and prognostic factors for OS (secondary end-points).
One hundred thirty-eight patients (119 men and 19 women), median age 62.5 years, with mpRCC type 1 (n = 24) or non-type 1 (n = 114), received first-line sunitinib (n = 107) or everolimus (n = 31). With a median follow-up of 92 months, we found no significant difference between the treatment groups in terms of PFS-1 (5.5 versus 6.2 months) and DCR (69% versus 83%). Ninety-eight patients received a second-line treatment, 69% with mTOR inhibitors after sunitinib and 100% with tyrosine kinase inhibitors after everolimus, with similar DCR (64% versus 58%), median PFS-2 (3.4 versus 4.8 months) and OS (16.0 versus 20.3 months). No factor was prognostic for PFS-1, whereas leukocytosis, anaemia and the time from diagnosis to first systemic therapy < 1 year were prognostic for OS. We found no prognostic difference between both pRCC subtypes. The International Metastatic Renal Cell Database Consortium risk factors were prognostic for OS.
Sunitinib and everolimus had similar efficacy in first-line treatment of patients with mpRCC.
European journal of cancer (Oxford, England : 1990). 2021 Oct 04 [Epub ahead of print]
Mathilde Cancel, Gaelle Fromont, Cyriac Blonz, Christine Chevreau, Nathalie Rioux-Leclercq, Brigitte Laguerre, Stéphane Oudard, Marine Gross-Goupil, Gwenaelle Gravis, François Goldwasser, Frédéric Rolland, Rémy Delva, Laura Moise, Sheik Emambux, Cécile Vassal, Sylvie Zanetta, Nicolas Penel, Aude Fléchon, Philippe Barthélémy, Carolina Saldana, Félix Lefort, Bernard Escudier, Claude Linassier, Laurence Albiges
Department of Medical Oncology, CHU Bretonneau Tours, France., Department of Pathology, CHU Bretonneau, Tours, France., Department of Medical Oncology, Institut de Cancérologie de L'Ouest, Saint-Herblain, France., Department of Medical Oncology, IUCT Oncopole - CLCC Institut Claudius Regaud, Toulouse, France., Department of Pathology, CHU Pontchaillou, Rennes, France., Department of Medical Oncology, Centre Eugène Marquis, Rennes., Department of Medical Oncology, CHU Hôpital Européen Georges Pompidou, Paris, France., Department of Medical Oncology, CHU Saint-André, Bordeaux, France., Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France., Department of Medical Oncology, CHU Hôpital Cochin, Paris., Department of Medical Oncology, Institut de Cancérologie de L'Ouest, Angers, France., Department of Medical Oncology, Centre François Baclesse, Caen, France., Department of Medical Oncology, CHU La Milétrie, Poitiers, France., Department of Medical Oncology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France., Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France., Lille University and Department of Medical Oncology, Centre Oscar Lambret, Lille, France., Department of Medical Oncology, Centre Léon Bérard, Lyon, France., Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France., Department of Medical Oncology, CHU Mondor, Créteil, France., Department of Medical Oncology, Gustave Roussy, Villejuif, France., Department of Medical Oncology, CHU Bretonneau Tours, France. Electronic address: .