OBJECTIVES: The aim of the present study was to describe the efficacy and safety of everolimus in the treatment of metastatic renal cell carcinoma (mRCC) after administration of 1 vs. 2 prior tyrosine kinase inhibitors (TKIs).
PATIENTS AND METHODS: A national renal information system database was used as the data source for the retrospective study. There were 483 patients who received everolimus as the second (n = 350) or the third (n = 112) targeted agent following TKIs.
RESULTS: Median progression-free survival (PFS) from the start of everolimus in the second or the third line of targeted therapy was 6.1 months for both subgroups (P = 0.863). Median total PFS from the start of the first targeted agent to progression on the third targeted agent for patients receiving 3 lines of therapy with TKI-TKI-everolimus (n = 112) and TKI-everolimus-TKI (n = 27) sequences was 28.3 months vs. 31.3 months, respectively (P = 0.16), and there was no significant difference in overall survival. PFS on everolimus was associated with PFS on previous TKIs in patients receiving 1 but not 2 previous TKIs. Only 13% of 352 patients starting targeted therapy for mRCC in 2010 had received 3 sequential targeted agents by the data cutoff in March 2013.
CONCLUSION: PFS on everolimus correlated with PFS on TKIs in patients pretreated with 1 but not 2 TKIs. Everolimus can be deferred to the third line without loss of efficacy or increased toxicity. However, only a minority of patients with mRCC starting targeted treatment can be expected to receive third-line therapy.
Written by:
Buchler T, Bortlicek Z, Poprach A, Kubackova K, Kiss I, Zemanova M, Fiala O, Dusek L, Vyzula R, Melichar B. Are you the author?
Department of Oncology, Thomayer Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic; Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Oncology, Motol University Hospital and Charles University Second Faculty of Medicine, Prague, Czech Republic; Department of Oncology, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic; Department of Oncology, University Hospital, Pilsen, Czech Republic; Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic.
Reference: Urol Oncol. 2014 Mar 11. pii: S1078-1439(13)00509-7.
doi: 10.1016/j.urolonc.2013.12.007
PubMed Abstract
PMID: 24629497
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