Vascular endothelial growth factor (VEGF)-targeted therapies are standard treatment for metastatic renal cell carcinoma (mRCC); however, toxicities can lead to drug discontinuation, which can affect patient outcomes.
This study was aimed at identifying risk factors for toxicity and constructing the first model to predict toxicity-related treatment discontinuation (TrTD) in mRCC patients treated with VEGF-targeted therapies.
The baseline characteristics, treatment outcomes, and toxicity data were collected for 936 mRCC patients receiving first-line VEGF-targeted therapy from the International Metastatic Renal Cell Carcinoma Database Consortium. A competing risk regression model was used to identify risk factors for TrTD, and it accounted for other causes as competing risks.
Overall, 198 (23. 8%) experienced TrTD. Sunitinib was the most common VEGF-targeted therapy (77%), and it was followed by sorafenib (18. 4%). The median time on therapy was 7. 1 months for all patients and 4. 4 months for patients with TrTD. The most common toxicities leading to TrTD included fatigue, diarrhea, and mucositis. In a multivariate analysis, significant predictors for TrTD were a baseline age ≥60 years, a glomerular filtration rate (GFR)
In the largest series to date, age, GFR, number of metastatic sites, and baseline sodium level were found to be independent risk factors for TrTD in mRCC patients receiving VEGF-targeted therapy. Based on the number of risk factors present, a model for predicting TrTD was built to be used as a tool for toxicity monitoring in clinical practice. Cancer 2015. © 2015 American Cancer Society.
Cancer. 2015 Nov 05 [Epub ahead of print]
Marina D Kaymakcalan, Wanling Xie, Laurence Albiges, Scott A North, Christian K Kollmannsberger, Martin Smoragiewicz, Nils Kroeger, J Connor Wells, Sun-Young Rha, Jae Lyun Lee, Rana R McKay, André P Fay, Guillermo De Velasco, Daniel Y C Heng, Toni K Choueiri
Dana-Farber Cancer Institute, Boston, Massachusetts. , Dana-Farber Cancer Institute, Boston, Massachusetts. , Dana-Farber Cancer Institute, Boston, Massachusetts. , Department of Medicine, Cross Cancer Institute, Edmonton, Canada. , British Columbia Cancer Agency, Vancouver, Canada. , British Columbia Cancer Agency, Vancouver, Canada. , Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada. , Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada. , Yonsei University College of Medicine, Seoul, Korea. , Asan Medical Center, Seoul, Korea. , Dana-Farber Cancer Institute, Boston, Massachusetts. , Dana-Farber Cancer Institute, Boston, Massachusetts. , Dana-Farber Cancer Institute, Boston, Massachusetts. , Department of Medicine, Cross Cancer Institute, Edmonton, Canada. , Dana-Farber Cancer Institute, Boston, Massachusetts.