BACKGROUND: Therapy targeted against the vascular endothelial growth factor (VEGF) pathway is a standard of care for patients with metastatic renal cell carcinoma (RCC). The identification of patients who are more likely to benefit from these agents is warranted. METHODS: In total, 120 patients with metastatic clear-cell RCC received bevacizumab, sorafenib, sunitinib, or axitinib on 1 of 9 prospective clinical trials at the Cleveland Clinic. Clinical features associated with outcome were identified by univariate analysis; then, a stepwise modeling approach based on Cox proportional hazards regression was used to identify independent prognostic factors and to form a model for progression-free survival (PFS). A bootstrap algorithm was used to provide internal validation. RESULTS: The overall median PFS was 13.8 months, and the objective response according to the Response Criteria in Solid Tumors was 34%. Multivariate analysis identified time from diagnosis to current treatment <2 years; baseline platelet and neutrophil counts >300 K/microL and >4.5 K/microL, respectively; baseline corrected serum calcium <8.5 mg/dL or >10 mg/dL; and initial Eastern Cooperative Oncology Group performance status >0 as independent, adverse prognostic factors (PF) for PFS. Three prognostic subgroups were formed based on the number of adverse prognostic factors present. The median PFS in patients with 0 or 1 adverse prognostic factor was 20.1 months compared with 13 months in patients with 2 adverse prognostic factors and 3.9 months in patients with >2 adverse prognostic factors. CONCLUSIONS: Five independent prognostic factors for predicting PFS were identified and were used to categorize patients with metastatic RCC who received VEGF-targeted therapies into 3 risk groups. These prognostic factors can be incorporated into patient care and clinical trials that use such novel, VEGF-targeted agents. (c) 2007 American Cancer Society.
BACKGROUND: Therapy targeted against the vascular endothelial growth factor (VEGF) pathway is a standard of care for patients with metastatic renal cell carcinoma (RCC). The identification of patients who are more likely to benefit from these agents is warranted. METHODS: In total, 120 patients with metastatic clear-cell RCC received bevacizumab, sorafenib, sunitinib, or axitinib on 1 of 9 prospective clinical trials at the Cleveland Clinic. Clinical features associated with outcome were identified by univariate analysis; then, a stepwise modeling approach based on Cox proportional hazards regression was used to identify independent prognostic factors and to form a model for progression-free survival (PFS). A bootstrap algorithm was used to provide internal validation. RESULTS: The overall median PFS was 13.8 months, and the objective response according to the Response Criteria in Solid Tumors was 34%. Multivariate analysis identified time from diagnosis to current treatment <2 years; baseline platelet and neutrophil counts >300 K/microL and >4.5 K/microL, respectively; baseline corrected serum calcium <8.5 mg/dL or >10 mg/dL; and initial Eastern Cooperative Oncology Group performance status >0 as independent, adverse prognostic factors (PF) for PFS. Three prognostic subgroups were formed based on the number of adverse prognostic factors present. The median PFS in patients with 0 or 1 adverse prognostic factor was 20.1 months compared with 13 months in patients with 2 adverse prognostic factors and 3.9 months in patients with >2 adverse prognostic factors. CONCLUSIONS: Five independent prognostic factors for predicting PFS were identified and were used to categorize patients with metastatic RCC who received VEGF-targeted therapies into 3 risk groups. These prognostic factors can be incorporated into patient care and clinical trials that use such novel, VEGF-targeted agents. (c) 2007 American Cancer Society.
Authors: David Cella; Joseph C Cappelleri; Andrew Bushmakin; Claudie Charbonneau; Jim Z Li; Sindy T Kim; Isan Chen; M Dror Michaelson; Robert J Motzer Journal: J Oncol Pract Date: 2009-03 Impact factor: 3.840
Authors: I Yildiz; F Sen; L Kilic; M Ekenel; C Ordu; I Kilicaslan; E Darendeliler; H M Tunc; U Varol; S Bavbek; M Basaran Journal: Curr Oncol Date: 2013-12 Impact factor: 3.677
Authors: Jenny J Kim; Susan A J Vaziri; Brian I Rini; Paul Elson; Jorge A Garcia; Robert Wirka; Robert Dreicer; Mahrukh K Ganapathi; Ram Ganapathi Journal: Cancer Date: 2011-08-31 Impact factor: 6.860
Authors: Sabine Brookman-May; Matthias May; Vincenzo Ficarra; Manuela Christine Kainz; Karin Kampel-Kettner; Stephanie Kohlschreiber; Valentina Wenzl; Meike Schneider; Maximilian Burger; Wolf F Wieland; Wolfgang Otto; Derya Tilki; Christian Gilfrich; Markus Hohenfellner; Sascha Pahernik; Thomas F Chromecki; Christian Stief; Richard Zigeuner Journal: World J Urol Date: 2012-08-19 Impact factor: 4.226