Tomas Buchler1, Zbynek Bortlicek2, Alexandr Poprach3, Katerina Kubackova4, Igor Kiss3, Milada Zemanova5, Ondrej Fiala6, Ladislav Dusek2, Rostislav Vyzula3, Bohuslav Melichar7. 1. Department of Oncology, Thomayer Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic. Electronic address: tomas.buchler@ftn.cz. 2. Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic. 3. Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic. 4. Department of Oncology, Motol University Hospital and Charles University Second Faculty of Medicine, Prague, Czech Republic. 5. Department of Oncology, General University Hospital and Charles University First Faculty of Medicine, Prague, Czech Republic. 6. Department of Oncology, University Hospital, Pilsen, Czech Republic. 7. Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic.
Abstract
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.
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.
Authors: Radek Lakomy; Alexandr Poprach; Zbynek Bortlicek; Bohuslav Melichar; Renata Chloupkova; Rostislav Vyzula; Milada Zemanova; Katerina Kopeckova; Marek Svoboda; Ondrej Slaby; Igor Kiss; Hana Studentova; Jaroslav Juracek; Ondrej Fiala; Jindrich Kopecky; Jindrich Finek; Ladislav Dusek; Karel Hejduk; Tomas Buchler Journal: BMC Cancer Date: 2017-12-21 Impact factor: 4.430