Authors: Nicola Calvani Franco Morelli Vincenzo Chiuri Antonio Gnoni Claudio Scavelli Palma Fedele Laura Orlando Evaristo Maiello Vito Lorusso Saverio Cinieri
Publish Date: 2013/04/24
Volume: 30, Issue: 2, Pages: 578-
Abstract
We retrospectively analyzed metastatic renal cell carcinoma RCC patients treated with 3 targeted agents Patients started the sequence with a tyrosine kinase inhibitor TKI sunitinib or sorafenib and were divided into 2 groups based on the order in which they received the other reciprocal TKI and everolimus EVE TKI–TKI–EVE group n = 19 and TKI–EVE–TKI group n = 14 Median progressionfree survival PFS with first TKI was 13 months in the TKI–TKI–EVE group and 10 months in the TKI–EVE–TKI group PFS with the second agent showed a trend in favor of the TKI–TKI–EVE sequence with a median of 11 versus 65 months whereas median PFS with the third agent was 6 months in both groups Total PFS also showed a trend in favor of the TKI–TKI–EVE sequence with a median of 31 versus 23 months Median overall survival OS was 38 months in both groups with more patients receiving subsequent treatment in the TKI–EVE–TKI group The subgroup of patients no longterm responders ≤9 months to first TKI showed similar outcomes irrespective of the sequence The subgroup of longterm responders to first TKI 9 months who received the other TKI instead of EVE had better outcomes in terms of median PFS with the second agent 13 vs 55 months p = 00271 median total PFS 395 vs 235 months p = 00415 and median OS 46 vs 38 months In conclusion no apparent advantage was observed with early use of EVE in advanced RCC even in those patients who did not benefit long from firstline TKI whereas longterm duration of firstline TKI seems to be predictor of secondline TKI efficacy
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