Third-Line Sorafenib After Sequential Therapy With Sunitinib and mTOR Inhibitors in Metastatic Renal Cell Carcinoma

被引:55
作者
Di Lorenzo, Giuseppe [1 ]
Buonerba, Carlo [1 ]
Federico, Piera [1 ]
Rescigno, Pasquale [1 ]
Milella, Michele [2 ]
Ortega, Cinzia [3 ]
Aieta, Michele [4 ]
D'Aniello, Carmine [1 ]
Longo, Nicola [5 ]
Felici, Alessandra [2 ]
Ruggeri, Enzo Maria [2 ]
Palmieri, Giovannella [1 ]
Imbimbo, Ciro [5 ]
Aglietta, Massimo [3 ]
De Placido, Sabino [1 ]
Mirone, Vincenzo [5 ]
机构
[1] Univ Naples Federico II, Dipartimento Endocrinol & Oncol Clin & Mol, Naples, Italy
[2] Natl Canc Inst, Rome, Italy
[3] Inst Canc Res & Treatment, Turin, Italy
[4] UO Oncol Osped Oncol Reg, Potenza, Italy
[5] Univ Naples Federico II, Urol Clin, Naples, Italy
关键词
Sorafenib; Sequential therapy; Metastatic renal cell cancer;
D O I
10.1016/j.eururo.2010.09.008
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Sunitinib and everolimus have been approved for first-and second-line treatment, respectively, in metastatic renal cell carcinoma (mRCC). The role of sorafenib, which is approved for second-line treatment after cytokines failure, is presently to be defined. Objective: To determine whether third-line sorafenib after sequential use of sunitinib and mammalian target of rapamycin inhibitors (everolimus or temsirolimus) is feasible and effective. Design, setting, and participants: One hundred fifty medical records of patients with mRCC treated with first-line sunitinib between January 2006 and January 2010 were reviewed at four participating centers. Data regarding patients treated with the sequence sunitinib-everolimus or temsirolimus-sorafenib were extracted. Central analysis of radiographic images was performed using RECIST criteria to determine progression-free survival (PFS) and overall response rate (oRR) to sorafenib treatment. Measurements: PFS and oRR to sorafenib were the primary end points. Secondary outcomes were safety and overall survival (OS). Results and limitations: Thirty-four patients were eligible for the study. A median PFS of 4 mo (range: 3-6 mo) and a median OS of 7 mo since sorafenib treatment (range: 6-10 mo) were reported. Of the patients, 23.5% showed response to sorafenib, with an overall disease control rate (complete responses plus partial responses plus stable disease) of 44%. Selection bias, data incompleteness, and absence of study design are inevitable limitations of the study, although central review can strengthen the quality of presented data. Conclusions: Third-line sorafenib appears to be active and well tolerated in mRCC after first-line sunitinib and second-line everolimus or temsirolimus, with no patients interrupting sorafenib because of toxicity or lack of compliance. Prospective, placebo-controlled trials are completely lacking and are required in this setting. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:906 / 911
页数:6
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