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Efficacy of targeted treatment beyond third-line therapy in metastatic kidney cancer: retrospective analysis from a large-volume cancer center.

Abstract：

INTRODUCTION/BACKGROUND:Currently, 7 agents are approved for the first- and second-line therapy for metastatic renal cell carcinoma. In contrast, data supporting their use beyond second line are limited. Here we summarize our experience in patients treated with more than 4 lines of therapy. METHODS:We retrospectively assessed the outcome of 24 patients treated at our institution with at least 4 lines of therapy. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier estimates. RESULTS:Median OS from the initiation of first-line therapy for the whole cohort is 64.7 months. Up to 96% of the patients received a tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitor (mTOR-I) within the first 3 lines of treatment. In the fourth or following lines, patients were treated with TKI, mTOR-I, bevacizumab/interferon, or experimental drugs. Seven patients continued treatment with a sixth-line agent; one has been treated up to the ninth line. Sixteen percent of the patients receiving fourth-line therapy and 13% receiving fifth-line therapy experienced a partial remission, which was independent from response to previous therapies. Median OS from fourth and fifth line was 30.8 and 26.2 months, respectively. Median PFS for fourth-line therapy was 5.8 months. No significant difference in PFS was observed for patients with disease that responded or did not respond to first-line therapy. CONCLUSION:Despite the limitations of a retrospective analysis, our study suggests that selected patients benefit from multiple lines of treatment, independent of response to first-line therapy. However, the optimal sequence of treatment with regard to later lines remains to be determined.

journal_name

Clin Genitourin Cancer

journal_title

Clinical genitourinary cancer

authors

Vallet S,Pahernik S,Höfner T,Tosev G,Hadaschik B,Duensing S,Sedlaczek O,Hohenfellner M,Jäger D,Grüllich C,Renal Cancer Center at the National Center for Tumor Diseases (NCT) Heidelberg, Germany.

doi

10.1016/j.clgc.2014.12.012

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

e145-52

issue

eissn

1558-7673

issn

1938-0682

pii

S1558-7673(14)00286-9

journal_volume

pub_type

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Efficacy of targeted treatment beyond third-line therapy in metastatic kidney cancer: retrospective analysis from a large-volume cancer center.