Targeted Oncology

, Volume 8, Issue 3, pp 203–209

The association of clinical outcome to first-line VEGF-targeted therapy with clinical outcome to second-line VEGF-targeted therapy in metastatic renal cell carcinoma patients

Authors

  • Mhd Y. Al-Marrawi
    • Taussig Cancer InstituteCleveland Clinic Foundation
  • Brian I. Rini
    • Taussig Cancer InstituteCleveland Clinic Foundation
  • Lauren C. Harshman
    • Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women’s HospitalHarvard Medical School
  • Georg Bjarnason
    • Sunnybrook Odette Cancer Centre
  • Lori Wood
    • Queen Elizabeth II Health Sciences Center
  • Ulka Vaishampayan
    • Karmanos Cancer InstituteWayne State University
  • Mary MacKenzie
    • London Health Sciences Center
  • Jennifer J. Knox
    • Princess Margaret HospitalUniversity of Toronto
  • Neeraj Agarwal
    • Division of Medical Oncology, Huntsman Cancer InstituteUniversity of Utah
  • Hulayel Al-Harbi
    • University of Calgary
  • Christian Kollmannsberger
    • Vancouver Cancer CenterBritish Columbia Cancer Agency
  • Min-Han Tan
    • Institute of Bioengineering and NanotechnologyNational Cancer Centre Singapore
  • Sun Young Rha
    • Yonsei Cancer CenterYonsei University College of Medicine
  • Frede N. Donskov
    • Department of OncologyAarhus University Hospital
  • Scott North
    • Cross Cancer InstituteUniversity of Alberta
  • Toni K. Choueiri
    • Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women’s HospitalHarvard Medical School
    • Tom Baker Cancer CentreUniversity of Calgary
  • For the International mRCC Database Consortium
Original Research

DOI: 10.1007/s11523-012-0252-7

Cite this article as:
Al-Marrawi, M.Y., Rini, B.I., Harshman, L.C. et al. Targ Oncol (2013) 8: 203. doi:10.1007/s11523-012-0252-7

Abstract

There are many active drugs to treat metastatic renal cell carcinoma (mRCC) patients who progress through their first-line vascular endothelial growth factor (VEGF) inhibitor. Many clinicians choose a second-line VEGF inhibitor based on the type of response to first-line VEGF inhibitor, without data supporting this practice. This study was conducted to determine the association of response to second-line VEGF inhibitor with response to first-line VEGF inhibitor. All mRCC patients in participating centers of the International mRCC Database Consortium who were treated from January 2004 through June 2011 with a second-line VEGF inhibitor after failure of a different first-line VEGF inhibitor were retrospectively identified. The primary outcome is objective response rate (ORR) and the secondary outcome is progression-free survival (PFS) in each line of therapy. Of 1,602 total database patients, 464 patients received a first- and second-line VEGF inhibitor. The ORR to first-line therapy was 22 %, and the ORR to second-line therapy was 11 %. The ORR to second-line therapy was not different among patients achieving partial response versus stable disease versus progressive disease to first-line therapy (14 % vs. 10 % vs. 11 %, respectively; chi-squared trend test p = 0.17). The median PFS on first-line VEGF-targeted therapy was 7.5 months (95 % CI, 6.6–8.1), and the median PFS on second-line VEGF inhibitor was 3.9 months (95 % CI, 3.6–4.5). There was no correlation between first-line and second-line PFS (Pearson correlation coefficient 0.025; p = 0.59). The clinical response to a second-line VEGF inhibitor is not dependent on response to the first-line VEGF-inhibitor. Further studies are needed to define clinical parameters that predict response to second-line therapy to optimize the sequence of VEGF-targeted therapy in metastatic RCC patients.

Keywords

Association of TKIsFirst-line and second-line VEGF inhibitorsRenal cell cancerTyrosine kinase inhibitorsVEGF-targeted therapy

Copyright information

© Springer-Verlag France 2013