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Clinical factors associated with outcome in patients with metastatic clear‐cell renal cell carcinoma treated with vascular endothelial growth factor‐targeted therapy
Author(s) -
Choueiri Toni K.,
Garcia Jorge A.,
Elson Paul,
Khasawneh Mohamad,
Usman Saif,
Golshayan Ali Reza,
Baz Rachid C.,
Wood Laura,
Rini Brian I.,
Bukowski Ronald M.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22827
Subject(s) - medicine , sunitinib , renal cell carcinoma , bevacizumab , axitinib , oncology , sorafenib , adverse effect , vascular endothelial growth factor , proportional hazards model , performance status , clear cell renal cell carcinoma , cancer , chemotherapy , hepatocellular carcinoma , vegf receptors
BACKGROUND. Therapy targeted against the vascular endothelial growth factor (VEGF) pathway is a standard of care for patients with metastatic renal cell carcinoma (RCC). The identification of patients who are more likely to benefit from these agents is warranted. METHODS. In total, 120 patients with metastatic clear‐cell RCC received bevacizumab, sorafenib, sunitinib, or axitinib on 1 of 9 prospective clinical trials at the Cleveland Clinic. Clinical features associated with outcome were identified by univariate analysis; then, a stepwise modeling approach based on Cox proportional hazards regression was used to identify independent prognostic factors and to form a model for progression‐free survival (PFS). A bootstrap algorithm was used to provide internal validation. RESULTS. The overall median PFS was 13.8 months, and the objective response according to the Response Criteria in Solid Tumors was 34%. Multivariate analysis identified time from diagnosis to current treatment <2 years; baseline platelet and neutrophil counts >300 K/μL and >4.5 K/μL, respectively; baseline corrected serum calcium <8.5 mg/dL or >10 mg/dL; and initial Eastern Cooperative Oncology Group performance status >0 as independent, adverse prognostic factors (PF) for PFS. Three prognostic subgroups were formed based on the number of adverse prognostic factors present. The median PFS in patients with 0 or 1 adverse prognostic factor was 20.1 months compared with 13 months in patients with 2 adverse prognostic factors and 3.9 months in patients with >2 adverse prognostic factors. CONCLUSIONS. Five independent prognostic factors for predicting PFS were identified and were used to categorize patients with metastatic RCC who received VEGF‐targeted therapies into 3 risk groups. These prognostic factors can be incorporated into patient care and clinical trials that use such novel, VEGF‐targeted agents. Cancer 2007. © 2007 American Cancer Society.