Premium
Outcomes of unselected patients with metastatic clear‐cell renal cell carcinoma treated with first‐line pazopanib therapy followed by vascular endothelial growth factor receptor tyrosine kinase inhibitors or mammalian target of rapamycin inhibitors: a single institution experience
Author(s) -
Matrana Marc R.,
Bathala Tharakeswara,
Campbell Matthew T.,
Duran Cihan,
Shetty Aditya,
Teegavarapu Purnima,
Kalra Sarathi,
Xiao Lianchun,
Atkinson Bradley,
Corn Paul,
Jonasch Eric,
Tannir Nizar M.
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13374
Subject(s) - pazopanib , renal cell carcinoma , medicine , cancer research , tyrosine kinase , vascular endothelial growth factor , clear cell renal cell carcinoma , oncology , kinase insert domain receptor , tyrosine kinase inhibitor , cabozantinib , vegf receptors , sunitinib , vascular endothelial growth factor a , receptor , cancer
Objective To explore the efficacy and safety of pazopanib in a ‘real‐world’ setting in unselected patients, as data regarding unselected patients with metastatic clear‐cell renal cell carcinoma (cc RCC ) treated with first‐line pazopanib are limited. Patients and Methods We reviewed records of patients with metastatic cc RCC treated with first‐line pazopanib from 1 November 2009 through to 1 November 2012. Cox models were fitted to evaluate the association of progression‐free survival ( PFS ) and overall survival ( OS ) with patient co‐variables. Results In all, 88 patients were identified; 74 were evaluable for response: two (3%) had a complete response, 27 (36%) a partial response, 36 (49%) had stable disease and nine (12%) had progressive disease. The median PFS was 13.7 months [95% confidence interval ( CI ) 8.7–18.3]. PFS was correlated with a Karnofsky Performance Status score of <80 [hazard ratio ( HR ) 3.26, P < 0.001] and serum lactate dehydrogenase of >1.5 × upper limit of normal ( HR 3.25, P = 0.014). The median OS was 29.1 months (95% CI 20.2–not reached). The OS was correlated with brain metastasis ( HR 2.55, P = 0.009), neutrophilia ( HR 1.179, P = 0.018), and anaemia ( HR 3.51, P < 0.001). There were no treatment‐related deaths. In all, 53 patients received second‐line therapy [vascular endothelial growth factor receptor tyrosine kinase inhibitors ( VEGFR ‐ TKI ) in 22 patients, mammalian target of rapamycin inhibitors ( mTOR i) in 22 patients, and other therapy in nine patients]; the median PFS was 8.6 months (95% CI 3.3–25.7) with VEGFR ‐ TKI and 5 months (95% CI 3.5–15.2) with mTOR i ( P = 0.41); the median OS was 19.9 months (95% CI 12.9–not reached) and 14.2 months (95% CI 8.1–not reached), from initiation of second‐line VEGFR ‐ TKI or mTOR i, respectively ( P = 0.37). Conclusions In this retrospective study, first‐line pazopanib confirmed its efficacy in metastatic cc RCC . Trends for longer PFS and OS were seen with VEGFR ‐ TKI compared with mTOR i after first‐line pazopanib.