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Objective response and time to progression on sequential treatment with sunitinib and sorafenib in metastatic renal
Tomas Buchler1, Tomas Pavlik, Zbynek Bortlicek
1Department of Oncology, First Faculty of Medicine, Thomayer Hospital and Charles University, Videnska 800, 140 59, Prague, Czech Republic. tomas.buchler@ftn.cz
Abstract:
Patients with metastatic renal cell carcinoma (mRCC) are often treated sequentially with targeted agents, although the optimal strategy is not known. A retrospective, registry-based study has been carried out to assess correlation between clinical response and progression-free survival in patients with mRCC treated sequentially with tyrosine-kinase inhibitors (TKIs) sunitinib and sorafenib. Data on 218 mRCC patients treated with sunitinib and sorafenib who completed therapy with both TKIs were obtained from a database of mRCC patients. Standard nonparametric methods were used to assess correlation between response, PFS and length of treatment on the two agents. A strong correlation between responses to first- versus second TKI was observed (p < 0.001). No significant association was noted between the duration of therapy with the two TKIs (p = 0.056), although there was a weak statistically significant correlation between progression-free survival times in the subgroup patients who discontinued treatment because of disease progression. In conclusion, the duration of response on first TKI is of limited value in selecting mRCC patients for sequential TKI therapy. There is a strong correlation between the types of tumour response on the first- versus the second TKI.
Insights
Sequential tyrosine-kinase inhibitor (TKI) therapy for metastatic renal cell carcinoma (mRCC) shows a strong correlation between patient responses to first- and second-line TKIs. However, response duration on the first TKI has limited value in guiding subsequent treatment selection.
Area of Science:
- Oncology
- Medical Oncology
- Clinical Research
Background:
- Metastatic renal cell carcinoma (mRCC) treatment often involves sequential targeted therapies, but optimal strategies remain unclear.
- Tyrosine-kinase inhibitors (TKIs) like sunitinib and sorafenib are commonly used in sequential regimens.
- Predicting response to subsequent TKIs based on initial treatment outcomes is an area of clinical interest.
Purpose of the Study:
- To assess the correlation between clinical response and progression-free survival (PFS) in mRCC patients receiving sequential sunitinib and sorafenib.
- To evaluate the predictive value of response to a first-line TKI for outcomes with a second-line TKI.
- To determine if treatment duration with sequential TKIs correlates with patient outcomes.
Main Methods:
- Retrospective, registry-based study analyzing data from 218 mRCC patients.
- Patients included had completed therapy with both sunitinib and sorafenib.
- Nonparametric statistical methods were employed to analyze correlations between response, PFS, and treatment duration.
Main Results:
- A strong correlation was observed between tumor response to the first-line TKI and response to the second-line TKI (p < 0.001).
- No significant association was found between the duration of therapy with either TKI and overall outcomes (p = 0.056).
- A weak but statistically significant correlation in PFS was noted in patients who discontinued treatment due to disease progression.
Conclusions:
- The duration of response to a first-line TKI is not a reliable indicator for selecting patients for sequential TKI therapy in mRCC.
- Tumor response patterns between first- and second-line TKIs are strongly correlated, suggesting potential cross-reactivity or shared response mechanisms.
- Further research is needed to optimize sequential TKI strategies in mRCC based on response correlations.