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Treatment, Outcome and Prognostic Factors in Renal Cell Carcinoma - A Single Center Study (2000-2010)
Christof Achermann1, Frank Stenner1, Sacha I Rothschild1
1Department of Internal Medicine, Clinic of Medical Oncology, University Hospital Basel, Switzerland.
Abstract:
In Switzerland efficient availability of novel drugs for renal cell cancer (RCC) has been granted early. Since the advent of the targeted agents for RCC the usage of these drugs has been reported to improve progression free survival. Here, we find that patients who are able to receive sequential targeted therapy, including tyrosine kinase inhibitors (TKI) and mTOR inhibitors (mTORi), have a largely better outcome than those who have less exposure to these agents. The value of the prognostic scores developed by Motzer and Heng is fully reflected by the outcomes according to prognostic risk groups in our unselected patient cohort. Also, the use of surgical intervention appears to be an important prognostic factor, however with a somehow diminished effect by novel systemic therapies. The importance of multiple lines of targeted therapies is underlined by this retrospective analysis. For patients with metastatic RCC not receiving targeted therapy the median OS was 22.6 months compared to those with one TKI 25.4 months. Patients receiving a second-line therapy (median overall survival 27.6 months) and those patients with three or more lines of therapy (43.8 months) have the greatest benefit. Also, exposure to a mTORi improves survival versus non-exposure to mTORi (63.3 vs. 22.3 months, p=0.038). In conclusion a trend towards improved survival is confirmed for an unselected population when the full variety of therapeutic options is available and can be used for the individual patient.
Insights
Sequential targeted therapy, including tyrosine kinase inhibitors (TKI) and mTOR inhibitors (mTORi), significantly improves outcomes for renal cell cancer (RCC) patients. Multiple lines of therapy offer the greatest survival benefit in metastatic RCC.
Area of Science:
- Oncology
- Pharmacology
Background:
- Novel targeted therapies have improved progression-free survival in renal cell cancer (RCC).
- Early availability of these novel drugs in Switzerland facilitated their use in clinical practice.
Purpose of the Study:
- To evaluate the impact of sequential targeted therapy on patient outcomes in metastatic renal cell cancer (mRCC).
- To assess the benefit of multiple lines of therapy, including tyrosine kinase inhibitors (TKI) and mTOR inhibitors (mTORi).
Main Methods:
- Retrospective analysis of an unselected patient cohort in Switzerland.
- Evaluation of outcomes based on the number of targeted therapy lines received.
- Comparison of overall survival (OS) between patients with varying exposure to TKIs and mTOR inhibitors.
Main Results:
- Patients receiving sequential targeted therapy, especially multiple lines, demonstrated significantly better overall survival.
- Median OS increased with successive lines of therapy: 22.6 months (no therapy) to 43.8 months (3+ lines).
- Exposure to mTOR inhibitors (mTORi) significantly improved survival compared to non-exposure (63.3 vs. 22.3 months).
Conclusions:
- Multiple lines of targeted therapies, including TKIs and mTOR inhibitors, are crucial for improving survival in metastatic RCC.
- The availability and utilization of a comprehensive range of therapeutic options positively impact patient survival.
- Prognostic scores remain valuable, and surgical intervention's effect is somewhat diminished by novel systemic treatments.
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