Prognostic factors in second-line targeted therapy for metastatic clear-cell renal cell carcinoma after progression on an anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor.
Acta Oncol
; 55(3): 329-40, 2016.
Article
em En
| MEDLINE
| ID: mdl-26494607
ABSTRACT
BACKGROUND:
About 40% of metastatic clear-cell renal cell carcinoma (m-ccRCC) patients receive a second-line targeted therapy after failure of anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGFR-TKI). Efficacy of second-line therapy is usually limited and prognostic and predictive factors at the start of second-line therapy are lacking. To identify the subgroup of patients that will benefit from such treatment remains a challenge.METHODS:
We performed a multi-institutional, retrospective study of patients who received a second-line therapy after progression on an anti-VEGFR-TKI. Univariate and multivariate analyses were performed in order to identify prognostic factors for progressive disease (PD) as best response, progression-free survival (PFS) and overall survival (OS) on second-line therapy.RESULTS:
For the whole cohort of 108 patients, mOS from the start of second-line therapy was 8.9 months while mPFS on second-line therapy was 2.8 months. A total of 49/105 (47%) patients had PD, 50/105 (48%) stable disease (SD) and 6/105 (6%) a partial response (PR). On multivariate analysis, the following markers were associated with improved outcome on second-line therapy a PFS on first-line therapy ≥12 months (HR for PFS 1.961; p = 0.008) (HR for OS 1.724; p = 0.037) and Fuhrman grade 1-2 tumors (HR for OS 2.198; p = 0.007). Markers associated with poorer outcome on second-line therapy were elevated serum lactate dehydrogenase (LDH) levels (HR for PFS 0.511; p = 0.04) (HR for OS 0.392; p = 0.017), low albumin (HR for OS 0.392; p = 0.01) and elevated corrected calcium levels (HR for OS 0.416; p = 0.01). The impact on OS of the Memorial Sloan Kettering Cancer Centre (MSKCC) and International Renal Cell Carcinoma Database Consortium (IMDC) prognostic scores as calculated at start of second-line therapy was validated in our patient series.CONCLUSIONS:
Duration of first-line PFS, Fuhrman grade, serum LDH levels, albumin levels, corrected calcium levels and the MSKCC and IMDC scores calculated at start of second-line therapy are prognostic factors for m-ccRCC patients treated with second-line targeted therapy.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Carcinoma de Células Renais
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Terapia de Salvação
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Fator A de Crescimento do Endotélio Vascular
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Inibidores de Proteínas Quinases
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Terapia de Alvo Molecular
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Neoplasias Renais
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Recidiva Local de Neoplasia
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article