Sequential TKI May Benefit Advanced Renal Cell Carcinoma Patients

For patients with metastatic clear cell renal cell carcinoma (mccRCC), administering a sequential, second-line tyrosine kinase inhibitor (TKI) may be more beneficial over a mammalian target of rapamycin inhibitor (mTORi).

These results are published in the December 2014 issue of Annals of Oncology.

Of the 241 patients with mccRCC who had received a first-line TKI for at least 6 months before discontinuing due to disease progression, toxicity, or other reasons, 118 patients went on to receive second-line treatment with a different TKI while 123 switched treatments to an mTORi. The second-line TKI was associated with improved progression-free survival (PFS) when compared with the second-line mTORi treatment, at a median of 7.9 and 5.2 months, respectively.

Reza Elaidi, from Hôpital Européen Georges Pompidou in Paris, France, and colleagues note that this benefit was mostly attributed to the subgroup of participants with an 11- to 22-month duration of first-line therapy. PFS in this subgroup was 11.2 months for second-line TKI versus 3.9 months with second-line mTORi.

While PFS was improved with a second-line TKI, the time-to-treatment failure was also much longer as well for those patients receiving sequential TKI-TKI therapy versus the TKI-mTORi sequence.

Elaidi notes that the need for clinical trials to confirm their findings is necessary." Our findings suggest that a second-line TKI might be a pragmatic and beneficial option in long-term responders to a first-line TKI (between 11 and 22 months) in whom drug toxicity is manageable."

References:

• Medwire News (2014). Metastatic RCC patients may benefit from sequential TKI strategy.