Abstract
ABSTRACT The best sequence of targeted therapy options has not been sufficiently defined and also the significance of Cytokine (Cy) in TKI (Sorafenib-So, Sunitinib-Su) and mTOR era. The objective of this study was to describe the clinical activity of sequence options in 2nd line treatment. Methods Retrospective study of 42 patients receiving TKI or Everolimus (EV) treatment after progression on first-line therapy. Sequence of systemic targeted treatment consisted of an Cy-TKI-sequence (n = 20; Cy-So, n = 12; Cy-Su, n = 8), TKI-TKI-sequence (n = 15; Su-So, n= 11; So-Su, n = 4) or an TKI-EV-sequence (n = 7; Su-EV, n = 7). We measured response to treatment (RECIST 1.0). Progression free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method. Results Sequence treatment groups did not significantly differ by gender, MSKCC prognostic group, or ECOG PS. Best response to 2nd line therapy included CR (Su: n = 2, sequential therapy after Cy), PR (So: n = 3, after Cy) and SD (EV: n = 5, after TKI; TKI: n = 13; So: n = 5 after Cy, Su: n= 3 after So, n= 5 after Cy). The estimated 2nd line PFS was 5.2 months for EV and 5.86 months for So sequential therapy after Su, 6.56 months for So sequential Cy, 6.7 months for Su sequential therapy after So, 6.54 months for Su sequential Cy. The estimated OS was longer for the group of patients receiving the Cy-TKI-sequence (49.87 months; 95% CI:16–26 for the group Cy-So and 40.36 months; 95% CI:16–26 for the group Cy-Su) and TKI-EV sequence (40.72 months; 95%CI:32–48) than for those receiving the TKI-TKI sequence So-Su (33.36 months, 95%CI:21–62) and Su-So (16.32 months, 95%CI:13–37). However, the TKI-TKI group was characterized by a relatively short first-line PFS (6.12 months of the Su-So group to 12.37 So-Su compared to 12.8 months of the TKI-EV group) which may at least in part explain the observed OS difference. Conclusions Common sequence treatment options may have comparable efficacy in terms of PFS and response. The observed differences in OS await further confirmation in prospective randomized trials. Disclosure All authors have declared no conflicts of interest.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
