Abstract
Data on the outcomes of third- or fourth-line therapy for metastatic renal cell carcinoma (mRCC) are limited. The aim of our study was to evaluate the efficacy of therapy beyond the second line. We retrospectively analysed data of mRCC patients who underwent systemic therapy at Yamagata University Hospital. The best objective response (BOR), response rate (RR), and progression-free survival (PFS) were assessed for each line of treatment. To investigate the correlation between overall survival (OS) and the number of treatment lines during a patient’s lifetime, the median OS was assessed using univariate and multivariate analyses. In the first-, second-, and third-line therapies, approximately 20% of patients had long PFS of >15 months. In targeted treatments beyond the third line, only one treatment suppressed disease progression for >10 months. Among patients who died during the follow-up period, those treated with triple and quadruple lines had similar OS (42.5 months vs. 48.4 months, respectively). Multivariate analysis showed that patients with triple or more lines of therapy had better OS; however, quadruple or more lines of therapy was not an independent prognostic factor. We concluded that third-line systemic therapy could improve OS; however, fourth-line therapy could not.
Highlights
Sei Naito*, Osamu Ichiyanagi, Tomoyuki Kato, Hidenori Kanno, Takafumi Narisawa, Masayuki Kurokawa, Masaki Ushijima, Michinobu Ozawa, Mayu Yagi, Yuta Kurota, Hiroki Fukuhara, Atsushi Yamagishi, Toshihiko Sakurai, Hayato Nishida, Hisashi Kawazoe, Takuya Yamanobe & Norihiko Tsuchiya
With the increasing number of agents for metastatic renal cell carcinoma (mRCC) having been developed since the 2000s, the efficacy of sequential therapy has been demonstrated
Nivolumab was the first agent to demonstrate a superior effect on overall survival (OS) as sequential therapy[7]
Summary
Sei Naito*, Osamu Ichiyanagi, Tomoyuki Kato, Hidenori Kanno, Takafumi Narisawa, Masayuki Kurokawa, Masaki Ushijima, Michinobu Ozawa, Mayu Yagi, Yuta Kurota, Hiroki Fukuhara, Atsushi Yamagishi, Toshihiko Sakurai, Hayato Nishida, Hisashi Kawazoe, Takuya Yamanobe & Norihiko Tsuchiya. In the first-, second-, and third-line therapies, approximately 20% of patients had long PFS of >15 months. Multivariate analysis showed that patients with triple or more lines of therapy had better OS; quadruple or more lines of therapy was not an independent prognostic factor. We concluded that third-line systemic therapy could improve OS; fourth-line therapy could not. The number of novel therapies has increased, the effects of third- and fourth-line sequential therapies remain controversial[4]. This is, because the majority of patients evaluated in clinical randomised controlled trials (RCTs) received the first- or second-line therapy. Retrospective studies have suggested the efficacy of third-line therapy for improving overall survival (OS).
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