Abstract
This retrospective study compared the outcomes of sequential therapy using sunitinib followed by axitinib or the mammalian target of rapamycin (mTOR) inhibitors (everolimus or temsirolimus). Among 234 patients treated with molecular-targeted drugs for metastatic renal cell carcinoma, we selected 137 patients treated with sunitinib as the first-line therapy. We then compared patients treated with axitinib (n = 52) or mTOR inhibitors (n = 31), as the second-line treatment, and investigated the progression-free survival (PFS) and overall survival (OS). The PFS of axitinib-treated patients (median 8.7 months) was superior to that of mTOR inhibitors-treated patients (median 3.4 months; P = 0.001). Additionally, the OS from baseline of axitinib-treated patients (median 69 months) was superior to that of mTOR inhibitors-treated patients (median 33.4 months; P = 0.034). A multivariate analysis was performed with the following factors: the drugs used for the second-line treatment, the Memorial Sloan Kettering Cancer Center risk classification during the initial treatment, whether the discontinuation of the first-line treatment was due to adverse events, and whether the duration of response of the first-line treatment was less than 6 or 12 months. Importantly, the drugs used for the second-line treatment and Memorial Sloan Kettering Cancer Center risk classification were independent factors. Our findings suggest that axitinib works better than mTOR inhibitors after the first-line treatment with sunitinib.
Highlights
The replacement of cytokines with moleculartargeted drugs has achieved prolongation of overall survival (OS) in the treatment of metastatic renal cell carcinoma [1, 2]
A multivariate analysis was performed with the following factors: the drugs used for the second-line treatment, the Memorial Sloan Kettering Cancer Center risk classification during the initial treatment, whether the discontinuation of the first-line treatment was due to adverse events, and whether the duration of response of the first-line treatment was less than 6 or 12 months
Among 234 patients treated with moleculartargeted drugs for metastatic renal cell carcinoma (mRCC), 137 patients were treated with sunitinib as the first-line therapy
Summary
The replacement of cytokines with moleculartargeted drugs has achieved prolongation of overall survival (OS) in the treatment of metastatic renal cell carcinoma (mRCC) [1, 2]. Sequential therapy using these drugs has been studied and has been reported that prognosis was better when sunitinib was switched to sorafenib, rather than to temsirolimus. In Japan, it is a common practice to use sunitinib as the first-line treatment, followed by axitinib [10]. This is supported by the AXIS trial that demonstrated the contribution of axitinib to the prolongation of progression-free survival (PFS) was higher than that of sorafenib as the second-line treatment following sunitinib [11]. We conducted this study to compare the outcomes of the sequential therapy that used sunitinib followed by either axitinib or mTOR inhibitors and clarify the outcomes of sequential therapy in the real-world setting
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