Abstract
At present there are several drugs for the treatment of advanced renal cell carcinoma (ARCC). The main objective of this work was to perform a systematic review (SR) and meta-analysis (MA) of clinical randomized studies that compared target cell therapies (TCT). SR identified clinical randomized trials that compared TCT versus interferon-alpha in the treatment of patients with ARCC. In order to analyze efficiency, it was evaluated free-survival progression (FSP), total survival (TS) and response rate (RR). In relation to first line treatment, seven studies of TCT were identified using sunitinib, sorafenib, bevacizumab and temsirolimus; and two studies with sorafenib and everolimus for second line treatment. Relative risk (RRi) of MA for FSP of first line therapies was: 0.83, CI = 0.78-0.87, I2 = 94% and p < 0.00001. Best results of RR of specific FSP among studies were: 0.38, sunitinib, CI = 0.25-0.58, bevacizumab, 0.62, CI = 0.47-0.83; and temsirolimus, 0.78, CI = 0.70-0.87. MA didn't show any benefit regarding TS of first line treatment of all analyzed drugs. As for RR significant results were: sunitinib, 3.83 CI = 2.86-5.12; bevacizumab, 2.52 CI = 1.78-3.57 and bevacizumab, 1.97 CI = 1.43-2.71. For first line treatment, sunitinib was the most effective TCT in relation to FPS; there was no alteration of TS and RR was small but significant for sunitinib and bevacizumab. Available studies could not conclude any results for second line treatments.
Highlights
The best treatment for renal tumor is surgery, especially when the tumor is located in the kidney with no lymph node involvement or metastasis
Thirteen studies were included for systematic revision analysis, divided by: first line treatment: Cella et al, 2008 (8); Escudier et al, 2007 (9), 2009 (10); 2010 (11); Hudes et al, 2007 (12); Motzer et al, 2007 (13), 2009 (14); Rini et al, 2008 (15); Rini et al, 2010 (16); Yang et al, 2010 (17) and second line treatment: Escudier et al, 2007 (18); Motzer et al, 2008 (19) and Bukowski et al, 2007 (20)
Ibju | Meta-analysis of target terapies for the treatment of metastatic renal cancer Figure 1 - Search result: systematic review
Summary
The best treatment for renal tumor is surgery, especially when the tumor is located in the kidney with no lymph node involvement or metastasis. In advanced renal cell carcinoma (ARCC), being the tumor incurable, most available treatments are palliative and the patients usually die. In those cases, the objective is to increase total survival (TS), free survival progression (FSP), response rate (RR) and quality of life (QF) of patients. Before target cell therapies (TCT) became available, interleucin-2 (IL2) and interferon-alpha (IFN-α) were the main used therapies for this disease, with low response, from 5% to 20% (1-4). TCT include sorafenib, sunitinib, bevacizumab, temsirolimus and everolimus. Sorafenib and sunitinib are oral inhibitors of tirosine-kinases. Sorafenib inhibits endothelial growth receptors (VEGF) and platelet-derived growth factors (PDGF). Sunitinib inhibits VEGF 1, 2 and 3 with antitumor and anticoagulant effects
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