Evaluation of second line and subsequent targeted therapies in metastatic renal cell cancer (mRCC) patients treated with first line cediranib

Authors

  • Suzanne Richter Princess Margaret Cancer Center, University of Toronto, Toronto, ON
  • Jo-An Seah Princess Margaret Cancer Center, University of Toronto, Toronto, ON
  • Gregory R Pond McMaster University, Hamilton, ON
  • Hui K Gan Austin Health, Ludwig Institute for Cancer Research, Melbourne, Australia
  • Mary J. Mackenzie London Region Cancer Program, Western University, London, ON, Canada
  • Sebastien J. Hotte Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
  • Som D. Mukherjee Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
  • Nevin Murray BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
  • Christian Kollmannsberger BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
  • Daniel Heng Tom Baker Cancer Centre, University of Alberta, Calgary, AB, Canada
  • Masoom A. Haider Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
  • Robert Halford Princess Margaret Cancer Center, University of Toronto, Toronto, ON
  • S. Percy Ivy Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, United States
  • Malcolm J. Moore Princess Margaret Cancer Center, University of Toronto, Toronto, ON
  • Srikala S. Sridhar Princess Margaret Cancer Center, University of Toronto, Toronto, ON

DOI:

https://doi.org/10.5489/cuaj.2426

Keywords:

cediranib, mRCC, second-line, sequencing

Abstract

Introduction: Pivotal phase III trials have positioned angiogenesis inhibitors as first-line therapy for the management of most advanced or metastatic renal cell carcinomas (mRCC). Approaches to second-line therapy, however, remain more controversial with respect to drug selection and drug sequencing.

Methods: In this study we evaluated mRCC patients who were initially treated on the first-line National Cancer Institute (NCI) trial with the highly potent vascular endothelial growth factor receptor tyrosine kinase inhibitor (TKI), cediranib, to determine the efficacy and tolerability of subsequent therapies.

Results: Twenty-eight (65.1%) of the 43 patients enrolled on the first-line cediranib trial were known to receive second-line therapy, most commonly sunitinib (n = 21), with 4 (14%), 2 (7%) and 1 (3%) patients receiving temsirolimus, sorafenib, and interleukin, respectively. Of these, 14 (50%) went on to have 3 or more lines of therapy. The progression-free survival (PFS) proportion (PFS) at 1 year from starting second line was 30% (14.5%–47.9%). Longer duration of first-line cediranib treatment was modestly associated with longer duration of second-line treatment (Spearman rho 0.26). Patients who discontinued cediranib for toxicity were less likely to receive second-line sunitinib.

Conclusion: In this real world evaluation, sequential use of TKIs for the management of mRCC was common. PFS with sequential TKIs was similar to observed and published results for any second-line therapy. Prior toxicity affected treatment patterns and the frequent use of at least 3 lines of therapy underscores the need for prospective sequencing trials in this disease.

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Published

2014-12-15

How to Cite

Richter, S., Seah, J.-A., Pond, G. R., Gan, H. K., Mackenzie, M. J., Hotte, S. J., Mukherjee, S. D., Murray, N., Kollmannsberger, C., Heng, D., Haider, M. A., Halford, R., Ivy, S. P., Moore, M. J., & Sridhar, S. S. (2014). Evaluation of second line and subsequent targeted therapies in metastatic renal cell cancer (mRCC) patients treated with first line cediranib. Canadian Urological Association Journal, 8(11-12), 398–402. https://doi.org/10.5489/cuaj.2426

Issue

Vol. 8 No. 11-12 (2014): CUAJ December

Section

Original Research

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