Second-line treatment after sunitinib therapy in patients with renal cell carcinoma: a comparison of axitinib and mammalian target of rapamycin inhibitors
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Satoshi Tamada1, Taro Iguchi1, Minoru Kato1, Sayaka Yasuda1, Takeshi Yamasaki1 and Tatsuya Nakatani1
1Department of Urology, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka 545–8585, Japan
Satoshi Tamada, email: [email protected]
Keywords: molecular targeted therapy; renal cell carcinoma; second-line treatment; axitinib; mammalian target of rapamycin
Received: August 06, 2018 Accepted: November 26, 2018 Published: December 11, 2018
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.
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