Phase 3 trial of everolimus for metastatic renal cell carcinoma: Final results and analysis of prognostic factors

Robert J. Motzer, Bernard Escudier, Stephane Oudard, Thomas E. Hutson, Camillo Porta, Sergio Bracarda, Viktor Grünwald, John A. Thompson, Robert A. Figlin, Norbert Hollaender, Andrea Kay, Alain Ravaud

Research output: Contribution to journalArticle

Abstract

BACKGROUND: A phase 3 trial demonstrated superiority at interim analysis for everolimus over placebo in patients with metastatic renal cell carcinoma (mRCC) progressing on vascular endothelial growth factor receptor-tyrosine kinase inhibitors. Final results and analysis of prognostic factors are reported. METHODS: Patients with mRCC (N = 416) were randomized (2:1) to everolimus 10 mg/d (n = 277) or placebo (n = 139) plus best supportive care. Progression-free survival (PFS) and safety were assessed to the end of double-blind treatment. Mature overall survival (OS) data were analyzed, and prognostic factors for survival were investigated by multivariate analyses. A rank-preserving structural failure time model estimated the effect on OS, correcting for crossover from placebo to everolimus. RESULTS: The median PFS was 4.9 months (everolimus) versus 1.9 months (placebo) (hazard ratio [HR], 0.33; P <.001) by independent central review and 5.5 months (everolimus) versus 1.9 months (placebo) (HR, 0.32; P <.001) by investigators. Serious adverse events with everolimus, independent of causality, in ≥5% of patients included infections (all types, 10%), dyspnea (7%), and fatigue (5%). The median OS was 14.8 months (everolimus) versus 14.4 months (placebo) (HR, 0.87; P = .162), with 80% of patients in the placebo arm crossed over to everolimus. By the rank-preserving structural failure time model, the survival corrected for crossover was 1.9-fold longer (95% confidence interval, 0.5-8.5) with everolimus compared with placebo only. Independent prognostic factors for shorter OS in the study included low performance status, high corrected calcium, low hemoglobin, and prior sunitinib (P <.01). CONCLUSIONS: These results established the efficacy and safety of everolimus in patients with mRCC after progression on sunitinib and/or sorafenib.

Original languageEnglish
Pages (from-to)4256-4265
Number of pages10
JournalCancer
Volume116
Issue number18
DOIs
Publication statusPublished - Sep 15 2010

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Keywords

  • Everolimus
  • Metastatic renal cell carcinoma
  • Phase 3
  • Prognostic factors
  • RAD001

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Motzer, R. J., Escudier, B., Oudard, S., Hutson, T. E., Porta, C., Bracarda, S., Grünwald, V., Thompson, J. A., Figlin, R. A., Hollaender, N., Kay, A., & Ravaud, A. (2010). Phase 3 trial of everolimus for metastatic renal cell carcinoma: Final results and analysis of prognostic factors. Cancer, 116(18), 4256-4265. https://doi.org/10.1002/cncr.25219