Sequential targeted therapy after pazopanib therapy in patients with metastatic renal cell cancer: Efficacy and toxicity

Joaquim Bellmunt, Francesc Pons, Abigail Foreshew, André P. Fay, Thomas Powles, Camillo Porta, Sergio Bracarda, Megan E. Lampron, Linda Cerbone, Cora N. Sternberg, Thomas E. Hutson, Toni K. Choueiri

Research output: Contribution to journalArticle

Abstract

Introduction/Background Patients with metastatic renal cell carcinoma (mRCC) in whom first-line therapies have failed might derive clinical benefit with sequential targeted agents. Limited data are available on the efficacy and toxicity of subsequent therapies after disease progression during pazopanib therapy. Patients and Methods Patients with mRCC who received subsequent systemic treatment after pazopanib treatment failure were identified across 7 institutions. Pazopanib was given as first-line therapy in 28 patients and after cytokines therapy in 7 patients. Clinical outcome and toxicity analyses of 2 sequential treatment options (anti-vascular endothelial growth factor [VEGF] or mammalian target of rapamycin inhibitor [mTORi]) is presented. Results Subsequent therapy was anti-VEGF in 22 patients and mTORi in 13. One patient who received bevacizumab and temsirolimus combination was excluded. VEGF-targeted therapies included sorafenib (n = 10), sunitinib (n = 3), bevacizumab (n = 2), cediranib (n = 4) and cabozantinib (n = 3). Patients treated with mTORi received everolimus. Median progression-free survival was 5.6 months from the start of subsequent therapy with anti-VEGF and 2.4 months with mTORi (P =.009). Overall survival (OS) was not significantly different (P =.68). Clinical benefit (including partial response and stable disease) on subsequent therapy was observed in 15 patients (64%) and 4 patients (31%) of anti-VEGF- and everolimus-treated patients, respectively (P =.021). Conclusion In this retrospective study, targeting VEGF was an effective strategy after disease progression during pazopanib treatment, although OS was not different among patients treated with VEGF or mTORi.

Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalClinical Genitourinary Cancer
Volume12
Issue number4
DOIs
Publication statusPublished - 2014

Keywords

  • mTOR inhibitor
  • Pazopanib
  • Renal cell carcinoma
  • Sequential therapy
  • VEGF-targeted therapy

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

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    Bellmunt, J., Pons, F., Foreshew, A., Fay, A. P., Powles, T., Porta, C., Bracarda, S., Lampron, M. E., Cerbone, L., Sternberg, C. N., Hutson, T. E., & Choueiri, T. K. (2014). Sequential targeted therapy after pazopanib therapy in patients with metastatic renal cell cancer: Efficacy and toxicity. Clinical Genitourinary Cancer, 12(4), 262-269. https://doi.org/10.1016/j.clgc.2014.03.002