881 - Sequential use of treatment options in advanced renal-cell carcinoma (RCC): a retrospective analysis of 42 patient cases

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Renal Cell Cancer
Presenter Lisa Derosa
Authors L. Derosa1, L. Galli2, A. Fontana3, E. Biasco4, R. Marconcini1, C. Cianci5, A. Farnesi1, F. Orlandi1, A. Falcone6
  • 1Polo Oncologico, Azienda Ospedaliero Universitaria S.Chiara, 56100 - Pisa/IT
  • 2Azienda Ospedaliero-universitaria Pisana, Istituto Toscano Tumori, Division of Medical Oncology, 55100 - Pisa/IT
  • 3U.o. Oncologia Medica 2 Universitaria, Azienda Ospedaliero Universitaria S.Chiara, 56100 - Pisa/IT
  • 4Azienda Ospedaliero-universitaria Pisana, Istituto Toscano Tumori, 1Division of Medical Oncology, 55100 - Pisa/IT
  • 5Istituto Toscano Tumori,, Azienda Ospedaliero-Universitaria Pisana, 55100 - Pisa/IT
  • 6Dept. Of Oncology-presidio Ospedaliero, Polo Oncologico - Azienda Ospedaliero-Universitaria Pisana - Istituto Toscano Tumori, 56126 - Pisa/IT


The best sequence of targeted therapy options has not been sufficiently defined and also the significance of Cytokine (Cy) in TKI (Sorafenib-So, Sunitinib-Su) and mTOR era. The objective of this study was to describe the clinical activity of sequence options in 2nd line treatment.


Retrospective study of 42 patients receiving TKI or Everolimus (EV) treatment after progression on first-line therapy. Sequence of systemic targeted treatment consisted of an Cy-TKI-sequence (n = 20; Cy-So, n = 12; Cy-Su, n = 8), TKI-TKI-sequence (n = 15; Su-So, n= 11; So-Su, n = 4) or an TKI-EV-sequence (n = 7; Su-EV, n = 7). We measured response to treatment (RECIST 1.0). Progression free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method.


Sequence treatment groups did not significantly differ by gender, MSKCC prognostic group, or ECOG PS. Best response to 2nd line therapy included CR (Su: n = 2, sequential therapy after Cy), PR (So: n = 3, after Cy) and SD (EV: n = 5, after TKI; TKI: n = 13; So: n = 5 after Cy, Su: n= 3 after So, n= 5 after Cy). The estimated 2nd line PFS was 5.2 months for EV and 5.86 months for So sequential therapy after Su, 6.56 months for So sequential Cy, 6.7 months for Su sequential therapy after So, 6.54 months for Su sequential Cy. The estimated OS was longer for the group of patients receiving the Cy-TKI-sequence (49.87 months; 95% CI:16–26 for the group Cy-So and 40.36 months; 95% CI:16–26 for the group Cy-Su) and TKI-EV sequence (40.72 months; 95%CI:32–48) than for those receiving the TKI-TKI sequence So-Su (33.36 months, 95%CI:21–62) and Su-So (16.32 months, 95%CI:13–37). However, the TKI-TKI group was characterized by a relatively short first-line PFS (6.12 months of the Su-So group to 12.37 So-Su compared to 12.8 months of the TKI-EV group) which may at least in part explain the observed OS difference.


Common sequence treatment options may have comparable efficacy in terms of PFS and response. The observed differences in OS await further confirmation in prospective randomized trials.


All authors have declared no conflicts of interest.