Tamaskar Ila, Garcia Jorge A, Elson Paul, Wood Laura, Mekhail Tarek, Dreicer Robert, Rini Brian I, Bukowski Ronald M
Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2008 Jan;179(1):81-6; discussion 86. doi: 10.1016/j.juro.2007.08.127. Epub 2007 Nov 12.
Antiangiogenic therapy with sunitinib and sorafenib has become the standard of care for patients with advanced renal cell carcinoma. However, the clinical benefit of these agents after prior antiangiogenic therapy has not been defined. Currently, several agents with a putative antiangiogenic mechanism exist and they are often being used in sequence with little to no data regarding activity in a second line or later setting.
Patients with advanced renal cell carcinoma currently being treated with either sunitinib or sorafenib after receiving 1 or more prior antiangiogenic agent(s) were investigated in a retrospective analysis. Time to progression and the overall response rate by Response Evaluation Criteria in Solid Tumors were evaluated.
Thirty patients receiving current sunitinib (16 patients) or sorafenib (14 patients) were identified. Patients received 1 or more prior antiangiogenic therapies: thalidomide, lenalidomide, bevacizumab, volociximab, AG13736, sorafenib or sunitinib. Of 16 patients treated with sunitinib 13 had some degree of tumor shrinkage, including 9 with a partial response by Response Evaluation Criteria in Solid Tumors. Of 14 patients treated with sorafenib 10 had some degree of tumor shrinkage, including 1 with a partial response. The median time to progression for the entire cohort was 10.4 months.
Significant antitumor activity is observed when sorafenib or sunitinib are used in patients who have failed prior therapy with an antiangiogenic agent. Prior response to an antiangiogenic agent does not appear to predict subsequent clinical benefit to either sunitinib or sorafenib.
舒尼替尼和索拉非尼的抗血管生成疗法已成为晚期肾细胞癌患者的标准治疗方案。然而，这些药物在先前接受抗血管生成治疗后的临床获益尚未明确。目前，有几种具有假定抗血管生成机制的药物，它们经常被相继使用，但关于二线或更晚期治疗活性的数据很少或几乎没有。
对在接受1种或更多种先前抗血管生成药物治疗后目前正在接受舒尼替尼或索拉非尼治疗的晚期肾细胞癌患者进行回顾性分析。根据实体瘤疗效评价标准评估疾病进展时间和总缓解率。
确定了30例目前正在接受舒尼替尼（16例）或索拉非尼（14例）治疗的患者。患者接受了1种或更多种先前的抗血管生成治疗：沙利度胺、来那度胺、贝伐单抗、沃罗昔单抗、AG13736、索拉非尼或舒尼替尼。在接受舒尼替尼治疗的16例患者中，13例有一定程度的肿瘤缩小，其中9例根据实体瘤疗效评价标准达到部分缓解。在接受索拉非尼治疗的14例患者中，10例有一定程度的肿瘤缩小，其中1例达到部分缓解。整个队列的中位疾病进展时间为10.4个月。
在先前抗血管生成药物治疗失败的患者中使用索拉非尼或舒尼替尼时，观察到显著的抗肿瘤活性。先前对抗血管生成药物的反应似乎不能预测随后使用舒尼替尼或索拉非尼的临床获益。
