Comprehensive Cancer Centers of Nevada, Las Vegas, NV 89169, USA.
Clin Genitourin Cancer. 2013 Jun;11(2):115-20. doi: 10.1016/j.clgc.2012.09.008. Epub 2012 Oct 12.
The National Comprehensive Cancer Network (NCCN) guidelines suggest the use of inhibitors of mammalian target of rapamycin (mTOR), such as temsirolimus and everolimus, as first- and second-line therapy, respectively, for advanced or metastatic renal cell carcinoma (mRCC). However, adherence to this recommendation in clinical practice and the use of these 2 agents in mRCC is unknown.
We determined the prescribing patterns of temsirolimus and everolimus in a retrospective longitudinal cohort study of patients with mRCC receiving clinical care within The US Oncology Network. Outpatient health care use in patients with mRCC was derived for the categories of laboratory visits, acute care visits, minor procedures, radiation therapy, drug/medication use, and other services.
Among 462 patients with mRCC, 144 (31%) were treated with everolimus and 318 (69%) were treated with temsirolimus. The use of temsirolimus vs. everolimus as first-, second-, and third-line therapy was 50.7% vs. 16.7%, 30.1% vs. 42.1%, and 19.3% vs. 83.2%, respectively. Despite similarities in disease stage and demographic features, compared with temsirolimus, everolimus use was independently associated with lower use of outpatient health care resources, regardless of the line of therapy.
Notwithstanding the potential limitation that this was an observational retrospective study, our results indicate that everolimus results in substantial savings in the use of resources relative to temsirolimus. In a large geographically dispersed network of community-based oncology practices, both of these agents are used frequently outside of NCCN guidelines. A direct comparison of the efficacy and costs of everolimus vs. temsirolimus for mRCC is warranted.
美国国家综合癌症网络（NCCN）指南建议将哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂，如替西罗莫司和依维莫司，分别作为晚期或转移性肾细胞癌（mRCC）的一线和二线治疗药物。然而，在临床实践中，这种建议的遵循情况以及这两种药物在 mRCC 中的应用情况尚不清楚。
我们在 US Oncology Network 内对接受临床治疗的 mRCC 患者进行了回顾性纵向队列研究，以确定替西罗莫司和依维莫司的处方模式。mRCC 患者的门诊医疗保健使用情况来源于实验室就诊、急性护理就诊、小手术、放射治疗、药物/药物使用以及其他服务等类别。
在 462 例 mRCC 患者中，144 例（31%）接受依维莫司治疗，318 例（69%）接受替西罗莫司治疗。替西罗莫司与依维莫司作为一线、二线和三线治疗药物的使用率分别为 50.7%比 16.7%、30.1%比 42.1%和 19.3%比 83.2%。尽管疾病分期和人口统计学特征相似，但与替西罗莫司相比，无论治疗线如何，依维莫司的使用与门诊医疗资源使用量的降低独立相关。
尽管这是一项观察性回顾性研究，可能存在局限性，但我们的研究结果表明，依维莫司的使用相对于替西罗莫司可显著节省资源。在一个由社区肿瘤学实践组成的大型地理分布网络中，这两种药物经常在 NCCN 指南之外使用。依维莫司与替西罗莫司治疗 mRCC 的疗效和成本的直接比较是合理的。
