Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
Cancer J. 2013 May-Jun;19(3):189-96. doi: 10.1097/PPO.0b013e318292e8a4.
To analyze the outcomes of patients with metastatic renal cell carcinoma treated with salvage-targeted therapy after progressing on high-dose interleukin (IL)-2 immunotherapy in a tertiary referral center.
A retrospective nonrandomized cohort consisting of 286 patients with metastatic renal cell carcinoma treated from 2003 to 2010 was analyzed from the University of California, Los Angeles (UCLA) Kidney Cancer database. All patients underwent cytoreductive nephrectomy, and 21 patients received salvage-targeted therapy after progression on high-dose IL-2, whereas 111 patients received targeted therapy alone. The remaining 154 patients had other treatment combinations or experimental targeted therapy agents only. Since 2003, selection of patients for high-dose IL-2 was increasingly based on clinical, pathologic, and molecular criteria (UCLA CPM criteria). Disease-specific survival was calculated from diagnosis of metastatic renal cell carcinoma.
Patients selected according to UCLA CPM criteria and treated with salvage-targeted therapy after progressing on high-dose IL-2 experienced a significantly greater disease-specific survival (median not reached) than those treated with targeted therapy alone (30 months; P = 0.004). Since 2006, all high-dose IL-2 patients met the UCLA CPM criteria and were able to receive salvage-targeted therapy upon progression. Disease-specific survival calculated from initiation of targeted therapy was comparable for patients treated with salvage-targeted therapy after progression on high-dose IL-2 (34 months) versus first-line targeted therapy (26 months; P = 0.175).
Patients selected for high-dose IL-2 based on UCLA CPM criteria and treated with salvage-targeted therapy upon progression have achieved outstanding disease-specific survival. Our data suggest a new algorithm for carefully selected patients with metastatic renal cell carcinoma based on UCLA CPM criteria to receive first-line high-dose IL-2 while reserving their option for salvage-targeted therapy with uncompromised efficacy upon progression.
分析在加利福尼亚大学洛杉矶分校（UCLA）肾癌数据库中，286 例转移性肾细胞癌患者在接受高剂量白细胞介素（IL）-2 免疫治疗进展后接受挽救性靶向治疗的结局。
对 2003 年至 2010 年期间接受治疗的转移性肾细胞癌患者的回顾性非随机队列进行了分析。所有患者均接受了细胞减灭性肾切除术，21 例患者在高剂量 IL-2 治疗进展后接受了挽救性靶向治疗，而 111 例患者仅接受了靶向治疗。其余 154 例患者采用了其他治疗组合或实验性靶向治疗药物。自 2003 年以来，高剂量 IL-2 患者的选择越来越基于临床、病理和分子标准（UCLA CPM 标准）。从转移性肾细胞癌诊断开始计算疾病特异性生存率。
根据 UCLA CPM 标准选择并在高剂量 IL-2 治疗进展后接受挽救性靶向治疗的患者，疾病特异性生存率显著更高（未达到中位数），而单独接受靶向治疗的患者则为 30 个月（P=0.004）。自 2006 年以来，所有接受高剂量 IL-2 治疗的患者均符合 UCLA CPM 标准，并能在进展时接受挽救性靶向治疗。从靶向治疗开始计算的疾病特异性生存率，在高剂量 IL-2 治疗进展后接受挽救性靶向治疗的患者与一线靶向治疗的患者（34 个月 vs. 26 个月；P=0.175）相当。
根据 UCLA CPM 标准选择并在高剂量 IL-2 治疗进展后接受挽救性靶向治疗的患者，取得了出色的疾病特异性生存率。我们的数据提示了一种新的算法，用于根据 UCLA CPM 标准精心选择转移性肾细胞癌患者，一线接受高剂量 IL-2 治疗，同时保留其在进展时进行挽救性靶向治疗的选择，而不影响疗效。
