Jonasch Eric, Signorovitch James E, Lin Peggy L, Liu Zhimei, Culver Ken, Pal Sumanta K, Scott Jeffrey A, Vogelzang Nicholas J
MD Anderson Cancer Center , Houston, TX , USA.
Curr Med Res Opin. 2014 Oct;30(10):2041-50. doi: 10.1185/03007995.2014.938730. Epub 2014 Jul 9.
Vascular endothelial growth factor (VEGF) inhibitors, including targeted therapy with tyrosine kinase inhibitors (TKIs) and the angiogenesis inhibitor bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors are now the standard of care for metastatic renal cell carcinoma (mRCC). However, real-world treatment patterns are not well characterized.
To describe treatment patterns during the first, second, and third lines of targeted therapies for mRCC among community oncologists in the US.
Participating physicians recruited from a nationwide panel each identified up to 15 adult mRCC patients who initiated a second therapy after January 2010. Information extracted from medical records included types of targeted therapies, reasons for treatment choices, patterns of treatment discontinuation, and dose adjustments.
Thirty-six physicians contributed charts from 433 mRCC patients. Seventy-seven percent of patients received a VEGF inhibitor as first targeted therapy; 23% received an mTOR inhibitor. Among first-line VEGF users, second-line treatments were 66% mTOR and 34% VEGF inhibitors. Among first-line mTOR users, second-line treatments were 94% VEGF and 6% mTOR inhibitors. Sunitinib followed by everolimus was the most commonly used treatment sequence. Estimated median duration for second targeted therapy was 8.6 months, and median overall survival (OS) and progression-free survival (PFS) were 27.4 and 10.8 months, respectively. Efficacy, treatment guidelines and mechanism of action were the most important considerations for treatment choice.
LIMITATIONS include no adjustment for baseline characteristics, possible difference between physician-defined progression and central review in the clinical trial setting, and limited data availability for axitinib during the study period.
In this large retrospective chart review among community oncologists, VEGF-mTOR-VEGF was the most common treatment sequence for mRCC. The most common drugs were sunitinib in the first line and everolimus in the second line.
血管内皮生长因子（VEGF）抑制剂，包括酪氨酸激酶抑制剂（TKIs）靶向治疗和血管生成抑制剂贝伐单抗，以及哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂，目前是转移性肾细胞癌（mRCC）的标准治疗方案。然而，实际治疗模式尚未得到充分描述。
描述美国社区肿瘤医生对mRCC进行一线、二线和三线靶向治疗期间的治疗模式。
从全国性专家小组招募的参与医生，每人识别出最多15例在2010年1月后开始接受二线治疗的成年mRCC患者。从医疗记录中提取的信息包括靶向治疗类型、治疗选择原因、治疗中断模式和剂量调整。
36名医生提供了433例mRCC患者的病历。77%的患者接受VEGF抑制剂作为一线靶向治疗；23%接受mTOR抑制剂。在一线使用VEGF的患者中，二线治疗为66%使用mTOR抑制剂和34%使用VEGF抑制剂。在一线使用mTOR的患者中，二线治疗为94%使用VEGF抑制剂和6%使用mTOR抑制剂。舒尼替尼后接依维莫司是最常用的治疗顺序。二线靶向治疗的估计中位持续时间为8.6个月，中位总生存期（OS）和无进展生存期（PFS）分别为27.4个月和10.8个月。疗效、治疗指南和作用机制是治疗选择时最重要的考虑因素。
局限性包括未对基线特征进行调整、医生定义的疾病进展与临床试验环境中的中心评估可能存在差异，以及研究期间阿昔替尼的数据可用性有限。
在这项针对社区肿瘤医生的大型回顾性病历审查中，VEGF-mTOR-VEGF是mRCC最常见的治疗顺序。最常用的药物是一线的舒尼替尼和二线的依维莫司。
