Miyake Hideaki, Imai Satoshi, Tamura Keita, Sugiyama Takayuki, Furuse Hiroshi, Ozono Seiichiro, Fujisawa Masato
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
Anticancer Res. 2017 Mar;37(3):1523-1528. doi: 10.21873/anticanres.11480.
The objective of this study was to compare the efficacies of tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin inhibitor (mTORI) as second-line molecular-targeted therapy in patients with poor-risk metastatic renal cell carcinoma (mRCC).
This study included 89 consecutive patients with mRCC who were classified into a poor-risk group after the failure of first-line molecular-targeted agent and subsequently received second-line targeted therapy.
Of the 89 patients, 59 and 30 were treated with TKI and mTORI, respectively, as second-line targeted therapy, and no significant differences in the clinicopathological characteristics were noted between the TKI and mTORI groups. There was no significant difference in the response rate to the second-line agent between the TKI and mTORI groups; however, the proportion of patients with tumor shrinkage in the TKI group was significantly higher than that in the mTORI group. There was no significant difference in the progression-free survival between the TKI and mTORI groups, while the overall survival for the TKI group was significantly superior to that of the mTORI group (median of 15.0 vs. 7.6 months, respectively). Furthermore, the type of second-line agent (i.e. TKI vs. mTORI) was identified as an independent predictor of the OS, but not of PFS.
Favorable disease control might be achieved by introducing TKI as second-line targeted therapy for patients with poor-risk mRCC.
本研究的目的是比较酪氨酸激酶抑制剂（TKI）和雷帕霉素靶蛋白抑制剂（mTORI）作为高危转移性肾细胞癌（mRCC）患者二线分子靶向治疗的疗效。
本研究纳入了89例连续性mRCC患者，这些患者在一线分子靶向药物治疗失败后被分类为高危组，随后接受二线靶向治疗。
89例患者中，分别有59例和30例接受TKI和mTORI作为二线靶向治疗，TKI组和mTORI组之间的临床病理特征无显著差异。TKI组和mTORI组对二线药物的反应率无显著差异；然而，TKI组肿瘤缩小的患者比例显著高于mTORI组。TKI组和mTORI组的无进展生存期无显著差异，而TKI组的总生存期显著优于mTORI组（分别为15.0个月和7.6个月）。此外，二线药物类型（即TKI与mTORI）被确定为总生存期的独立预测因素，但不是无进展生存期的独立预测因素。
对于高危mRCC患者，引入TKI作为二线靶向治疗可能实现良好的疾病控制。
