Kim Sung Han, Suh Yoon Seok, Kim Jung Kwon, Joung Jae Young, Seo Ho Kyung, Lee Kang Hyun, Chung Jinsoo
Center for Prostate Cancer, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
Oncotarget. 2017 Oct 19;8(59):100056-100065. doi: 10.18632/oncotarget.21926. eCollection 2017 Nov 21.
To evaluate the progression-free survival (PFS) and overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) treated with double- and triple-sequence targeted therapy (TT) using tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors (mTORi).
Records of 292 patients with mRCC, treated with TT between January 2005 and July 2015, were analyzed retrospectively. Kaplan-Meier and log-rank analyses were used to calculate and compare the total PFS (tPFS) and OS when patients underwent double- or triple-TT using TKIs or mTORi.
Eighty-one (27.7%) patients who underwent second-line TT were enrolled; 30 (10.3%) of whom underwent third-line TT. The tPFS and OS of double-TT using TKI-mTORi (5.4 and 30 months, respectively) were significantly better compared with TKI-TKI (0.3 and 2 months) or mTORi-TKI (2 and 6 months) (p <0.001). For triple-TT, the tPFS and OS of TKI-mTORi-TKI (22.8 and 25 months, respectively) were significantly superior compared with those for TKI-TKI-mTORi (4 and 9 months) (p <0.05).For patients with intermediate-risk according to the Heng or Memorial Sloan-Kettering Cancer Center risk models, TKI-mTORi was associated with a significantly longer tPFS and OS compared with TKI-TKI [expect for OS in the Heng group (p = 0.086)]. For the triple TT group, TKI-mTORi-TKI resulted in improved tPFS and OS compared with TKI-TKI-TKI or TKI-TKI-mTORi (p <0.05).
In patients with mRCC, sequential administration of TKI-mTORi led to a significantly superior tPFS compared with any other TT sequence. By contrast, OS did not differ significantly according to TT sequence.
评估使用酪氨酸激酶抑制剂（TKIs）和雷帕霉素靶蛋白抑制剂（mTORi）进行双序列和三序列靶向治疗（TT）的转移性肾细胞癌（mRCC）患者的无进展生存期（PFS）和总生存期（OS）。
回顾性分析2005年1月至2015年7月间接受TT治疗的292例mRCC患者的记录。当患者使用TKIs或mTORi进行双序列或三序列TT时，采用Kaplan-Meier法和对数秩检验来计算和比较总PFS（tPFS）和OS。
81例（27.7%）接受二线TT的患者入组；其中30例（10.3%）接受三线TT。与TKI-TKI（分别为0.3个月和2个月）或mTORi-TKI（分别为2个月和6个月）相比，使用TKI-mTORi的双序列TT的tPFS和OS（分别为5.4个月和30个月）显著更好（p<0.001）。对于三序列TT，TKI-mTORi-TKI的tPFS和OS（分别为22.8个月和25个月）与TKI-TKI-mTORi（分别为4个月和9个月）相比显著更优（p<0.05）。根据Heng或纪念斯隆凯特琳癌症中心风险模型，对于中危患者，与TKI-TKI相比，TKI-mTORi的tPFS和OS显著更长[Heng组的OS除外（p=0.086）]。对于三序列TT组，与TKI-TKI-TKI或TKI-TKI-mTORi相比，TKI-mTORi-TKI的tPFS和OS有所改善（p<0.05）。
在mRCC患者中，与任何其他TT序列相比，序贯给予TKI-mTORi导致显著更优的tPFS。相比之下，OS根据TT序列无显著差异。
