免疫联合治疗进展后 VEGFR TKI 治疗转移性肾细胞癌的疗效。
The efficacy of VEGFR TKI therapy after progression on immune combination therapy in metastatic renal cell carcinoma.
机构信息
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary of London, London, UK.
出版信息
Br J Cancer. 2018 Jul;119(2):160-163. doi: 10.1038/s41416-018-0104-z. Epub 2018 May 24.
BACKGROUND
The outcome of patients who progress on front-line immune-based combination regimens (IC) including immune checkpoint inhibitors (CPI) and receive subsequent systemic therapy is unknown.
METHODS
Retrospective analysis of consecutive patients with clear-cell mRCC who progressed on one of seven clinical trials investigating an IC and received ≥1 line of subsequent VEGFR TKI therapy.
RESULTS
Thirty-three patients [median age 57 (37-77), 85% male, 73% ECOG 0] were included. For evaluable patients (N = 28), the best response to first subsequent therapy was 29% partial response, 54% stable disease, and 18% progressive disease. The median PFS (mPFS) for first subsequent therapy was 6.4 months (95% CI, 4.4-8.4); no difference in mPFS by prior type of IC (VEGFR TKI-CPI vs. CPI-CPI) was noted (p = 0.310). Significant AEs were observed in 30% of patients, more frequently transaminitis (9%).
CONCLUSIONS
VEGFR TKIs have clinical activity in mRCC refractory to IC therapy, possibly impacted by the mechanism of prior combination therapy.
背景
接受包括免疫检查点抑制剂（CPI）在内的一线免疫联合治疗方案（IC）后进展的患者的治疗结局以及接受后续系统性治疗的患者的结局尚不明确。
方法
对在七种临床试验中接受 IC 治疗后进展且随后接受≥1 线 VEGFR TKI 治疗的明确的肾细胞癌（mRCC）患者进行回顾性分析。
结果
共纳入 33 例患者[中位年龄 57（37-77）岁，85%为男性，73%为 ECOG 0 评分]。对于可评估患者（N=28），首次后续治疗的最佳反应为 29%部分缓解、54%疾病稳定和 18%疾病进展。首次后续治疗的中位无进展生存期（mPFS）为 6.4 个月（95%CI，4.4-8.4）；既往 IC 类型（VEGFR TKI-CPI 与 CPI-CPI）对 mPFS 无影响（p=0.310）。30%的患者发生了严重不良事件，更常见的是肝转氨酶升高（9%）。
结论
VEGFR TKI 对 IC 治疗耐药的 mRCC 具有临床活性，可能受先前联合治疗机制的影响。
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