Panian Justine, Zhong Caiwei, Choi Sharon H, Ly Kristine, Quinn Roxanne, Ferrier Evan, Saad Eddy, Saliby Renee Maria, Malvar Carmel, Pal Sumanta, Ebrahimi Hedyeh, Tran Ben, Jude Evon, Lalani Aly-Khan, Suarez Cristina, Velasco Guillermo De, Kanesvaran Ravindran, Zarba Martin, Liow Elizabeth, El Hajj Chehade Razane, Choueiri Toni K, Heng Daniel Y C, McKay Rana R
Division of Hematology Oncology, University of California-San Diego, San Diego, CA, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Eur Urol Focus. 2024 Dec 7. doi: 10.1016/j.euf.2024.11.011.
Lenvatinib is a multitargeted tyrosine kinase inhibitor (TKI) used in the upfront and refractory settings for metastatic renal cell carcinoma (mRCC). However, there are limited data on the efficacy of subsequent TKI therapies after lenvatinib. We investigated the activity of TKI therapies after lenvatinib in patients with mRCC.
We conducted a retrospective analysis of data from the International Metastatic RCC Database Consortium (IMDC). Patients who received post-lenvatinib treatment were divided into two cohorts: a second-line cohort after first-line lenvatinib; and a third-line cohort after second-line lenvatinib. The primary endpoint was the objective response rate (ORR). Secondary endpoints included the time to treatment failure (TTF).
Of the 168 patients included, 122 (73%) had clear-cell histology. In the second-line cohort (n = 20), all patients received first-line pembrolizumab + lenvatinib. The ORR was 50% and median TTF was 19.7 mo for first-line treatment. Median follow-up from initiation of second-line treatment was 4.9 mo. The ORR to second-line treatment was 5% (95% confidence interval [CI] 0.2-25%) and median TTF was 5.8 mo (95% CI 1.9-14.9). In the third-line cohort (n = 34), most patients received second-line everolimus + lenvatinib (97%). The ORR was 31% and median TTF was 9.2 mo for second-line therapy. Median follow-up from initiation of third-line treatment was 14.9 mo. The ORR to third-line treatment was 12% (95% CI 3.3-27%) and median TTF was 2.8 mo (95% CI 1.9-7.4).
Our data demonstrate modest activity of TKI-based therapy after exposure to lenvatinib. The results highlight the need for better treatment options for patients who experience progression on lenvatinib-based therapies.
Lenvatinib is a type of drug called a tyrosine kinase inhibitor (TKI). It is used to treat metastatic kidney cancer either when first diagnosed or after progression on a previous treatment. There is limited information on how patients respond to a different TKI after receiving lenvatinib. Our results show that other TKIs have modest clinical activity after patients have received lenvatinib.
乐伐替尼是一种多靶点酪氨酸激酶抑制剂（TKI），用于转移性肾细胞癌（mRCC）的一线及难治性治疗。然而，关于乐伐替尼之后序贯TKI治疗疗效的数据有限。我们研究了mRCC患者接受乐伐替尼后TKI治疗的活性。
我们对国际转移性肾细胞癌数据库联盟（IMDC）的数据进行了回顾性分析。接受乐伐替尼后治疗的患者被分为两个队列：一线乐伐替尼后的二线队列；二线乐伐替尼后的三线队列。主要终点是客观缓解率（ORR）。次要终点包括治疗失败时间（TTF）。
纳入的168例患者中，122例（73%）为透明细胞组织学类型。在二线队列（n = 20）中，所有患者均接受一线帕博利珠单抗 + 乐伐替尼治疗。一线治疗的ORR为50%，中位TTF为19.7个月。从二线治疗开始的中位随访时间为4.9个月。二线治疗的ORR为5%（95%置信区间[CI] 0.2 - 25%），中位TTF为5.8个月（95% CI 1.9 - 14.9）。在三线队列（n = 34）中，大多数患者接受二线依维莫司 + 乐伐替尼治疗（97%）。二线治疗的ORR为31%，中位TTF为9.2个月。从三线治疗开始的中位随访时间为14.9个月。三线治疗的ORR为12%（95% CI 3.3 - 27%），中位TTF为2.8个月（95% CI 1.9 - 7.4）。
我们的数据表明，乐伐替尼治疗后基于TKI的治疗活性一般。结果突出显示，对于接受基于乐伐替尼治疗后病情进展的患者，需要更好的治疗选择。
乐伐替尼是一种称为酪氨酸激酶抑制剂（TKI）的药物。它用于在首次诊断转移性肾癌时或先前治疗进展后进行治疗。关于患者在接受乐伐替尼后对不同TKI的反应的信息有限。我们的结果表明，患者接受乐伐替尼后，其他TKI具有一定的临床活性。
