Prognostic Significance of Early Tumor Shrinkage Under Second-Line Targeted Therapy for Metastatic Renal Cell Carcinoma:
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ORIGINAL RESEARCH ARTICLE
Prognostic Significance of Early Tumor Shrinkage Under SecondLine Targeted Therapy for Metastatic Renal Cell Carcinoma: A Retrospective Multi-Institutional Study in Japan Hideaki Miyake1,2 • Ken-ichi Harada1 • Seiichiro Ozono2 • Masato Fujisawa1
Ó Springer International Publishing Switzerland 2016
Abstract Background The prognostic significance of early tumor shrinkage (ETS) under second-line targeted therapy for metastatic renal cell carcinoma (mRCC) has not been fully documented. Aims The objective of this study was to evaluate the impact of ETS induced by a second-line targeted agent on overall survival (OS) in mRCC patients. Patients and Methods This study retrospectively included 271 consecutive Japanese patients with mRCC who received second-line targeted therapy for at least 3 months. ETS was defined as the degree of tumor shrinkage at the first post-baseline radiological evaluation conducted 4–8 weeks after initiating second-line targeted therapy. Results Of the 271 patients, 26 had ETS from -100 to -50 %, 70 from -49 to -25 %, 84 from -24 to 0 %, and the remaining 91 failed to achieve a reduction in the tumor size. The median OS following the initiation of second-line targeted therapy stratified according to ETS was 45.8, 30.9, 22.1 and 14.2 months, respectively. Univariate analysis identified prior nephrectomy, the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification, C-reactive protein (CRP) level, number of metastatic organs, sarcomatoid feature, introduced second-line agent and ETS induced by a second-line agent as parameters significantly
& Hideaki Miyake [email protected] 1
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
2
Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
associated with OS, of which, only the MSKCC classification, CRP level and ETS appeared to have independent impacts on OS on multivariate analysis. Conclusions These findings suggest that ETS at the first post-baseline assessment under treatment with a secondline targeted agent could serve as a useful parameter with an independent impact on OS in mRCC patients receiving second-line targeted therapy.
Key Points The degree of tumor shrinkage at the first postbaseline assessment under treatment with secondline targeted agent was closely correlated with the overall survival after initiating second-line therapy in metastatic renal cell carcinoma patients. Early tumor shrinkage induced by a second-line targeted agent was identified as an independent factor associated with overall survival in metastatic renal cell carcinoma patients.
1 Introduction In recent years, various novel agents, targeted against the vascular endothelial growth factor (VEGF) or mammalian target of rapamycin (mTOR) pathways, have been introduced into clinical practice for the treatment of metastatic renal cell carcinoma (mRCC), and the use of these agents has led to marked i
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