Survival Benefits of Second-line Axitinib Versus Everolimus After First Line Sunitinib Treatment in Metastatic Renal Cel
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ORIGINAL ARTICLE
Survival Benefits of Second-line Axitinib Versus Everolimus After First Line Sunitinib Treatment in Metastatic Renal Cell Carcinoma Lajos Géczi 1 & György Bodoky 2 & György Rokszin 3 & Ibolya Fábián 3,4 & László Torday 5 Received: 31 July 2019 / Accepted: 24 March 2020 # The Author(s) 2020
Abstract Background Targeted therapies significantly improve clinical outcomes among patients with metastatic renal cell carcinoma (mRCC). Several new agents have been approved for first- and second-line use. However, there is a lack of compelling evidence comparing sequencing strategies, and available comparative data regarding the real-world effectiveness of different therapeutic sequences are limited. Materials and Methods We identified mRCC patients who initiated targeted therapy between January 1, 2008 and May 31, 2017 from the National Health Insurance Fund (NHIF) database of Hungary. Overall survival (OS) and duration of first-line treatment (DFT) were obtained for patients receiving sunitinib-everolimus, sunitinib-axitinib, or pazopanib-everolimus treatment sequences. OS of sunitinib-everolimus and sunitinib-axitinib sequences was also determined for patients having better or worse response to sunitinib first-line therapy. Results Median OS was significantly longer among patients treated with sunitinib-axitinib compared to those receiving sunitinibeverolimus. Median DFT was also significantly longer in the sunitinib-axitinib vs. sunitinib-everolimus group. Sunitinib-axitinib was associated with significantly longer median OS compared to sunitinib-everolimus in patients with better response to first-line sunitinib in the pooled sunitinib population. In patients with worse response to sunitinib, sunitinib-axitinib was associated with a trend towards greater OS compared to sunitinib-everolimus, but the difference did not reach statistical significance. Conclusions In this nationwide database analysis, mRCC patients treated with the sunitinib-axitinib sequence had significantly longer OS compared to those receiving sunitinib-everolimus therapy. The OS benefits of second-line axitinib were consistent among patients with better response to sunitinib defined by DFT values. Keywords Metastatic renal cell carcinoma . Axitinib . Sequential therapy . VEGF inhibitors . Overall survival
Introduction Vascular endothelial growth factor (VEGF) and its receptors have a central role in the development and progression of renal
* Lajos Géczi [email protected] 1
Urogenital Tumors and Clinical Pharmacology Department, National Institute of Oncology, Ráth György u. 7–9, 1122 Budapest, Hungary
2
Department of Oncology, Szent László Hospital, Albert Flórián út 5, 1097 Budapest, Hungary
3
RxTarget Ltd, Bacsó Nándor út 10, 5000 Szolnok, Hungary
4
University of Veterinary Medicine, István út 2, 1078 Budapest, Hungary
5
Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720 Szeged, Hungary
cell cancer (RCC). The activation of VEGF-driven signal transduction pathways promotes tumor angiogenesis, growth an
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