A multicenter, phase II study of the RAF-kinase inhibitor sorafenib in patients with advanced renal cell carcinoma

Abstract

Abstract. The treatment of advanced renal cell carcinoma (RCC) has advanced significantly over the last two decades. This multicenter study was designed with the primary objective to evaluate the efficacy and safety of sorafenib as first-line treatment in patients with advanced or metastatic RCC in the Middle East, who were considered to be ineligible for other approved first-line therapies. A total of 75 eligible patients from 8 centers in the Middle East were included in this study. The patients comprised 48 men and 27 women, with a median age of 52 years (range, 19-78 years). A total of 50 patients had clear cell carcinoma, 17 had papillary carcinoma and 8 had other pathological subtypes. At enrollment, 55 of the 75 patients had undergone previous nephrectomy. A total of 67 patients presented with metastatic disease, while 8 patients had regional residual lesions or local recurrence. The patients were treated with 400 mg oral sorafenib twice daily on a continuous basis as a single agent. Treatment was discontinued upon disease progression, prohibitive toxicity, surgical complications, loss to follow-up, or refusal to continue therapy. The median treatment duration was 21 weeks (range, 1-137 weeks). Sorafenib was tolerated by the majority of the patients. Grade 3/4 hand-foot syndrome occurred in 17 patients; diarrhea, elevated liver enzymes and fatigue were observed in 3 patients each; and grade 3̸4 vomiting, hypertension and anemia, in 1 patient each. Of the 75 patients included in this study, 60 were evaluable for response. One patient achieved a complete response for 91 weeks and 6 patients exhibited a partial response (median duration of 23 weeks) with an overall response rate of 11.7%. Disease stabilization occurred in 37 patients (61.7%). Thus, disease control was achieved in 44 of the 60 patientrs (73%). At a median follow-up period of 53.5 weeks (range, 8.5-192 weeks), an intention-to-treat analysis demonstrated a median time-to-disease progression of 25.7 weeks, with a median overall survival of 54.8 weeks. In conclusion, sorafenib was found to be tolerable and effective as first-line therapy in patients with advanced RCC. IntroductionRenal cell carcinoma (RCC) represents 2.4% of all malignancies worldwide (http://globocan.iarc.fr/Pages/fact_ sheets_cancer.aspx). In addition, RCC accounts for 90% of renal tumors, with 85% of RCCs being of the clear cell type (1). According to the Surveillance of Epidemiology and End Results data from the USA, the 5-year survival rate of advanced renal cancer is ~12.6% (http://seer.cancer.gov/statfacts/html/kidrp.html). Cytoreduction surgery followed by systemic therapy is generally recommended for patients with advanced disease (2,3). Tyrosine kinase inhibitors are widely used as first-and second-line treatment and, to date, 7 such agents, including sorafenib, have been approved by the Food and Drug Administration for the treatment of advanced RCC [National Comprehensive Cancer Network (NCCN) guidelines 2014, www.nccn.com].Sorafenib tosylate is a small molecule that i...

LncRNA RP11-436H11.5, functioning as a competitive endogenous RNA, upregulates BCL-W expression by sponging miR-335-5p and promotes proliferation and invasion in renal cell carcinoma

“…The mortality of RCC patients appears to be increasing each year, resulting in frequent studies on biological detections and treatments [ 2 ]. Drug targeted therapies, including mammalian targets of rapamycin and vascular endothelial growth factor, have boomed [ 3 , 4 ]. Unfortunately, drug resistance can occur in late stage patients, resulting in a bad prognosis [ 5 , 6 ].…”

A Systematic Review of Systemic Treatment Options for Advanced Non-Clear Cell Renal Cell Carcinoma

“…The majority of the single arm studies involving nccRCC patients evaluated TKIs targeting the VEGF pathway, including sunitinib [18][19][20][21], sorafenib [22][23][24], axitinib [25], and pazopanib [26]. Legend: (-) = Data not reported; CR = complete response; HR = hazard ratio; NE = not evaluable; NR = not reached; mOS = median overall survival; mPFS = median progression-free survival; ORR = objective response rate.…”

“…The majority of the single arm studies involving nccRCC patients evaluated TKIs targeting the VEGF pathway, including sunitinib [ 18 - 21 ], sorafenib [ 22 - 24 ], axitinib [ 25 ], and pazopanib [ 26 ].…”