Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma: a real-world multicenter analysis

Konishi, Sakae; Tanaka, Toshiaki; Ikehata, Yoshinori; Tanaka, Toshikazu; Fujita, Naoki; Ishibashi, Yutaka; Yamamoto, Hayato; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Yoshikawa, Kunio; Kawaguchi, Toshiaki; Masumori, Naoya; Kitamura, Hiroshi; Οhyama, Chikara

doi:10.1007/s12032-018-1231-3

Cited by 21 publications

(20 citation statements)

References 30 publications

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“…The clinical outcomes of these patients were reported, and prognostic factors for these patients were elucidated. The median OS of all patients was 65.0 months, which was comparable with the findings of subgroup analysis in a pivotal study on sunitinib 10 and a first-line axitinib regimen 7 in Japanese patients with mRCC. In addition, we identified CRP expression level as a potential prognostic factors of PFS and poor IMDC risk score and spindle histology as potential prognostic factors of OS.…”

Section: Discussionsupporting

confidence: 81%

“…This distinctive characteristic might allow for the same or better clinical outcomes as well as effective first-line therapy, although axitinib has not demonstrated improved prognosis over that of sorafenib in first-line settings 6 . In contrast, axitinib has resulted in superior clinical outcomes, in terms of both survival and safety profile, compared to those of sunitinib in a real-world retrospective cohort 7 .…”

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confidence: 88%

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First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

Numakura

Kobayashi

Muto

et al. 2020

Sci Rep

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Axitinib, a vascular endothelial growth factor receptor-tyrosine kinase inhibitor, will be used in combination first-line therapies against metastatic renal cell carcinoma (mRCC), but its effects as a first-line monotherapy are unclear. Thus, we aimed to elucidate pretreatment clinical factors that predict the prognosis of patients with mRCC receiving first-line axitinib therapy. We enrolled 63 patients with mRCC treated with axitinib as first-line therapy between Nov. 2003 and Jul. 2018. Progression-free survival (PFS) and overall survival (OS) were assessed using the Wald χ2 statistic in Cox proportional hazards regression. Median patient age was 67 (range: 25–85) years. Seven (11.1%) patients were classified as being at favorable risk, 33 (52.4%) at intermediate risk, and 23 (36.5%) at poor risk according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classification system. Median follow-up duration after axitinib initiation was 14 (range: 1–72) months. Median PFS and OS were 18 months and 65 months, respectively. Cox regression analyses of clinical predictors revealed that high C-reactive protein (CRP) levels were significantly correlated with shorter PFS [hazard ratio (HR), 1.63; 95% confidence interval (CI) 1.7–4.0)], whereas spindle cells and poor IMDC risk scores were related to worse OS (HR, 2.87 and 2.88, respectively; 95% CI 1.4–11.0 and 1.1–8.5, respectively). Thus, patients with mRCC and spindle histology or poor IMDC risk scores had worse OS, and those with high CRP levels had shorter PFS in first-line axitinib treatment. Other therapies might be more suitable for initial management of such patients.

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Section: Discussionsupporting

confidence: 81%

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confidence: 88%

First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

Numakura

Kobayashi

Muto

et al. 2020

Sci Rep

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“…Our database did not include the patients treated with the first‐line pazopanib. Conversely, we used axitinib as the first‐line therapy for elderly or frail patients, because it has more feasible safety profiles on hematological toxicity than sunitinib and on the liver toxicity than pazopanib . Furthermore, a lack of NLR data prevents comparing the predictive ability of CAR with NLR.…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, molecular-targeted therapies have been generally used for treatment of mRCC. [1][2][3][4][5][6][7][8][9][10][11] As prognoses in mRCC have improved, more precise stratifications based on risk factors have been required. In the molecular-targeted therapy era, the IMDC risk classification is a standard riskbased stratification.…”

Section: Introductionmentioning

confidence: 99%

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C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

et al. 2019

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Objectives To evaluate the effect of pretreatment C‐reactive protein/albumin ratio and modified Glasgow prognostic score on the prognosis in patients with metastatic renal cell carcinoma. Methods A retrospective study was carried out in 176 patients with metastatic renal cell carcinoma who received first‐line tyrosine kinase inhibitors. The effect of adding inflammatory prognostic scores to the International Metastatic Renal Cell Carcinoma Database Consortium model (International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio and International Metastatic Renal Cell Carcinoma Database Consortium‐Glasgow prognostic score models) on overall survival was evaluated using receiver operating characteristic curves. The prognostic value of inflammatory prognostic scores (C‐reactive protein/albumin ratio‐modified Glasgow prognostic score) was tested using the Kaplan–Meier method and Cox proportional regression models. Results Patients were stratified into two groups using the cut‐off value of 0.05: C‐reactive protein/albumin ratio‐low (<0.05) and C‐reactive protein/albumin ratio‐high (≥0.05). The area under the curve was significantly higher in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model (0.720) than that of the International Metastatic Renal Cell Carcinoma Database Consortium model (0.689) and the International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score model (0.703). Significant differences were observed in overall survival stratified by the number of risk factors in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio risk model between one or two and three or four factors (P < 0.001), and three or four and five or more factors (P = 0.001). For the patients in the International Metastatic Renal Cell Carcinoma Database Consortium intermediate‐risk group, overall survival was significantly different between the C‐reactive protein/albumin ratio‐low and ‐high groups (P = 0.001), whereas it was not significantly different between the patients with one and two International Metastatic Renal Cell Carcinoma Database Consortium risk factors (P = 0.106). Conclusion The C‐reactive protein/albumin ratio is a simple and independent predictor of overall survival in patients with metastatic renal cell carcinoma. The predictive activity was significantly improved in the International Metastatic Renal Cell Carcinoma Database Consortium‐C‐reactive protein/albumin ratio model compared with the International Metastatic Renal Cell Carcinoma Database Consortium/International Metastatic Renal Cell Carcinoma Database Consortium‐modified Glasgow prognostic score models.

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Outcomes of axitinib versus sunitinib as first‐line therapy to patients with metastatic renal cell carcinoma in the immune‐oncology era

et al. 2021

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Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma: a real-world multicenter analysis

Cited by 21 publications

References 30 publications

First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

First-line axitinib therapy is less effective in metastatic renal cell carcinoma with spindle histology

C‐reactive protein/albumin ratio is a predictive factor for prognosis in patients with metastatic renal cell carcinoma

Outcomes of axitinib versus sunitinib as first‐line therapy to patients with metastatic renal cell carcinoma in the immune‐oncology era

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