Optimal management of metastatic renal cell carcinoma: an algorithm for treatment

Bellmunt, Joaquim; Flodgren, Per; Roigas, Jan; Oudard, Stéphane

doi:10.1111/j.1464-410x.2009.08563.x

Cited by 25 publications

(13 citation statements)

References 55 publications

(131 reference statements)

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“…They showed that PFS, OS, reduction in tumor burden, and overall response rate were all similar in the elderly patients with mRCC and the whole RECORD-1 population, concluding that EVE was effective in elderly patients with mRCC (Porta et al, 2012). The International Society of Geriatric Oncology (SIOG) recommends that patients should be managed based on biological rather than chronological age (Bellmunt et al, 2009a;Bellmunt et al, 2009b;Bellmunt et al, 2011). Because half of patients presenting with RCC are ≥65 (Bellmunt et al, 2009a), older patients should not be precluded access to effective molecular targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The International Society of Geriatric Oncology (SIOG) recommends that patients should be managed based on biological rather than chronological age (Bellmunt et al, 2009a;Bellmunt et al, 2009b;Bellmunt et al, 2011). Because half of patients presenting with RCC are ≥65 (Bellmunt et al, 2009a), older patients should not be precluded access to effective molecular targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, these patients are often under-represented in clinical trials; besides, studies devoted to elderly patients with mRCC are few and present several limitations (Escudier, 2010a;Escudier et al, 2010b). Approximately one-third of patients with mRCC enrolled in recent phase III trials that set the bases for treatment with sunitinib, sorafenib, temsirolimus and bevacizumab+IFN-α, were >65 years of age clearly showing an under-representation of elderly patients with mRCC (Bellmunt et al, 2009a). Inhibition of the mTOR pathway has emerged as one of the main approaches for the development of new targeted agents in mRCC.…”

Section: Introductionmentioning

confidence: 99%

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Favorable Outcome in Elderly Asian Patients with Metastatic Renal Cell Carcinoma Treated with Everolimus: The Osaka Urologic Oncology Group

Inamoto¹,

Azuma²,

Nonomura³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ≥ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ≥ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/ SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/-0.31 vs 3.1 +/-0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Favorable Outcome in Elderly Asian Patients with Metastatic Renal Cell Carcinoma Treated with Everolimus: The Osaka Urologic Oncology Group

Inamoto¹,

Azuma²,

Nonomura³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Insgesamt ist die Inzidenz des NZK um etwa 2% / Jahr steigend. In der BRD werden pro Jahr etwa 15.000 Neuerkrankungen registriert [1].…”

Section: Das Nierenzellkarzinom üBersichten Hintergrundunclassified

Das Nierenzellkarzinom

Fornara

2011

Urologe

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Approximately 85% of all malignant tumors of the kidney are renal cell carcinomas (RCC). Sonography is the leading examination for early detection of kidney tumors. The treatment of RCC has been enriched in recent years by new therapeutic options for localized and metastatic cancer. The classification of RCC is based on TNM and UICC criteria. The so-called Motzer criteria are being increasingly employed to assess prognosis and monitor therapy and as the basis for reaching decisions on choosing the type of systemic treatment.

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“…In addition to signifi cantly improving median PFS, sunitinib produces a higher response rate and results in a better quality of life than IFN- [2,15]. It may represent the reference standard of care for the fi rst-line treatment of mRCC [1,2,5,7,[15][16][17] and, based on robust clinical evidence, it meets the criteria for being a life-extending end-of-life treatment [16]. A systematic review demonstrated that, although the OS with sunitinib and BEV plus IFN- (BEV/ IFN) was prolonged, compared with IFN-, indirect comparison suggested that sunitinib was superior to BEV/IFN in terms of PFS [18,19].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain

et al. 2011

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INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.

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Optimal management of metastatic renal cell carcinoma: an algorithm for treatment

Cited by 25 publications

References 55 publications

Favorable Outcome in Elderly Asian Patients with Metastatic Renal Cell Carcinoma Treated with Everolimus: The Osaka Urologic Oncology Group

Favorable Outcome in Elderly Asian Patients with Metastatic Renal Cell Carcinoma Treated with Everolimus: The Osaka Urologic Oncology Group

Das Nierenzellkarzinom

Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain

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