Outcomes of Patients With Metastatic Renal Cell Carcinoma and End-Stage Renal Disease Receiving Dialysis and Targeted Therapies: A Single Institution Experience

Abstract

Data are limited regarding outcomes in patients with end-stage renal disease (ESRD) and metastatic renal cell carcinoma (mRCC) receiving targeted therapy. We retrospectively identified patients with mRCC and ESRD treated at the University of Texas M.D. Anderson Cancer Center from 2002 to 2012. Fourteen patients were identified with a median number of targeted therapies (TTs) per patient of 3 (range, 1–4). Outcomes in patients with mRCC and ESRD were similar to those reported in patients with normal kidney function. Introduction Limited data are available regarding patients with renal cell carcinoma and ESRD treated with TTs. The objective of this study was to explore the tolerability and safety of TT in patients with mRCC and ESRD. Patients and Methods We retrospectively identified patients with mRCC and ESRD treated at the University of Texas M.D. Anderson Cancer Center from 2002 to 2012. Patient characteristics including demographic, histology, treatment, and adverse events are reported. Duration of treatment (TOT) was determined from date of drug initiation to discontinuation. Overall survival (OS) was determined from initiation of TT to death. Statistics are descriptive. Results Fourteen patients were identified. Ten patients had clear-cell histology and 4 had papillary histology. The median number of TTs per patient was 3 (range, 1–4) with median TOT of 28 months for all TTs. Eighty-eight percent of all toxicities were Grade 1 to 2; no Grade 4 toxicities were noted. Treatment discontinuations included 3 patients treated with sorafenib due to hand-foot syndrome, intolerable fatigue, and squamous cell skin cancer development; 2 patients treated with pazopanib due to intolerable fatigue and increased transaminase levels; and 1 patient treated with everolimus due to pneumonitis. Eight patients died from progressive disease. Median OS from initiation of TT was 28.5 months and 35 months from time of diagnosis. Conclusion Toxicities were mild to moderate and consistent with those reported in previous studies. TTs appear to be safe, well tolerated and produce antitumor response in patients with mRCC and ESRD receiving dialysis.

Retrospective Analysis on Safety and Efficacy of Everolimus in Treatment of Metastatic Renal Cancer Patients Receiving Dialysis

“…One patient discontinued the treatment with everolimus due to pneumonitis. The median d uration of treatment was 1.9 months [19].…”

“…More recently Shelly et al analyzed 14 patients with end-stage renal disease and with mRCC treated with target therapy (sunitinib, sorafenib, pazopanib, everolimus, temsirolimus and bevacizumab). The median number of target therapy per patient is 3, with a median duration of treatment of 28 months [19]. Masini et al also reported a multicentric retrospective Italian study evaluating the outcome of patients treated with sunitinib and sorafenib in this setting [20].…”

Sequential molecularly targeted drug therapy including axitinib for a patient with end‐stage renal failure and metastatic renal cell carcinoma

“…Targeted drugs such as sorafenib, sunitinib, pazopanib, everolimus, temsirolimus, and axitinib have recently been developed, and this has dramatically changed the therapeutic approach and disease prognosis . Very few clinical trials include patients with renal impairment; however, some retrospective analyses have shown that molecularly targeted therapies can benefit patients with ESRD . Axitinib as a single agent has been shown to have an acceptable safety profile, and it has been observed to demonstrate anti‐tumor effects in Japanese patients with mRCC .…”

Pazopanib as first-line therapy for patients with metastatic kidney cancer

“…Таким образом, почечная недо-статочность вряд ли будет иметь клиническое значение при применении препарата. Следует отметить, что в слу-чае тяжелой почечной недостаточности (клиренс креати-нина < 30 мл/мин) применение пазопаниба не изучалось, и исследования в этом направлении представляются интересными и оправданными [9].…”