Immunotherapy and Targeted Therapies in Metastatic Renal Cell Carcinoma: Is There a Preferred Sequence?

Introduction: Currently, the best sequence of targeted therapy in patients with metastatic renal cell carcinoma (mRCC) has not been sufficiently defined and is based on the patient's and physician's decision, which may be influenced by comorbidities and toxicity profiles. The aim of this study was to evaluate the outcome of target therapies on clinical practice after the era of cytokine-based therapy in mRCC. Materials and Methods: We retrospectively analyzed all consecutive patients with mRCC treated at our Clinical Oncology Unit from June 1998 to September 2010. Results: We evaluated 61 patients: 21 (34.4%) with only cytokine-based therapy (95.2% interferon-alpha), 24 (39.3%) with target therapies in first line (100% sunitinib), and 16 (26.2%) with target therapies in second or subsequent line. Median time follow-up was 16.18 months (range 2.1-171.1). Considering the type of therapy, the univariate analysis for overall survival showed statistically significant advantages for the use of target therapies in second or subsequent line (p = 0.024). Conclusions: Our data and consequently our proposal to revaluate the role of immunotherapy (also with the possibility of adding bevacizumab) in the first line are heavily provocative to point out the attention to this actually partially unsolved question; other larger experiences, pre-eminent opinion, and clinical trials are needed.