Second-line treatment for metastatic clear cell renal cell cancer: experts' consensus algorithms

被引:9
|
作者
Rothermundt, C. [1 ]
von Rappard, J. [2 ]
Eisen, T. [3 ]
Escudier, B. [4 ]
Gruenwald, V. [5 ]
Larkin, J. [6 ]
McDermott, D. [7 ]
Oldenburg, J. [8 ]
Porta, C. [9 ]
Rini, B. [10 ]
Schmidinger, M. [11 ]
Sternberg, C. N. [12 ,13 ]
Putora, P. M. [14 ]
机构
[1] Kantonsspital St Gallen, Dept Haematol & Oncol, CH-9007 St Gallen, Switzerland
[2] Univ Hosp Bern, Dept Nephrol, Bern, Switzerland
[3] Cambridge Univ Hosp NHS Fdn Cambridge, Dept Oncol, Cambridge, England
[4] Gustave Roussy, Villejuif, France
[5] Hannover Med Sch, Klin Hamatol Hamostaseol Onkol & Stammzelltranspl, Hannover, Germany
[6] Royal Marsden Hosp, London, England
[7] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[8] Norwegian Radium Hosp, Dept Med Oncol, Oslo, Norway
[9] Policlin San Matteo Pavia Fdn IRCCS, Pavia, Italy
[10] Cleveland Clin, Dept Solid Tumor Oncol, Cleveland, OH 44106 USA
[11] Univ Kliniken, Allgemeines Krankenhaus, Abt Onkol, Vienna, Austria
[12] San Camillo Hosp, Dept Med Oncol, Rome, Italy
[13] Forlanini Hosp, Dept Med Oncol, Rome, Italy
[14] Kantonsspital St Gallen, Dept Radiat Oncol, St Gallen, Switzerland
关键词
Algorithm; Renal cell cancer; Consensus; Diagnostic nodes; DIAGNOSTIC NODES; PHASE-3; TRIAL; CARCINOMA; EVEROLIMUS; SWITZERLAND; LENVATINIB; SORAFENIB; SUNITINIB; PATTERNS; AXITINIB;
D O I
10.1007/s00345-016-1903-6
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making. Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach. The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria. In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
引用
收藏
页码:641 / 648
页数:8
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