First-Line TKIs Less Effective in Non-Clear-Cell Renal Cell Carcinoma

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First-line treatment of metastatic renal cell carcinoma with tyrosine kinase inhibitors is associated with worse progression-free and overall survival in patients with non-clear-cell vs clear-cell his
First-line treatment of metastatic renal cell carcinoma with tyrosine kinase inhibitors is associated with worse progression-free and overall survival in patients with non-clear-cell vs clear-cell his

Patients with metastatic non-clear-cell renal cell carcinoma (nccRCC) have worse outcomes from first-line therapy with tyrosine kinase inhibitors (TKIs) than patients with metastatic clear-cell RCC (ccRCC), new study findings confirm.

Investigators compared data from 93 patients with metastatic nccRCC treated with first-line TKIs with a control group of 1788 patients with metastatic ccRCC treated with first-line TKIs. Median progression-free and overall survival was significantly longer in the control group than in the nccRCC group (11.8 vs 6.5 months and 33.2 vs 22.0 months, respectively), Alexandr Poprach, MD, PhD, of Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic, and colleagues reported in Urologic Oncology.

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Multivariable analysis revealed that independent factors associated with inferior progression-free survival included high tumor grade, worse Memorial Sloan Kettering Cancer Center (MSKCC) risk group, absence of nephrectomy, and use of sunitinib instead of pazopanib as first-line targeted therapy, according to the investigators.

Independent predictors of inferior overall survival included non-clear-cell histology, tumor grade, worse MSKCC risk group, older age, sunitinib as first-line targeted therapy, and absence of nephrectomy.

The nccRCC group included 87 patients with papillary RCC and 6 with chromophobe RCC.

The median duration of first-line targeted treatment was 7.1 months in the ccRCC patients compared with 4.5 months in the nccRCC patients. Objective response rates were higher in the ccRCC than nccRCC groups (27.5% vs 15.7%).

Dr Poprach and his collaborators analyzed data from a national registry that collects anonymized data from patients with metastatic RCC treated with a targeted agents. The median age of patients in the nccRCC and ccRCC groups was 63 and 62 years, respectively. The group were generally similar with respect to baseline clinicial characteristics.

Reference

Poprach A, Rumanova K, Lakomý R, et al. Tyrosine kinase inhibitors in the first-line treatment for metastatic nonclear cell renal carcinoma: A retrospective analysis of a national database. Urol Oncol. 2019; published online ahead of print.

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