Sequential therapy with sorafenib and sunitinib in renal cell carcinoma

• Published in: Cancer Vol. 115; no. 1; pp. 61 - 67
• Main Authors: Dudek, Arkadiusz Z., Zolnierek, Jakub, Dham, Anu, Lindgren, Bruce R., Szczylik, Cezary
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-01-2009; Wiley-Blackwell
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Benzenesulfonates - administration & dosage; Biological and medical sciences; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - mortality; Disease-Free Survival; Female; Humans; Indoles - administration & dosage; Kidney Neoplasms - drug therapy; Kidney Neoplasms - mortality; Kidneys; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Niacinamide - analogs & derivatives; Phenylurea Compounds; Protein Kinase Inhibitors - administration & dosage; Pyridines - administration & dosage; Pyrroles - administration & dosage; renal cell carcinoma; Retrospective Studies; sequential therapy; sorafenib; sunitinib; Survival Analysis; Tumors; Tumors of the urinary system; tyrosine kinase inhibition; Kidney disease; Antineoplastic agent; Urinary system disease; Carcinoma; Enzyme; Tyrosine kinase inhibitor; Transferases; Enzyme inhibitor; tyrosine kinase inhibition; Malignant tumor; sequential therapy; Sunitinib; renal cell carcinoma; Cancerology; Treatment; Sequential; Sorafenib; Kidney cancer; Grawitz tumor; Multikinase inhibitor; Antiangiogenic agent; Protein-tyrosine kinase; Cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.24009

BACKGROUND:
Sunitinib and sorafenib are small‐molecule tyrosine kinase inhibitors (TKI) with antitumor activity in advanced renal cell carcinoma. A retrospective study was conducted to assess the response of renal cell carcinoma to sequential treatment with these two agents.
METHODS:
Tumor response was evaluated by using Response Evaluation Criteria In Solid Tumors (RECIST) criteria in patients failing first‐line therapy with either sunitinib or sorafenib and subsequently receiving second‐line therapy with the other TKI agent.
RESULTS:
Twenty‐nine patients received sorafenib followed by sunitinib (Group A), and 20 patients received sunitinib followed by sorafenib (Group B). TKI drugs were terminated in 6 (12%) patients in Group A and 4 (8%) in Group B because of toxicity. Median duration of stable disease for Groups A and B was 20 and 9.5 weeks, respectively. Median time from starting first TKI to disease progression after second TKI (time to progression) in Groups A and B was 78 and 37 weeks, respectively. Multivariate analysis revealed that Group B had a shorter time to progression than Group A (risk ratio [RR] 3.0; P = .016). Median overall survival was 102 and 45 weeks in Groups A and B, respectively (P = .061).
CONCLUSIONS:
The longer duration of disease control in patients who received sorafenib followed by sunitinib warrants further investigation. Cancer 2009. © 2008 American Cancer Society.
In a retrospective analysis of 49 patients with metastatic renal cell carcinoma, second‐line tyrosine kinase inhibitor (TKI) therapy using sorafenib or sunitinib was effective at achieving disease control after first‐line TKI failure using the other agent. Sorafenib followed by sunitinib appeared to be more effective at disease control than the reverse sequence as indicated by a reduced time to disease progression (78 vs 37 weeks) and overall survival (102 vs 45 weeks).