Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study
Jung Ki Joa*(),Seong Il Seob,MinYong Kangb,Jinsoo Chungc,Cheol Kwakd,Sung-Hoo Honge,Cheryn Songf,Jae Young Parkg,Chang Wook Jeongd,Seok Hwan Choih,Sung Han Kimc,Eu Chang Hwangi,Chan Ho Leej,Hakmin Leek
aDepartment of Urology, Medical and Digital Engineering, College of Medicine, Hanyang University, Seoul, Republic of Korea bDepartment of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea cDepartment of Urology, National Cancer Center, Goyang, Republic of Korea dDepartment of Urology, Seoul National University Hospital, Seoul, Republic of Korea eDepartment of Urology, Kangnam St Mary’s Hospital, Seoul, Republic of Korea fDepartment of Urology, Asan Medical Center, Seoul, Republic of Korea gDepartment of Urology, Korea University Ansan Hospital, Ansan, Republic of Korea hDepartment of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea iDepartment of Urology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea jDepartment of Urology, Inje University Busan Paik Hospital, Busan, Republic of Korea kDepartment of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
Objective: The purpose of the study was to identify the best sequence of therapy beginning with a tyrosine kinase inhibitor (TKI) as the first-line therapy for patients with metastatic renal cell carcinoma (mRCC) in terms of overall survival (OS), progression-free survival (PFS), and rates of discontinuation and adverse effects during the treatment period.
Methods: This is a retrospective, nationwide multicenter study of patients with mRCC after diagnosis at 10 different tertiary medical centers in Korea from January 1992 to December 2017. We focused on patients at either “favorable” or “intermediate” risk according to the International mRCC Database Consortium criteria, and they were followed up (median 335 days). Finally, a total of 1409 patients were selected as the study population. We generated a Cox proportional hazard model adjusted for covariates, and the different therapy schemes were statistically tested in terms of OS as well as PFS. In addition, frequencies of discontinuation and adverse events were compared among the therapy schemes.
Results: Of the primary patterns of treatment sequences (24 sequences), “sunitinib-pazopanib” and “sunitinib-everolimus-immunotherapy” showed the most beneficial results in both OS and PFS with significantly lower hazards than “sunitinib”, which is the most commonly treated agent in Korea. Considering that the “TKI-TKI” structure showed relatively higher discontinuation rates with higher adverse effects, the overall beneficial sequence would be “sunitinib-everolimus-immunotherapy”.
Conclusion: Among several sequential therapy starting with TKIs, “sunitinib-everolimus- immunotherapy” was found to be the best scheme for mRCC patients with “favorable” or “intermediate” risks.
. [J]. Asian Journal of Urology, 2024, 11(3): 450-459.
Jung Ki Jo, Seong Il Seo, MinYong Kang, Jinsoo Chung, Cheol Kwak, Sung-Hoo Hong, Cheryn Song, Jae Young Park, Chang Wook Jeong, Seok Hwan Choi, Sung Han Kim, Eu Chang Hwang, Chan Ho Lee, Hakmin Lee. Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study. Asian Journal of Urology, 2024, 11(3): 450-459.
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