BERKELEY, CA (UroToday.com) - The advent of targeted therapy in metastatic renal cell carcinoma (mRCC) does not eliminate the potential utility of immunotherapy, but rather requires a rational refinement of this approach through improvements in patient selection and combination therapy. The aim of this study was to evaluate the outcome of targeted therapies on clinical practice after the era of cytokine-based therapy in mRCC.
The results we obtained were probably related to the best rationalization of the sequential use of all possible drugs. We know from the randomized phase III trial of sunitinib versus INF-alpha that the median overall survival was greater in the sunitinib group than in the INF-alpha group.[1] We do not dispute this much larger data set, but instead we shifted the attention on the issue of the correct sequence of therapy in patients with mRCC, to take advantage of the increasing number of treatment options that actually exclude, for example, the use of INF-alpha and bevacizumab at the outside of the first line of treatment.[2] We also bore in mind that other retrospective studies have also emphasized the potential significance of utilizing immunotherapy in the initial treatment of mRCC in order to optimize treatment options.[3]
We recognize the limit of a retrospectve study, the small size of the cohorts, and the fact that data coming from a single institution could reflect only the habits of that particular set of physicians; on the contrary, studies like ours are able to evaluate treatment patterns in a real-world clinical practice, reflecting changes in therapy prescription (patients received cytokines in the pre-TKI era).
Our data, and consequently our proposal, are heavily provocative in order to give attention to this partially unanswered question.
References:
- Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007;356:115-24.
- Escudier B, Pluzanska A, Koralewski P, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet 2007;370:2103-11.
- Dillman RO, Barth NM, VanderMolen LA, et al. Should high-dose interleukin-2 still be the preferred treatment for patients with metastatic renal cell cancer? Cancer Biother Radiopharm 2011;26:273-7.
Written by:
Jacopo Giuliani, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Palliative Care Unit
Mater Salutis Hospital
U.L.S.S. 21
Legnago (VR), Italy
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