Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study

IF 2.4 3区 医学 Q2 UROLOGY & NEPHROLOGY
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引用次数: 0

Abstract

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.

使用酪氨酸激酶抑制剂作为转移性肾细胞癌患者一线治疗的最佳序贯疗法:一项全国多中心研究
目的本研究旨在从总生存期(OS)、无进展生存期(PFS)以及治疗期间的停药率和不良反应等方面,确定转移性肾细胞癌(mRCC)患者以酪氨酸激酶抑制剂(TKI)作为一线疗法的最佳治疗顺序。方法这是一项回顾性全国多中心研究,研究对象为1992年1月至2017年12月期间在韩国10家不同的三级医疗中心确诊后的mRCC患者。根据国际 mRCC 数据库联盟的标准,我们重点研究了 "有利 "或 "中等 "风险的患者,并对他们进行了随访(中位数为 335 天)。最后,我们共选择了1409名患者作为研究对象。我们生成了一个经协变量调整的 Cox 比例危险模型,并对不同治疗方案的 OS 和 PFS 进行了统计学检验。结果 在主要的治疗序列模式(24 个序列)中,"舒尼替尼-帕唑帕尼 "和 "舒尼替尼-依维莫司-免疫疗法 "在 OS 和 PFS 方面都显示出最有利的结果,其危险性明显低于 "舒尼替尼",而 "舒尼替尼 "是韩国最常用的治疗药物。考虑到 "TKI-TKI "结构显示出相对较高的停药率和较高的不良反应,"舒尼替尼-依维莫司-免疫疗法 "将是总体有利的序列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Asian Journal of Urology
Asian Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
4.00
自引率
3.80%
发文量
100
审稿时长
4 weeks
期刊介绍: Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.
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