Complete Remission With Tyrosine Kinase Inhibitors in Renal Cell Carcinoma

Abstract

Purpose Complete remission (CR) is uncommon during treatment for metastatic renal cell carcinoma (mRCC) with tyrosine kinase inhibitors (TKIs), but it may occur in some patients. It remains a matter of debate whether therapy should be continued after CR. Methods A multicenter, retrospective analysis of a series of patients with mRCC who obtained CR during treatment with TKIs (sunitinib or sorafenib), either alone or with local treatment (surgery, radiotherapy, or radiofrequency ablation), was performed. Results CR was identified in 64 patients; 36 patients had received TKI treatment alone and 28 had also received local treatment. Most patients had clear cell histology (60 of 64 patients), and all had undergone previous nephrectomy. The majority of patients were favorable or intermediate risk; however, three patients were poor risk. Most patients developed CR during sunitinib treatment (59 of 64 patients). Among the 36 patients who achieved CR with TKI alone, eight continued TKI treatment after CR, whereas 28 stopped treatment. Seventeen patients who stopped treatment (61%) are still in CR, with a median follow-up of 255 days. Among the 28 patients in CR after TKI plus local treatment, 25 patients stopped treatment, and 12 of these patients (48%) are still in CR, with a median follow-up of 322 days. Conclusion CR can occur after TKI treatment alone or when combined with local treatment. CR was observed at every metastatic site and in every prognostic group.

Local treatments for metastases of renal cell carcinoma: a systematic review

“…The great variation in type and distribution of systemic treatment, and its response being reported in only a subset of studies, prevents any conclusion on the role and eff ect of targeted treatment in the setting of complete metastasectomy. However, in a non-comparative report, 38 most patients who had a complete response after a combination of targeted treatment and local treatment stopped systemic treatment. After a median follow-up of 10·7 months (range 0·3-54·0), 48% of patients had still not experienced disease progression; these data suggest that local treatment might have a role in delaying return to systemic treatment and associated toxicity.…”

Complete response to low-dose sorafenib in a patient with metastatic renal cell carcinoma: A case report

“…and combining surgery, there are large series of patients with mRCC achieving CR during TKIs treatment, whereas agents of TKIs are mainly sunitinib. 11,12 One series included 36 patients who achieved CR during TKI treatment; in this series, 12 patients (33%) remained recurrence free at the 12-month median follow-up. 11 In another series, 64 patients achieved CR during TKI treatment.…”

Induction of Endoplasmic Reticulum Stress by Sorafenib and Activation of NF-κB by Lestaurtinib as a Novel Resistance Mechanism in Hodgkin Lymphoma Cell Lines

“…Tyrosine kinase inhibitors (TKI) are usually most effective in malignancies with mutation-activated tyrosine kinases such as lung cancer with mutated EGF receptor (EGFR) treated with gefitinib (9). However, several TKIs are also used for the treatment of cancers in which so far no tyrosine kinase-activating mutations have been identified such as sorafenib in advanced renal cell carcinoma and hepatocellular carcinoma (10)(11)(12).…”