Sequential use of sorafenib and sunitinib in renal cancer: Retrospective analysis in 90 patients

Abstract

5038 Background: Sorafenib (So) and sunitinib (Su) have been recently approved for the treatment of advanced renal cell carcinoma (RCC). Following this approval, sequential use of both drugs is often proposed, although very few data are available to support it. Material and Methods: We reviewed all patients (pts) who received sequentially So-Su or Su-So in the last 3 years from 4 sites in France. All pts had been enrolled in clinical studies or in the extended access programs. In all patients demography, prognostic factors (MSKCC score), number of metastatic sites, best response (BR) and PFS with each treatment were recorded. Some patients are still too early for response and PFS assessment under the second treatment. Results: 68 pts first received So while 22 pts received Su first (continuous dosing in 12, intermittent in 10). Results under the first treatments were as follows: median PFS 26.1 wks, mean duration of treatment 33.2 wks; and median PFS was 22 wks, mean duration of treatment 26.9 wks for So and Su respectively. BR in terms of partial response (PR), stable disease (SD), progressive disease (PD) is given in the table . 2 pts stopped So because of toxicity and response is not available (NA), and 22 pts (NE) are too early in the course of the second treatment. Overall, PR rate was 17.6% for So and 22.7% for Su. PR or SD was observed as best response in the second treatment in both sequences. Only 6 pts had PD with both drugs: all of them had 3 or more metastatic sites and were in intermediate or poor MSKCC risk groups. Conversely, 4 pts had PR with both drugs, and were in good (n=2) or intermediate (n=2) risk groups. 11 pts only have died so far. Conclusions: these results suggest the lack of cross resistance between So and Su, and support the sequential use of So and Su in RCC. Updated data will be presented at ASCO. [Table: see text] No significant financial relationships to disclose.

The medical management of metastatic renal cell carcinoma: integrating new guidelines and recommendations

“…Studies suggesting a lack of cross‐resistance between sorafenib and sunitinib are also cited. Available retrospective data suggest that patients treated with sorafenib and then sunitinib have longer overall disease control than patients treated with the reverse sequence [22,23]. A phase III trial is planned to investigate axitinib in the second‐line setting.…”

“…Finally, the SIOG guidelines make the suggestion that populations included in retrospective studies can give an indication of the investigators’ perceptions of the tolerability profiles of different agents. For example, in two studies assessing the sequential use of sorafenib and sunitinib, patients initially treated with sunitinib were younger than those initially treated with sorafenib [22,23].…”

Renal Cell Carcinoma: New Developments in Molecular Biology and Potential for Targeted Therapies

“…So far it appears that crossresistance is not complete and objective responses and meaningful disease stabilization are seen when the second multikinase inhibitor (sorafenib or sunitinib) is employed. Absolute resistance to both agents is, in fact, uncommon, and was seen in only 7% of patients in one report [64].…”

Recent advances in molecular targeted therapy for metastatic renal cell carcinoma

“…Sequential therapy with sorafenib and sunitinib for meatstatic RCC was reported. 28,29 Sablin et al analyzed 90 patients. The response rate of treatment with sorafenib then sunitinib was 15%, and the response rate of treatment with sunitinib then sorafenib was 9%.…”

“…Sequential therapy with sorafenib and sunitinib for meatstatic RCC was reported 28,29 . Sablin et al.…”