Minimizing Toxicity While Maintaining Efficacy in RCC - Episode 3

Frontline Treatment of Poor-Risk mRCC

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Prognostic risk assessment tools provide a clear indication of a patients overall prognosis and likelihood of response to therapy. However, their utilization in the metastatic setting for patients with renal cell carcinoma (RCC) provides little additional value for selecting an optimal treatment, since clinical trial data suggests a similar approach for patients with good- and intermediate-risk factors, Brian I. Rini, MD, believes. However, these tools remain important in patient conversations.

For patients with poor-risk metastatic RCC, the optimal treatment remains unclear. The mTOR inhibitor temsirolimus has demonstrated a prolongation in overall survival (OS) compared with interferon-alpha in a phase III trial that enrolled intermediate- and poor-risk patients with advanced RCC. The median OS with temsirolimus was 10.9 months compared with 7.3 months for interferon-alpha (HR = 0.73). However, Rini suggests, this study does not provide evidence that temsirolimus is superior to the VEGF-targeted TKIs.

To examine this notion further, Nizar M. Tannir, MD, explains that a phase II randomized study is comparing the VEGF inhibitor pazopanib to temsirolimus in patients with poor-risk clear-cell RCC (NCT01392183). The primary endpoint of the study is progression-free survival with a planned accrual of 90 patients. At this early point in the study, Tannir suggests that treatment with pazopanib is effective in the poor-risk setting.