Refining Approaches to Reach Treatment Goals in mRCC - Episode 7

Second-Line Treatments in RCC

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A number of studies have explored second-line treatment options for patients with metastatic renal cell carcinoma (RCC). One such study explored everolimus, and demonstrated its efficacy in the second-line setting in patients who were previously treated with tyrosine kinase inhibitor (TKIs), notes Saby George, MD. Additionally, in a second trial, axitinib was found to be superior to sorafenib. In the subset analysis in this latter trial, patients receiving axitinib who were previously treated with TKIs did not reap as much benefit as those who received cytokines (Escudier B, et al. Br J Cancer. 2014;110(12):2821-2828).

These 2 trials results cannot be compared and used as a guide for treatment selection, as they differed in design and patient populations, George cautions. When beginning axitinib in the second-line or third-line setting, Sumanta Kumar Pal, MD, starts individuals on 5 mg twice daily and evaluates patients every 2 weeks to monitor for toxicity. In the absence of toxicities, the dose is periodically titrated until the target of 10 mg twice daily is reached.

Both Pal and George advise that blood pressure must be monitored, as there have been some data that may link poor outcomes on axitinib to hypertension (Rini BI, et al. Ann Oncol. 2015 Feb 20. [Epub ahead of print]). When treating a patient whose RCC relapsed while on TKI therapy, Pal and George state they would choose to engage another mechanism of action, such as switching therapy to an mTOR inhibitor; for instance, everolimus.