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Real-world experience of everolimus as second-line treatment in metastatic renal cell cancer after failure of pazopanib

Authors Koutsoukos K, Bamias A, Tzannis K, Espinosa Montaño M, Bozionelou V, Christodoulou C, Stefanou D, Kalofonos H, Duran I, Papazisis K

Received 6 May 2017

Accepted for publication 23 August 2017

Published 6 October 2017 Volume 2017:10 Pages 4885—4893

DOI https://doi.org/10.2147/OTT.S141260

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Geoffrey Pietersz

Konstantinos Koutsoukos,1,2 Aristotelis Bamias,1,2 Kimon Tzannis,1 Marta Espinosa Montaño,3 Vasiliki Bozionelou,4 Christos Christodoulou,5 Dimitra Stefanou,6 Haralabos Kalofonos,7 Ignacio Duran,3 Konstantinos Papazisis1,8

1Hellenic Genito-Urinary Cancer Group, 2Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece; 3Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 4Department of Medical Oncology, University Hospital of Heraklion, Heraklion, 52nd Oncology Clinic, Metropolitan Hospital, Piraeus, 61st Department of Medical Oncology, Saint Savvas Anticancer Hospital, Athens, 7Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, 8Euromedica General Clinic, Thessaloniki, Greece

Aim: We aimed to provide real-life data on the outcomes of metastatic renal cell carcinoma (mRCC) patients treated with everolimus as second-line treatment after failure of first-line pazopanib.
Patients and methods: Data from the medical charts of mRCC patients from 8 centers in Greece and Spain were reviewed. All patients had received or were continuing to receive second-line everolimus treatment after failure of first-line treatment with pazopanib. No other previous therapies were allowed. The primary end point was the determination of progression-free survival (PFS).
Results: In total, 31 patients were enrolled. Of these, 26% had performance status (PS) >0, 88% were of intermediate/poor Memorial Sloan-Kettering Cancer Center (MSKCC) risk group, and only 61% had undergone prior nephrectomy. Median PFS was 3.48 months (95% CI: 2.37–5.06 months). Median overall survival (OS) from everolimus initiation was 8.9 months (95% CI: 6.47–13.14 months). Median OS from pazopanib initiation was 14.78 months (95% CI: 10.54–19.08 months). Furthermore, 32% of patients temporarily discontinued everolimus due to adverse events (AEs), and 22% of patients discontinued everolimus permanently due to toxicity. Most common toxicities were anemia (29%), stomatitis (26%), pneumonitis (19%), and fatigue (10%). Moreover, 14 AEs (27%) were graded as 3 or 4 and were reported by 13 patients (42%).
Conclusion: This study provides data exclusively on the sequence pazopanib–everolimus in mRCC. Everolimus has a favorable safety profile and is active. The short PFS and OS could be attributed to the fact that the pazopanib–everolimus sequence was mainly offered to patients with adverse prognostic features, resulting in a modest increase in the combined OS of our population.

Keywords: pazopanib, everolimus, renal cell carcinoma

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