A prognostic model for patients with metastatic renal cell cancer: what's new?

摘要

In recent years, there has been a shift in the management of patients with metastatic renal cell cancer (mRCC) from cytokines to agents that target the inhibition of angiogenic growth factors. Results of phase 3 trials with sunitinib, bevacizumab, temsirolimus, pazopanib, sorafenib, and everolimus have resulted in a new treatment paradigm for the management of mRCC [1]. The results of randomized phase 3 trials comparing bevacizumab with interferon (IFN)-alpha versus IFN-alpha alone established bevacizumab as a new standard, first-line treatment for mRCC. Median progression-free survival (PFS) was significantly improved in the bevacizumab-plus-IFN group compared with the control group, with a higher response rate in the combination arm (31% vs 13%; p< 0.0001) (AVOREN trial) [2]. A second multicenter phase 3 trial, conducted in the United States and Canada by the Cancer and Leukemia Group B (CALGB), confirmed previous results with PFS of 8.5 mo in patients receiving bevacizumab plus IFN versus 5.2 mo for patients receiving IFN monotherapy (p < 0.0001). The objective response rate was higher in patients receiving bevacizumab plus IFN (25.5%) than in those receiving IFN alone (13.1%, p< 0.0001) [3].