轉移性腎臟癌的接續性標靶治療----臺中榮總經驗
李建儀、楊晨洸1、楊啟瑞2、歐宴泉1
臺中榮民總醫院 外科部 泌尿外科；1中國醫藥大學附設醫院 泌尿部，2
Sequential treatment of metastatic renal cell carcinoma with targeted therapy---experience of taichung veterans general hospital
Jian-Ri Li, Cheng-Kuang Yang1, Chi-Rei Yang2, Yen-Chuan Ou
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Urology1, China Medical University Hospital, Taichung, Taiwan
Purpose: We performed a retrospective study in our metastatic renal cell carcinoma (mRCC) patients who received at least two lines of targeted therapies and identified clinical markers which can predict treatment outcome.
Materials and Methods: Between 2005 and 2016, 53 patients with clear cell type mRCC who received tyrosine kinase inhibitors (TKIs) or mammalian target of rapamycin inhibitors (mTORi) were included. Clinical parameters were analyzed and we divided patients into the TKIs and everolimus group according to their second line treatment regimens.
Results: The TKIs group patients had higher percentage in the use of first line sunitinib (96% vs. 75%, p=0.049), higher percentage of lymph node metastases (64% vs. 28.6%, p=0.021) and more regimens during the treatment course (2.8 vs. 2.2, p=0.025), than the everolimus group patients. The median overall survival were 3.65 years and 3.09 years in the TKIs and everolimus group respectively (p=0.725). In multi-variant analysis, first line and second line targeted therapy duration were correlated to overall survival positively (HR=0.9, 95% CI 0.84-0.98; HR=0.87, 95% CI 0.78-0.98, respectively). memorial Sloan-Kattering cancer center risk group (MSKCC), initial bone or brain metastases had a higher risk of mortality with 7.27, 3.13, 4.31 folds respectively.
Conclusions: We showed our real world data with more than 3 years overall survival benefit in the treatment of mRCC patients using targeted therapies. First line and second line targeted therapies duration, MSKCC risk group, initial bone or brain metastases can be used as overall survival predictors in the mRCC treatment.