轉移性腎癌接受標靶治療：新光醫院經驗
吳子翔1、林宜佳1,2、蔡德甫1,2、莊光達1,2、葉忠信1,2、鄭以弘1、仇光宇1、陳宏恩1、黃一勝1,2
Targeted Therapy for Metastatic Renal Cell Carcinoma: Case Series Study in Single Hospital Experience
Tzu-Hsiang Wu 1, Yi-Chia Lin 1,2, Te-Fu Tsai 1,2, Guang-Dar Juang 1,2, Chung-Hsin Yeh 1,2, Yi-Hung Cheng1,2, Kuang-Yu Chuo 1, Hung-En Chen 1, Thomas I.S. Hwang 1,2
1 Division of Urology, Department of Surgery, Shin-Kong WHS Memorial Hospital, Taipei, Taiwan, ROC
2 Department of Urology, Fu Jen Catholic University School of Medicine, Taipei, Taiwan, ROC
Introduction:
Treatment for metastatic renal cell carcinoma (mRCC) has recently focused on targeted therapy including tyrosine kinase inhibitors and mTOR inhibitors. Molecular-targeted therapies have been proved to be effective treatment options. We herein report the outcomes of targeted therapy for mRCC in our institution.
Materials and Methods:
From 2010 to 2015, 15 mRCC patients were identified in our institute under targeted therapy with a diagnosis of mRCC. Three targeted agents, namely temsirolimus, sunitinib, and everolimus, were given for patient according to the clinical condition. Sunitinib and Temsirolimus were served as first-line treatment and Everolimus was the second–line treatment. Demographics, the interval between diagnosis of metastasis and targeted therapy, the duration of targeted therapy, side effects and complications after treatment were collected with a retrospective medical record review. Response rate were analyzed according to RECIST criteria.
Results:
Among the 15 patients, 9 were male and 6 were female. The mean age was 70.3 (35-88) years old. Lung metastasis was noted in 80% (12/15) of the patient, and other sites of metastasis were also noted, including lymphnodes, liver, bone and adrenal gland. The mean interval between diagnosis of metastasis and targeted therapy is 27.5 (1-78) days. The mean duration of targeted therapy is 268.5 days with temsirolimus, 397.8 days with sunitinib and 360.3 days with everolimus. The most common side effect noted in targeted therapy is anemia (100%) in temsirolimus group, hand-foot mouth syndrome (61.5%) and hypertension (61.5%) in sunitinib group, and cough (50%) ( without radiologic sign of interstitial pneumonitis) in everolimus group. There were 2 patients (2/4) with disease regression and 2 (2/4) with stationary disease under everolimus usage, compared with 2 patients (2/12) with disease regression, 5 patients (5/12) with progression disease and 5 patients in stationary status under sunitinib usage. One patient with temsirolimus usage was in disease progression, and the other was in stationary status.
Conclusion:
Targeted therapy prolonged the life of mRCC patients with tolerable outcome. In our series, the response rate of Everolimus is higher than expected.