PFS with First-Line Therapy Prognostic for OS IN mRCC

REPORT FROM THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO) ANNUAL MEETING, CHICAGO, IL, JUNE 3-7, 2011 - A retrospective study of 119 mRCC patients treated with a first-line VEGF-targeted therapy has found that PFS is prognostic for overall survival (Seidel et al. J Clin Oncol 2011; 29(suppl): 4591;http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=102&abstractID=77895).

A majority of subjects received first-line treatment with sunitinib; other treatments included sorafenib, axitinib, and bevacizumab + interferon-alfa or everolimus. Best response was evaluated in 95 subjects and included complete remission in 6%, partial remission in 19%, stable disease in 48% and progressive disease in 26%. Median PFS with first-line therapy was 8.1 months; median OS was 22.7 months. The median OS in patients with PFS ≤ 6 or >6 months was 12 and 33 months, respectively.

PFS >6 months during first-line treatment, good MSKCC score and treatment with second-line therapy were independent prognostic factors for prolonged OS. The authors concluded that response to first-line VEGF therapy may inform clinical decision-making when selecting subsequent treatments.

These findings align with those reported in a recent analysis by Heng et al. at the University of Calgary (Heng et al. Cancer 2011; 117: 2637-2642; www.ncbi.nlm.nih.gov/pubmed/21656741). In their study, a proportional hazards model was used to evaluate the utility of PFS for predicting OS. Data were obtained from 1,158 mRCC patients at 12 centres with a median follow-up of 30.6 months.

Overall, the median PFS was 7.6 months; median OS was 19.7 months. Both PFS at 3 and 6 months were predictive of OS. For the 3-month PFS, OS was 7.8 versus 23.6 months for patients who progressed compared to those who did not progress (p<0.0001; adjusted hazard ratio 3.05). For 6-month PFS, OS was 8.6 versus 26.0 months for the two groups, respectively (p<0.0001; adjusted HR 2.96). PFS at 9 and 12 months were also predictive of OS.