Journal article
Second-line treatment for metastatic clear cell renal cell cancer: experts' consensus algorithms.
- Rothermundt C Department of Haematology and Oncology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. christian.rothermundt@kssg.ch.
- von Rappard J Department of Nephrology, University Hospital Bern, Bern, Switzerland.
- Eisen T Department of Oncology, Cambridge University Hospitals NHS Foundation Cambridge, Cambridge, UK.
- Escudier B Gustave Roussy, Villejuif, France.
- Grünwald V Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany.
- Larkin J The Royal Marsden Hospital, London, UK.
- McDermott D Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Oldenburg J Department of Medical Oncology, Norwegian Radium Hospital, Oslo, Norway.
- Porta C Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy.
- Rini B Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, OH, USA.
- Schmidinger M Abteilung für Onkologie, Allgemeines Krankenhaus, Universitätskliniken, Vienna, Austria.
- Sternberg CN Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy.
- Putora PM Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
- 2016-08-05
Published in:
- World journal of urology. - 2017
Algorithm
Consensus
Diagnostic nodes
Renal cell cancer
Algorithms
Anilides
Antibodies, Monoclonal
Antineoplastic Agents
Axitinib
Carcinoma, Renal Cell
Consensus
Decision Support Techniques
Decision Trees
Everolimus
Humans
Imidazoles
Indazoles
Kidney Neoplasms
Nivolumab
Protein Kinase Inhibitors
Pyridines
Treatment Failure
English
BACKGROUND
Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making.
MATERIALS AND METHODS
Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.
RESULTS
The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.
CONCLUSION
In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making.
MATERIALS AND METHODS
Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.
RESULTS
The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.
CONCLUSION
In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00345-016-1903-6
- PMID 27488984
- Persistent URL
- https://sonar.ch/global/documents/177786
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