Are Tyrosine Kinase Inhibitors Still Active in Patients With Metastatic Renal Cell Carcinoma Previously Treated With a Tyrosine Kinase Inhibitor and Everolimus? Experience of 36 Patients Treated in France in the RECORD-1 Trial

Everolimus has become a standard treatment after failure to VEGF inhibitors in RCC. Benefit of treatment after everolimus failure remains unknown. This study reports the efficacy of TKIs in third line or later, in RCC. Background: Because the response to treatment is limited, patients with metastatic renal cell carcinoma (mRCC) typically receive multiple treatments. Guidelines recommend everolimus for patients previously treated with tyrosine kinase inhibitors (TKI) sunitinib or sorafenib. This study evaluated the efficacy of TKI re-treatment in patients with disease progression after a TKI-everolimus sequence. Patients and Methods: Data were reviewed for patients enrolled in RECORD-1 (Renal Cell Cancer Treatment With Oral RAD001 Given Daily) at French sites. Response, progression-free survival (PFS), and overall survival were evaluated in patients treated with a TKI-everolimus-TKI sequence. Results: Thirty-six patients received a TKI after everolimus: sunitinib in 17 patients, sorafenib in 15, and dovitinib (TKI258) in 4. The response rate with TKI re-treatment was 8%, and the disease-control rate (response plus stable disease) was 75%. The median PFS with each component of the TKI-everolimus-TKI sequence was 10.7 months (95% CI, 1.8-28.5 months), 8.9 months (95% CI, 1.7-34.6 months), and 8.2 months (95% CI, 5.2-11.9 months), respectively. The median overall survival from the start of everolimus was 29.1 months (95% CI 21.1 to not reached months), which suggests a benefit in using TKI in this setting. Conclusions: Administration of a TKI-everolimus-TKI sequence may be associated with clinical benefit and should be prospectively investigated. (C) 2013 Elsevier Inc. All rights reserved.