J O U R N A L C L U B
Essential Peer-Reviewed Reading in Kidney Cancer
The peer-reviewed articles summarized in this section were selected by the
Guest Editor, Roberto Pili, MD, for their timeliness, importance, relevance,
and potential impact on clinical practice or translational research.
Quality of life outcomes for cabozantinib versus everolimus
in patients with metastatic renal cell carcinoma:
METEOR phase III randomized trial. Cella D, Escudier B,
Tannir NM, et al. J Clin Oncol. 2018 Mar 10;36(8):757-764.
Summary: In the phase III METEOR trial, 658 previously
treated patients with advanced renal cell carcinoma were
randomly assigned 1:1 to receive cabozantinib or
everolimus. The cabozantinib arm had improved progression
free survival, overall survival, and objective response
rate compared with everolimus. Changes in quality of
life (QoL), an exploratory end point, are reported here.
Patients completed functional assessment questionnaires.
Data were summarized descriptively and by repeated-measures
analysis (for which a clinically relevant difference
was an effect size ≥ 0.3). Time to deterioration (TTD) was
defined as the earlier of date of death, radiographic progressive
disease, or ≥ 4-point decrease from There was
no difference over time in data gathered between the
cabozantinib and everolimus arms. Cabozantinib
improved TTD overall, with a marked improvement in
patients with bone metastases at baseline.
Conclusion: In patients with advanced RCC, relative to
everolimus, cabozantinib generally maintained QoL to a
similar extent. Compared with everolimus, cabozantinib
extended TTD overall and markedly improved TTD in
patients with bone metastases.
Cabozantinib, a new standard of care for patients with
advanced renal cell carcinoma and bone metastases?
Subgroup analysis of the METEOR Trial. Escudier B,
Powles T, Motzer RJ, et al. J Clin Oncol. 2018 Mar
10;36(8):765-772.
Summary: Six hundred fifty-eight patients were randomly
assigned 1:1 to receive 60 mg cabozantinib or 10 mg
everolimus. Prespecified subgroup analyses of PFS, OS, and
ORR were conducted in patients grouped by baseline bone
metastases status per independent radiology committee
(IRC). Additional end points included bone scan response
per IRC, skeletal-related events, and changes in bone biomarkers.
For patients with bone metastases at baseline
(cabozantinib n = 77; everolimus n = 65), median PFS
was 7.4 months for cabozantinib versus 2.7 months for
everolimus. Median OS was also longer with cabozantinib
(20.1 months v 12.1 months), and ORR per IRC was higher
(17% v 0%). The rate of skeletal-related events was 23%
with cabozantinib and 29% with everolimus, and bone
scan response per IRC was 20% versus 10%, respectively.
PFS, OS, and ORR were also improved with cabozantinib
in patients without bone metastases. Changes in bone
biomarkers were greater with cabozantinib than with
everolimus. The overall safety profiles of cabozantinib and
everolimus in patients with bone metastases were consistent
with those observed in patients without bone
metastases.
Conclusion: Cabozantinib treatment was associated with
improved PFS, OS, and ORR when compared with
everolimus treatment in patients with advanced RCC and
bone metastases and represents a good treatment option
for these patients.
Pooled analysis of stereotactic ablative radiotherapy
for primary renal cell carcinoma: A report from the
International Radiosurgery Oncology Consortium for
Kidney (IROCK). Siva S, Louie AV, Warner A, et al. Cancer.
2018 Mar 1;124(5):934-942.
Summary: Individual patient data sets from 9 International
Radiosurgery Oncology Consortium for Kidney
institutions across Germany, Australia, the United States,
Canada, and Japan were pooled. Of 223 patients, 118
received single-fraction SABR, and 105 received multifraction
SABR. The mean patient age was 72 years, and 69.5%
of patients were men. There were 83 patients with grade 1
and 2 toxicity (35.6%) and 3 with grade 3 and 4 toxicities
(1.3%). The rates of local control, cancer-specific survival,
and progression-free survival were 97.8%, 95.7%, and
77.4%, respectively, at 2 years; and they were 97.8%,
91.9%, and 65.4%, respectively, at 4 years. Tumors with a
larger maximum dimension and the receipt of multifraction
SABR were associated with poorer progression-free
survival (hazard ratio, 1.16 P< .01 and 1.13 P= .02,
respectively) and poorer cancer-specific survival (hazard
ratio, 1.28 P< .01 and 1.33 P= .01, respectively). There
were no differences in local failure between the singlefraction
cohort (n = 1) and the multifraction cohort
(n = 2; P= .60).
Conclusion: SABR is well tolerated and locally effective
for treating patients who have primary renal cell carcinoma
and has an acceptable impact on renal function.
An interesting observation is that patients who receive
single-fraction SABR appear to be less likely to progress
distantly or to die of cancer.
Axitinib in combination with pembrolizumab in
patients with advanced renal cell cancer: a non-randomised,
open-label, dose-finding, and dose-expansion
phase 1b trial. Atkins MB, Plimack ER, Puzanov I, et al.
Lancet Oncol. 2018 Mar;19(3):405-415.
8 Kidney Cancer Journal
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