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Sunitinib Followed by Second-Line Axitinib in Metastatic Renal Cell Carcinoma

By: Cordi Craig
Posted: Thursday, October 17, 2019

The final results of a study published in the Journal of Translational Medicine suggest that the tyrosine kinase inhibitor axitinib appears to be a safe and effective second-line treatment in unselected patients with metastatic renal cell carcinoma who received prior sunitinib. The multi-institutional real-world SAX study was conducted by Gaetano Facchini, MD, of the National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy, and colleagues. 

The study authors retrospectively evaluated 148 patients with metastatic renal cell carcinoma across 22 Italian oncology centers. According to the Heng Score for Metastatic Renal Cell Carcinoma Prognosis, 15.5%, 60.1%, and 24.4% of patients were identified as at poor risk, intermediate risk, and favorable risk, respectively.

The patients treated with second-line axitinib achieved a progression-free survival of 7.14 months and an overall survival of 15.5 months. The disease control and objective response rates were 70.6% and 16.6%, respectively. The duration of prior sunitinib treatment among patients seemed to be correlated with a significantly longer median progression-free survival (8.8 months vs. 6.3 months). The patients treated with sunitinib followed by axitinib achieved a median overall survival of 41.15 months. Using multivariate analyses, the study authors found that progression-free survival was significantly correlated with sex and disease control rate to axitinib and to previous sunitinib. Furthermore, the disease control rate for axitinib, nephrectomy, and Heng score independently affected overall survival.

The sunitinib-axitinib sequence was found to be safe and effective. None of the patients experienced grade 4 adverse events associated with axitinib treatment. The most frequent toxicities among all grades included fatigue (50%), hypertension (26%), and hypothyroidism (18%)

According to the study authors, a prospective trial is necessary to determine the optimal sequence of treatments. In addition, they concluded, “head-to-head studies will be needful to determine the best VEGFR inhibitor….”

Disclosure: The study authors reported no conflicts of interest.



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