Efficacy and Safety of Axitinib in Higher Lines of Renal Carcinoma Treatment in Real Practice
Greek authors published a retrospective study from a single institution and demonstrated that axitinib is a safe and effective treatment option for metastatic renal carcinoma even in ≥ 3rd line treatment.
Methodology and Study Progress
The study included 22 adult patients with metastatic renal carcinoma who were treated with axitinib after at least 2 previous lines of therapy between 2013–2017. All patients underwent radical nephrectomy. The median age in this group was 55.4 years, with women comprising 50%. Axitinib was used by 54.5% of patients in the 3rd line, 18.2% in the 4th line, and 27.3% in ≥ 4th line. The prognostic risk according to Heng at the start of axitinib treatment was intermediate in 40.9% of patients and unfavorable in 50.0%. Nearly 82% had multiple metastases. Half of the patients had been treated with at least 2 other tyrosine kinase inhibitors (TKI) in previous lines of therapy.
Results
Efficacy
The results showed a benefit of axitinib in 68% of patients, with 27.0% achieving partial remission and 41.0% achieving disease stabilization. The median progression-free survival (PFS) reached 6.27 months (95% confidence interval [CI] 3.62–8.91) and the median overall survival (OS) was not reached at the time of analysis. No predictive significance was found for any clinicopathological factor (gender, histology, location of metastases, prognostic risk according to Heng) or treatment-related factor (line of therapy, type of previous treatment, number of previously administered TKIs). In 18.2% of patients, a long-term benefit of axitinib (> 12 months) was observed. PFS in this subgroup reached 14.3 months (95% CI 8.7–19.9).
Safety
Adverse events occurred in all but one patient (95.8%). In 69.0%, they were grade 1–2 and in the remaining 31.0%, they were grade 3. The most common events were fatigue, hypertension, hypothyroidism, palmar-plantar erythrodysesthesia, and hoarseness. Grade 3 adverse events most commonly included palmar-plantar erythrodysesthesia and hypertension. Dose reduction was necessary in 22% of patients, and treatment discontinuation in 13%.
Conclusion
Anti-angiogenic targeted therapy remains an important part of renal carcinoma treatment. Axitinib is a TKI with proven efficacy in 2nd line treatment. Real-world data confirm its efficacy and safety also in higher lines of treatment. The study also confirmed its known safety profile.
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Source: Tsironis G., Liontos M., Kyriazoglou A. et al. Axitinib as a third or further line of treatment in renal cancer: a single institution experience. BMC Urol 2020 Jun 2; 20 (1): 60, doi: 10.1186/s12894-020-00618-1.
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