Background

Targeted therapies significantly improve clinical outcomes among patients with metastatic renal cell carcinoma (mRCC). Several new agents have been approved for first- and second-line use. However, there is a lack of compelling evidence comparing sequencing strategies, and available comparative data regarding the real-world effectiveness of different therapeutic sequences are limited.

Materials and Methods

We identified mRCC patients who initiated targeted therapy between January 1, 2008 and May 31, 2017 from the National Health Insurance Fund (NHIF) database of Hungary. Overall survival (OS) and duration of first-line treatment (DFT) were obtained for patients receiving sunitinib-everolimus, sunitinib-axitinib, or pazopanib-everolimus treatment sequences. OS of sunitinib-everolimus and sunitinib-axitinib sequences was also determined for patients having better or worse response to sunitinib first-line therapy.

Results

Median OS was significantly longer among patients treated with sunitinib-axitinib compared to those receiving sunitinib-everolimus. Median DFT was also significantly longer in the sunitinib-axitinib vs. sunitinib-everolimus group. Sunitinib-axitinib was associated with significantly longer median OS compared to sunitinib-everolimus in patients with better response to first-line sunitinib in the pooled sunitinib population. In patients with worse response to sunitinib, sunitinib-axitinib was associated with a trend towards greater OS compared to sunitinib-everolimus, but the difference did not reach statistical significance.

Conclusions

In this nationwide database analysis, mRCC patients treated with the sunitinib-axitinib sequence had significantly longer OS compared to those receiving sunitinib-everolimus therapy. The OS benefits of second-line axitinib were consistent among patients with better response to sunitinib defined by DFT values.

中文翻译：

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一线舒尼替尼治疗转移性肾细胞癌后，二线阿昔替尼与依维莫司的生存获益。

背景

靶向治疗显着改善了转移性肾细胞癌（mRCC）患者的临床结局。几种新试剂已被批准用于一线和二线。但是，缺乏令人信服的证据来比较测序策略，并且关于不同治疗序列的实际有效性的可用比较数据有限。

材料和方法

我们从匈牙利国家健康保险基金（NHIF）数据库中识别了在2008年1月1日至2017年5月31日之间开始靶向治疗的mRCC患者。获得接受舒尼替尼-依维莫司，舒尼替尼-阿昔替尼或帕唑帕尼-依维莫司治疗序列的患者的总生存期（OS）和一线治疗持续时间（DFT）。还确定了对舒尼替尼一线治疗反应较好或较差的患者的舒尼替尼-依维莫司和舒尼替尼-阿昔替尼序列的OS。

结果

与接受舒尼替尼-依维莫司治疗的患者相比，接受舒尼替尼-阿昔替尼治疗的患者的中位OS明显更长。舒尼替尼-阿昔替尼组与舒尼替尼-依维莫司组的中值DFT也明显更长。在合并的舒尼替尼人群中，对一线舒尼替尼有较好反应的患者，与舒尼替尼-依维莫司相比，舒尼替尼-阿昔替尼与中位OS明显更长。在对舒尼替尼反应较差的患者中，与舒尼替尼-依维莫司相比，舒尼替尼-阿昔替尼与OS升高趋势相关，但差异无统计学意义。

结论

在这项全国性数据库分析中，与接受舒尼替尼-依维莫司治疗的患者相比，接受舒尼替尼-阿昔替尼序列治疗的mRCC患者的OS明显更长。二线阿昔替尼的OS获益在对DIT值定义的舒尼替尼有更好反应的患者中是一致的。