PMID- 24983741
OWN - NLM
STAT- MEDLINE
DCOM- 20150611
LR  - 20211203
IS  - 1473-4877 (Electronic)
IS  - 0300-7995 (Linking)
VI  - 30
IP  - 10
DP  - 2014 Oct
TI  - Treatment patterns in metastatic renal cell carcinoma: a retrospective review of 
      medical records from US community oncology practices.
PG  - 2041-50
LID - 10.1185/03007995.2014.938730 [doi]
AB  - BACKGROUND: Vascular endothelial growth factor (VEGF) inhibitors, including 
      targeted therapy with tyrosine kinase inhibitors (TKIs) and the angiogenesis 
      inhibitor bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors are 
      now the standard of care for metastatic renal cell carcinoma (mRCC). However, 
      real-world treatment patterns are not well characterized. OBJECTIVE: To describe 
      treatment patterns during the first, second, and third lines of targeted 
      therapies for mRCC among community oncologists in the US. METHODS: Participating 
      physicians recruited from a nationwide panel each identified up to 15 adult mRCC 
      patients who initiated a second therapy after January 2010. Information extracted 
      from medical records included types of targeted therapies, reasons for treatment 
      choices, patterns of treatment discontinuation, and dose adjustments. RESULTS: 
      Thirty-six physicians contributed charts from 433 mRCC patients. Seventy-seven 
      percent of patients received a VEGF inhibitor as first targeted therapy; 23% 
      received an mTOR inhibitor. Among first-line VEGF users, second-line treatments 
      were 66% mTOR and 34% VEGF inhibitors. Among first-line mTOR users, second-line 
      treatments were 94% VEGF and 6% mTOR inhibitors. Sunitinib followed by everolimus 
      was the most commonly used treatment sequence. Estimated median duration for 
      second targeted therapy was 8.6 months, and median overall survival (OS) and 
      progression-free survival (PFS) were 27.4 and 10.8 months, respectively. 
      Efficacy, treatment guidelines and mechanism of action were the most important 
      considerations for treatment choice. LIMITATIONS: LIMITATIONS include no 
      adjustment for baseline characteristics, possible difference between 
      physician-defined progression and central review in the clinical trial setting, 
      and limited data availability for axitinib during the study period. CONCLUSION: 
      In this large retrospective chart review among community oncologists, 
      VEGF-mTOR-VEGF was the most common treatment sequence for mRCC. The most common 
      drugs were sunitinib in the first line and everolimus in the second line.
FAU - Jonasch, Eric
AU  - Jonasch E
AD  - MD Anderson Cancer Center , Houston, TX , USA.
FAU - Signorovitch, James E
AU  - Signorovitch JE
FAU - Lin, Peggy L
AU  - Lin PL
FAU - Liu, Zhimei
AU  - Liu Z
FAU - Culver, Ken
AU  - Culver K
FAU - Pal, Sumanta K
AU  - Pal SK
FAU - Scott, Jeffrey A
AU  - Scott JA
FAU - Vogelzang, Nicholas J
AU  - Vogelzang NJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140709
PL  - England
TA  - Curr Med Res Opin
JT  - Current medical research and opinion
JID - 0351014
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Indoles)
RN  - 0 (Pyrroles)
RN  - 0 (Vascular Endothelial Growth Factor A)
RN  - 9HW64Q8G6G (Everolimus)
RN  - EC 2.7.10.1 (Protein-Tyrosine Kinases)
RN  - EC 2.7.11.1 (TOR Serine-Threonine Kinases)
RN  - V99T50803M (Sunitinib)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Adult
MH  - Animals
MH  - *Antineoplastic Agents/classification/therapeutic use
MH  - Antineoplastic Protocols
MH  - *Carcinoma, Renal Cell/drug therapy/pathology
MH  - Disease-Free Survival
MH  - Everolimus
MH  - Female
MH  - Humans
MH  - Indoles/therapeutic use
MH  - *Kidney Neoplasms/drug therapy/pathology
MH  - Male
MH  - Medical Records
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Protein-Tyrosine Kinases/*antagonists & inhibitors
MH  - Pyrroles/therapeutic use
MH  - Retrospective Studies
MH  - Sirolimus/analogs & derivatives/therapeutic use
MH  - Sunitinib
MH  - TOR Serine-Threonine Kinases/*antagonists & inhibitors
MH  - Treatment Outcome
MH  - Vascular Endothelial Growth Factor A/*antagonists & inhibitors
OTO - NOTNLM
OT  - chart review
OT  - mammalian target of rapamycin
OT  - metastatic renal cell carcinoma
OT  - treatment patterns
OT  - vascular endothelial growth factor
EDAT- 2014/07/02 06:00
MHDA- 2015/06/13 06:00
CRDT- 2014/07/02 06:00
PHST- 2014/07/02 06:00 [entrez]
PHST- 2014/07/02 06:00 [pubmed]
PHST- 2015/06/13 06:00 [medline]
AID - 10.1185/03007995.2014.938730 [doi]
PST - ppublish
SO  - Curr Med Res Opin. 2014 Oct;30(10):2041-50. doi: 10.1185/03007995.2014.938730. 
      Epub 2014 Jul 9.