Everolimus or sunitinib as first-line treatment of metastatic papillary renal cell carcinoma: A retrospective study of the GETUG group (Groupe d'Etude des Tumeurs Uro-Génitales).
BACKGROUND
Two phase II trials (NCT00688753 and NCT00541008) reported efficacy data of sunitinib and everolimus in first-line treatment of metastatic papillary renal cell carcinoma (mpRCC). Although most patients receive sunitinib or a mammalian target of rapamycin (mTOR) inhibitor in first- and second-line treatment, the optimal strategy remained unknown.


MATERIAL AND METHODS
In 23 centres of the Groupe d'Etude des Tumeurs Urogénitales group, after centralised pathological review, we analysed retrospectively progression-free survival (PFS) of patients with mpRCC treated in first-line treatment (PFS-1) with sunitinib or everolimus (primary end-point), PFS in second-line treatment (PFS-2), overall survival (OS), objective response rate, disease control rate (DCR), overall sequence and prognostic factors for OS (secondary end-points).


RESULTS
One hundred thirty-eight patients (119 men and 19 women), median age 62.5 years, with mpRCC type 1 (n = 24) or non-type 1 (n = 114), received first-line sunitinib (n = 107) or everolimus (n = 31). With a median follow-up of 92 months, we found no significant difference between the treatment groups in terms of PFS-1 (5.5 versus 6.2 months) and DCR (69% versus 83%). Ninety-eight patients received a second-line treatment, 69% with mTOR inhibitors after sunitinib and 100% with tyrosine kinase inhibitors after everolimus, with similar DCR (64% versus 58%), median PFS-2 (3.4 versus 4.8 months) and OS (16.0 versus 20.3 months). No factor was prognostic for PFS-1, whereas leukocytosis, anaemia and the time from diagnosis to first systemic therapy < 1 year were prognostic for OS. We found no prognostic difference between both pRCC subtypes. The International Metastatic Renal Cell Database Consortium risk factors were prognostic for OS.


CONCLUSION
Sunitinib and everolimus had similar efficacy in first-line treatment of patients with mpRCC.
['Cancel|Mathilde|M|', 'Fromont|Gaelle|G|', 'Blonz|Cyriac|C|', 'Chevreau|Christine|C|', 'Rioux-Leclercq|Nathalie|N|', 'Laguerre|Brigitte|B|', 'Oudard|Stéphane|S|', 'Gross-Goupil|Marine|M|', 'Gravis|Gwenaelle|G|', 'Goldwasser|François|F|', 'Rolland|Frédéric|F|', 'Delva|Rémy|R|', 'Moise|Laura|L|', 'Emambux|Sheik|S|', 'Vassal|Cécile|C|', 'Zanetta|Sylvie|S|', 'Penel|Nicolas|N|', 'Fléchon|Aude|A|', 'Barthélémy|Philippe|P|', 'Saldana|Carolina|C|', 'Lefort|Félix|F|', 'Escudier|Bernard|B|', 'Linassier|Claude|C|', 'Albiges|Laurence|L|']
Everolimus Sunitinib First-line treatment Metastatic Papillary renal cell carcinoma Prognostic factors IMDC risk groups Real world