title: Clinical response to therapy targeted at vascular endothelial growth factor in metastatic renal cell carcinoma: impact of patient characteristics and Von Hippel-Lindau gene status.
abstract: OBJECTIVE
  To describe the relationship among patient characteristics, Von Hippel-Lindau (VHL) gene status and clinical outcome in metastatic renal cell carcinoma (RCC) in patients receiving vascular endothelial growth factor (VEGF)-targeted therapy.
  
  
  METHODS
  All patients with metastatic RCC who received therapy with interferon-alpha plus bevacizumab, SU11248 or AG013736 at the authors' institution were considered. Clinical features were collected and activation status of the VHL gene (VHL) was determined from baseline paraffin-embedded tumour samples. Tumour response, time to tumour progression (TTP) and overall survival were recorded.
  
  
  RESULTS
  Forty-three patients were evaluable for determination of VHL status and clinical response. There was an objective response in 18 patients (43%; 95% confidence interval 28-59%). The median TTP for the entire cohort was 8.1 months. There was an improved clinical outcome in patients with the following clinical features: male gender, lack of hepatic metastases, no previous radiation therapy and higher baseline haemoglobin level. Twenty-six patients (60%) had evidence of VHL mutation or promoter methylation; such patients had an objective response rate of 48%, vs 35% in patients with no VHL mutation or methylation. Patients with VHL methylation or a mutation predicted to truncate or shift the VHL reading frame had a median TTP of 13.3 months, vs 7.4 months in patients with none of these features (P = 0.06).
  
  
  CONCLUSIONS
  VEGF-targeted therapy is active in metastatic RCC and the response can be associated with certain clinical features. The TTP with VEGF-targeted therapy might be prolonged in patients with VHL methylation or mutations that truncate or shift the VHL reading frame. Further investigation of VHL pathway components is needed to understand the biology of the response to VEGF-targeted agents in metastatic RCC.
authors.affiliation: Department of Medicine, the University of California San Francisco, San Francisco, California, USA. rinib2@ccf.org
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.forename: Erich
authors.initials: E
authors.lastname: Jaeger
authors.forename: Vivian
authors.initials: V
authors.lastname: Weinberg
authors.forename: Nancy
authors.initials: N
authors.lastname: Sein
authors.forename: Karen
authors.initials: K
authors.lastname: Chew
authors.forename: Kristen
authors.initials: K
authors.lastname: Fong
authors.forename: Jeffery
authors.initials: J
authors.lastname: Simko
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Small
authors.forename: Frederic M
authors.initials: FM
authors.lastname: Waldman
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077784:Axitinib; D000068258:Bevacizumab; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D007191:Indazoles / Q000008:administration & dosage; D007211:Indoles / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011758:Pyrroles / Q000008:administration & dosage; D000077210:Sunitinib; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000187:drug effects*; D006623:von Hippel-Lindau Disease / Q000150:complications / Q000188:drug therapy* / Q000235:genetics
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007093:Imidazoles; D007191:Indazoles; D007211:Indoles; D011758:Pyrroles; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000077784:Axitinib; D000077210:Sunitinib