title: Metastatic renal cell carcinoma treated sequentially with multiple VEGF receptor-targeted inhibitors--a case report.
abstract: Six targeted agents [sorafenib, sunitinib, temsirolimus, bevacizumab (plus interferon), everolimus and pazopanib] have been approved for the treatment of patients with metastatic renal cell carcinoma. As disease progression is inevitable, most patients will receive several lines of treatment. However, the choice regarding which sequence of drugs to use remains unclear, particularly concerning the drug class, i.e. those targeting the vascular endothelial growth factor (receptor) [VEGF(R)] pathway versus those acting on the mammalian target of rapamycin pathway. There appears to be no absolute crossresistance between tyrosine kinase inhibitors (TKIs) acting on the VEGF(R) pathway, and there have been numerous reports of two TKIs being successfully used in sequence. We report the case of a 63-year-old woman who responded for 24 months to three successive lines of treatment with different TKIs (sunitinib, axitinib and sorafenib). This suggests that TKIs targeting VEGFR should be considered as individual drugs and not as a single class.
authors.affiliation: Centre Hospitalier Universitaire Bretonneau, Centre Henry S. Kaplan, Department for Oncology, 2 Boulevard Tonnelle, 37044 Tours Cedex 9, France. linassier@med.univ-tours.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Linassier
authors.forename: Delphine
authors.initials: D
authors.lastname: Carmier
authors.forename: Pierre
authors.initials: P
authors.lastname: Combe
authors.forename: Benjamin Faivre
authors.initials: BF
authors.lastname: D'Arcier
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyere
authors.forename: Berangere
authors.initials: B
authors.lastname: Narciso
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000077784:Axitinib; D001557:Benzenesulfonates / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000201:enzymology; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007191:Indazoles / Q000627:therapeutic use; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000201:enzymology; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors*; D000077157:Sorafenib; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D001557:Benzenesulfonates; D007093:Imidazoles; D007191:Indazoles; D007211:Indoles; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077784:Axitinib; D040262:Receptors, Vascular Endothelial Growth Factor; D000077210:Sunitinib