title: [Revision of therapeutic index for targeted treatment in kidney cancer: What if toxicity could predict efficacy?].
abstract: Since 2006, new treatments as targeted therapies (anti angiogenic and mTOR inhibitors) are prescribed in renal cell cancer. Toxicity of these treatments is well known by clinicians. Occurrence of these side effects has been associated with anti tumoral efficacy. High blood pressure, hypothyroïdie and hand foot syndrome were reported to be predictive of anti tumoral response. Fatigue and hyponatremia are still largely discussed. Moreover, non infectious pneumonia, which frequently occurs with mTOR inhibitors, is associated with clinical benefit. The main objective of treatment of advanced kidney cancer, specially renal cell cancer, is obtaining clinical benefit (stabilization and response) with a chronic evolution of the disease. This prolong exposure to drugs, according to their toxicity profile, often contributes to dose reduction, moreover interruption of treatment, potentially associated with a loss of control of disease. Thus, the adverse effects, described hereby, may be considered as « positive events », predicting efficacy, and thus looked for… Moreover, the sequential approach, with new drugs, emphasizes the need of defining the optimal sequence. Thus, because of the lack of molecular biomarkers to date, this predictives secondary effects may help for selecting the therapeutic strategy.
authors: CHU de Bordeaux, Hôpital Saint-André, 1 rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors: Thomas
authors: T
authors: Grellety
authors: CHU de Bordeaux, Hôpital Saint-André, 1 rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors: Camille
authors: C
authors: Brugères-Chakiba
authors: Institut Bergonié, Centre de lutte contre le cancer de Bordeaux, 229 cours de l'Argonne, 33076 Bordeaux cedex, France.
authors: Axel
authors: A
authors: Chaminade
authors: Institut Bergonié, Centre de lutte contre le cancer de Bordeaux, 229 cours de l'Argonne, 33076 Bordeaux cedex, France.
authors: Guilhem
authors: G
authors: Roubaud
authors: CHU de Bordeaux, Hôpital Saint-André, 1 rue Jean-Burguet, 33075 Bordeaux cedex, France, Université Bordeaux 2, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
authors: Alain
authors: A
authors: Ravaud
authors: CHU de Bordeaux, Hôpital Saint-André, 1 rue Jean-Burguet, 33075 Bordeaux cedex, France.
authors: Marine
authors: M
authors: Gross-Goupil
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001247:Asthenia / Q000139:chemically induced; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000188:drug therapy*; D000068338:Everolimus; D060831:Hand-Foot Syndrome / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007037:Hypothyroidism / Q000139:chemically induced*; D007680:Kidney Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D058990:Molecular Targeted Therapy / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; C401859:temsirolimus; D000068338:Everolimus; D020123:Sirolimus
keywords: fatigue; hand foot syndrome; high blood pressure; hypothyroidism; non infectious pneumonia; predictive factor; renal cell cancer; targeted therapy