title: First-Line and Sequential Use of Pazopanib Followed by Mammalian Target of Rapamycin Inhibitor Therapy Among Patients With Advanced Renal Cell Carcinoma in a US Community Oncology Setting.
abstract: BACKGROUND
  Clinical trials have demonstrated that pazopanib prolongs progression-free survival (PFS), with an acceptable safety profile, for patients with advanced renal cell carcinoma (aRCC). The efficacy of second-line mammalian target of rapamycin (mTOR) inhibitors in pazopanib-treated patients has also been evaluated in clinical trials; however, few studies have evaluated first-line pazopanib or second-line mTOR inhibitors in real-world settings. The present study evaluated the outcomes of first-line pazopanib, and pazopanib followed by mTOR inhibitors, in a community oncology setting.
  
  
  METHODS
  The present study was a retrospective analysis of eligible patients in US Oncology's iKnowMed electronic health records database who had been treated for aRCC from November 1, 2009 to August 31, 2012. The patients received first-line therapy with pazopanib (cohort 1), followed by second-line therapy with either everolimus or temsirolimus (cohort 2). The key outcomes included overall survival (OS), PFS, adverse events (AEs), treatment patterns, and healthcare resource use.
  
  
  RESULTS
  The median OS in cohort 1 (n = 177) was 22 months, and the median PFS was 8.5 months. The most common AEs were fatigue (56%), diarrhea (52%), vomiting (44%), and nausea (40%). The median persistence was 151 days with pazopanib. The median OS in cohort 2 (n = 35) was 16 months; the median PFS was 5.7 months. The most common AEs were fatigue (51%) and nausea (34%). The median persistence was 93 days with everolimus and 49 days with temsirolimus.
  
  
  CONCLUSIONS
  The outcomes for the patients treated with first-line pazopanib in the community setting were consistent with those reported by previous prospective and retrospective studies. Although the second-line cohort was small, the results of mTOR inhibitors after pazopanib were also consistent with those of previous observations.
authors.affiliation: US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Comprehensive Cancer Centers of Nevada, Las Vegas, NV. Electronic address: Nicholas.Vogelzang@usoncology.com.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
authors.affiliation: GlaxoSmithKline, Collegeville, PA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Hackshaw
authors.affiliation: US Oncology Network, McKesson Specialty Health, The Woodlands, TX; Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hutson
authors.affiliation: US Oncology Network, McKesson Specialty Health, The Woodlands, TX.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Bhowmik
authors.affiliation: US Oncology Network, McKesson Specialty Health, The Woodlands, TX.
authors.forename: Mark
authors.initials: M
authors.lastname: Yap
authors.affiliation: US Oncology Network, McKesson Specialty Health, The Woodlands, TX.
authors.forename: Debra
authors.initials: D
authors.lastname: Rembert
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D019058:Community Networks; D057286:Electronic Health Records; D000068338:Everolimus / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007191:Indazoles; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D007191:Indazoles; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; C401859:temsirolimus; C516667:pazopanib; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus
keywords: Angiogenesis inhibition; Healthcare resource use; Real-world outcomes; Second-line everolimus; Treatment patterns