title: First-Line Treatments for Poor-Prognosis Metastatic Renal Cell Carcinoma: Experts' Prescribing Practices and Systematic Literature Review.
abstract: OBJECTIVE
  No head-to-head clinical trials are available to help physicians in the decision-making process of first-line therapy in poor-prognosis metastatic renal cell carcinoma (RCC). The objectives of our study were to identify experts' prescribing practices and to review available clinical data in first-line therapies for poor-prognosis metastatic RCC (mRCC).
  
  
  METHODS
  Thirteen RCC experts were asked to fill in a self-administered questionnaire evaluating prescribing practices. A systematic review was performed in July 2015 in MEDLINE for clinical trials evaluating first-line strategy in poor-prognosis mRCC.
  
  
  RESULTS
  Ten out of 13 experts completed the questionnaire (76.9%). Sunitinib was the most frequently prescribed first-line therapy (8/10; 80%). The main reason for prescribing sunitinib most frequently was the evidence of effectiveness for the majority (5/8 experts). A total of 21 articles were found suitable. Only one phase III randomized controlled trial in which all patients had a poor prognosis was retrieved. Temsirolimus increases progression-free survival and overall survival compared to IFN-alpha. Increased PFS with sunitinib in poor-prognosis patients was shown in a subgroup analysis of the pivotal trial. An expanded-access trial confirmed this result.
  
  
  CONCLUSIONS
  Experts tend to prefer sunitinib as first-line therapy even in poor-prognosis mRCC. In light of the systematic review, no targeted therapy appears to be more effective than another. The upcoming challenge is to discover more effective new drugs since the overall survival of poor-prognosis mRCC still remains extremely limited.
authors.affiliation: Centre Léon Bérard, Université de Lyon, 28, rue Laennec, 69373, Lyon Cedex 08, France. olivia.lesaux@gmail.com.|Department of Medical Oncology, HCL Cancer Institute, Lyon 1 University, Lyon, France. olivia.lesaux@gmail.com.
authors.forename: Olivia
authors.initials: O
authors.lastname: Le Saux
authors.affiliation: Department of Medical Oncology, HCL Cancer Institute, Lyon 1 University, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Freyer
authors.affiliation: Centre Léon Bérard, Université de Lyon, 28, rue Laennec, 69373, Lyon Cedex 08, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Négrier
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; C401859:temsirolimus; D000077210:Sunitinib; D020123:Sirolimus