Impact of Second-Line Targeted Therapy Dose Intensity on Patients With Metastatic Renal Cell Carcinoma.
Relative dose intensity (RDI) is a simple index for evaluation of the amount of drug administered per unit time. We retrospectively investigated the prognostic impact of RDI for patients with metastatic renal cell carcinoma (mRCC) treated with second-line targeted therapy.



We enrolled 168 patients with mRCC. We assessed RDI at 4 weeks after second-line targeted therapy induction.



The median follow-up after second-line targeted therapy was 18.1 months. The median time-to-treatment-failure (TTF) and overall survival (OS) were 4.9 and 25.4 months, respectively. In the Kaplan-Meier analysis, the median OS of patients with second-line RDI < 0.7 was significantly shorter than those with RDI ≥ 0.7 (12.1 vs. 31.3 months; P = .030). In the subgroup analysis, second-line RDI was definitely prognostic in the poor-risk group of the International Metastatic Renal Cell Carcinoma Database Consortium criteria, showing second-line RDI was an independent predictor for both TTF (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.6-8.0; P = .002) and OS (HR, 3.1; 95% CI, 1.1-8.4; P = .026). Also, assessing the type of second-line regimen, the multivariate analysis showed that second-line RDI was an independent prognostic indicator of TTF (HR, 1.7; 95% CI, 1.0-2.9; P = .040) and OS (HR, 2.7; 95% CI, 1.3-5.7; P = .009) in patients treated with everolimus. In this group, the median TTF and OS of patients with RDI < 0.7 were 2.4 and 11.1 months, and those with RDI ≥ 0.7 were 5.3 and 25.9 months, respectively.



The results suggest that second-line RDI may be a prognostic predictor for patients with mRCC treated with second-line targeted therapy, particularly in both the International Metastatic Renal Cell Carcinoma Database Consortium poor-risk group and everolimus-treated group.
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Suguru
S
Shirotake
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Yota
Y
Yasumizu
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Keiichi
K
Ito
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Ayako
A
Masunaga
Department of Urology, Saiseikai Central Hospital, Tokyo, Japan.
Yujiro
Y
Ito
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Yasumasa
Y
Miyazaki
Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan.
Masayuki
M
Hagiwara
Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan.
Kent
K
Kanao
Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan.
Shuji
S
Mikami
Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan.
Ken
K
Nakagawa
Department of Urology, National Hospital Organization Saitama Hospital, Wako, Japan.
Tetsuo
T
Momma
Department of Urology, Saitama City Hospital, Saitama, Japan.
Takeshi
T
Masuda
Department of Urology, National Defense Medical College, Tokorozawa, Japan.
Tomohiko
T
Asano
Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
Masafumi
M
Oyama
Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Saitama City Hospital, Saitama, Japan. Electronic address: urotanaka@gmail.com.
Nobuyuki
N
Tanaka
Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: mizunor@z7.keio.jp.
Ryuichi
R
Mizuno
Department of Urology, Keio University School of Medicine, Tokyo, Japan. Electronic address: moto-oya@z3.keio.jp.
Mototsugu
M
Oya
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D016208:Databases, Factual; D000068338:Everolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011758:Pyrroles / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D000077210:Sunitinib; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000068338:Everolimus; D000077210:Sunitinib
Dose modification; IMDC; Outcome; RDI; Renal cell carcinoma; Second-line; Targeted therapy