title: Biological toxicities as surrogate markers of efficacy in patients treated with mTOR inhibitors for metastatic renal cell carcinoma.
abstract: Metabolic toxicities of mTOR inhibitors (mTORi) are well characterized. The purpose of the study was to investigate the relationship between these metabolic toxicities and mTORi efficacy.
  
  
  
  From 2007 to 2011, metabolic toxicities were retrospectively collected in patients treated with an mTORi (everolimus, temsirolimus) for a metastatic renal cell carcinoma (mRCC) in a single institution. Patients were eligible if they have received an mTORi for at least 28 days. Changes in the following parameters were analyzed: lymphocytes, serum creatinine, glycemia, serum phosphate, liver transaminases, cholesterol, and triglycerides. The efficacy was assessed by progression-free survival (PFS) and tumor response.
  
  
  
  Data were collected from seventy-five patients (everolimus = 44 patients; temsirolimus = 31 patients). Six patients exhibited a partial response, 42 a stable disease and 15 had a progressive disease (12 missing). After a median follow-up of 12.8 months, the median PFS was 6.7 months (95% confidence interval: 4.0-9.1 months). Patients with CB had a statistically more severe absolute increase of glycemia and absolute decrease in phosphatemia (p = 0.002 and p = 0.02 respectively). The Progression Free Survival was significantly higher with the onset rate of hypophosphatemia (p = 0.03) and hyperglycemia (p = 0.001) and lower with the onset rate of lymphopenia (p = 0.004).
  
  
  
  Hyperglycemia, hypophosphatemia and lymphopenia, were significantly associated with tumor response and/or PFS. Those events, as well as their onset rate, should be prospectively monitored as predictors of response to mTORi.
authors.affiliation: Department of Medical Oncology (Centre d'Essais Clinique Précoces en Cancérologie [CEPEC]), Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Jebali
authors.affiliation: Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie (ARTIC), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Elaidi
authors.affiliation: Department of Medical Oncology (Centre d'Essais Clinique Précoces en Cancérologie [CEPEC]), Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.|Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie (ARTIC), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Brizard
authors.affiliation: Department of Pharmacy, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Fouque
authors.affiliation: Association pour la Recherche sur les Thérapeutiques Innovantes en Cancérologie (ARTIC), Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Takouchop
authors.affiliation: Department of Pharmacy, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Sabatier
authors.affiliation: Department of Medical Oncology (Centre d'Essais Clinique Précoces en Cancérologie [CEPEC]), Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.|Paris Descartes University, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Oudard
authors.affiliation: Department of Medical Oncology (Centre d'Essais Clinique Précoces en Cancérologie [CEPEC]), Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France. Jacques.medioni@aphp.fr.|Paris Descartes University, Paris, France. Jacques.medioni@aphp.fr.
authors.forename: J
authors.identifier: 0000-0003-1100-5264
authors.initials: J
authors.lastname: Medioni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D015415:Biomarkers; D014408:Biomarkers, Tumor; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D018572:Disease-Free Survival; D000068338:Everolimus / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005602:France; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D014408:Biomarkers, Tumor; D047428:Protein Kinase Inhibitors; C401859:temsirolimus; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus
keywords: Adverse reactions; Biomarkers; Drug-related side effects; Metastatic renal cell carcinoma; mTOR inhibitors