SEQUENTIAL TARGETTED THERAPY IN RENAL CELL CARCINOMA

[rohitrpandit]

HI, ONE OF MY KNOW PATIENT WHO IS SUFFERING FROM CANCER FOR THE LAST THREE YEARS, ONE FULL NEPHRECTOMY AND ONE PARTIAL NEPHRECOMY OF THE 2ND KIDNEY, POST SURGET, PATIENT WAS HAVING LUNG METS , STARTED INTERFERON FOR 3 MONTHS, DISEASE PROGRESSED, IN FEB.07 PATIENT STARTED NEXAVAR 800MG A DAY UPTO DEC.08, IN JANUARY 2009 PATIENT COMPLAINED THE HAEMATURIA AND THE DISEASE STARTED PROGRESSING AS PER THE LAST CT SCAN, NEXAVAR WAS STOPPED AND SWITCHED TO SUTENT 50 MG A DAY, PATIENT COULDN;TOLERATE AND THE DOSE WAS REDUCED TO 37.5 MONTHS, PATIENT TOOK THE SAME AND CONTINUED TO 4 MONTHS AFTER THAT FROM MAY DISEASE PROGRESSED AND HAEMATURIA AGAIN STARTED. SUTENT WAS STOPPED, SINCE THE OTHER TARGETTED DRUG TORISEL WAS NOT AVAILABLE IN INDIA, PATIENT WAS AGIN PUT ON NEXAVAR 800 MG A DAY, PATIENT THIS TIME COULDN'T TOLERATE THE FULL DOSE, BUT HE TOLERATED THE 400MG MORNING AND 200MG EVENING DOSE, FOR THE LAST THREE MONTH HE IS OK, NO HAEMATURIA , AND NO DISEASE PROGRESSION.
MY QUESTION IS IS IT WISE TO PUT THE NEXAVAR FAILURE, SUTENT FAILURE AGIN ON NEXAVAR.
IF AGIN THE DIASE PROGRESSES , THEN WHAT IS THE ALTERNATIVE TREATMENT FOR THIS.
THANKS

[rohitrpandit]

Hi Thankyou very much for the reply.

[Fernando Roque, MD]

Hi.  Sequential therapy with Sorafenib and Sunitinib has been studied by Dham, et al (2007) [web link: http://www.asco.org/ASCO/Abstracts+&+Virtual+Meeting/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=31160].  In this trial, 23 patients were given sorafenib followed by sunitinib, and 14 patients received sunitinib followed by sorafenib.  Patients switched to a different drug either because of unacceptable toxicity or disease progression with the original drug.  The median duration of disease control for those taking sunitinib as second line drug was 42 weeks, compared to 30.5 weeks for those given sorafenib as second line.

To date, no study has been done which investigates the efficacy of sunitinib or sorafenib as third line medication following failure of sequential treatment.  So to answer your question: if the patient's renal cell carcinoma progresses after failure of sequential treatment with Nexavar and Sutent, then it might be better to give the patient some other drug (e.g. Torisel or Axitinib).  Even if these drugs are not available or have not been approved by the regulatory authority in India, they can be imported directly from the United States for "compassionate use".  You may also wish to look for ongoing clinical trials for renal cell cancer in your country, as the patient may be eligible.