NEW YORK (Reuters Health) Jan 10 - Patients with less aggressive metastatic renal cell carcinoma may be able to discontinue treatment with vascular endothelial growth factor (VEGF)-targeted agents, a new study suggests.
"These data support a hypothesis that there may be a select group of metastatic renal cell carcinoma patients who can safely hold VEGF-targeted therapy and maintain disease control off therapy for a reasonable period of time," Dr. Brian I. Rini, from Ohio's Cleveland Clinic, told Reuters Health by email.
"Such a strategy," he added, "takes advantage of a more indolent underlying disease biology in these patients, with the advantage of reduced toxicity while off therapy."
In a December 2 online paper in Cancer, Dr. Rini and colleagues report on 40 patients who discontinued VEGF-targeted therapy. All had clear cell histology, and all had stable disease or better. The median duration of VEGF-targeted therapy was 14.6 months (range, 2.8 to 79). The drugs were stopped mainly due to toxicity (in 73%); no one stopped because of disease progression.
Median progression-free survival overall was 13.5 months. Twenty-five patients (63%) had disease progression, after a median interval of 10 months. In eight of these patients (32%), progression occurred at sites that were not previously involved, but there was no evidence of rapid disease progression in any patient.
Seventeen patients with progression were treated with local and systemic therapies. The other eight patients "chose to continue expectant management given the low volume and pace of disease," the authors reported.
The 15 patients with no progression also continued to be managed expectantly.
The researchers conclude that in patients achieving at least stable disease on VEGF-targeted therapy, a select subset "can be observed off therapy."
More specifically, they said, "only more favorable Heng risk group" -- which takes into account anemia, thrombocytosis, neutrophilia, hypercalcemia, Karnofsky performance status and time from diagnosis to treatment -- "and achievement of a complete response prior to discontinuing therapy were independent predictors of a longer progression-free survival off therapy."
SOURCE: http://bit.ly/AlR8Gm
Cancer 2011.
"These data support a hypothesis that there may be a select group of metastatic renal cell carcinoma patients who can safely hold VEGF-targeted therapy and maintain disease control off therapy for a reasonable period of time," Dr. Brian I. Rini, from Ohio's Cleveland Clinic, told Reuters Health by email.
"Such a strategy," he added, "takes advantage of a more indolent underlying disease biology in these patients, with the advantage of reduced toxicity while off therapy."
In a December 2 online paper in Cancer, Dr. Rini and colleagues report on 40 patients who discontinued VEGF-targeted therapy. All had clear cell histology, and all had stable disease or better. The median duration of VEGF-targeted therapy was 14.6 months (range, 2.8 to 79). The drugs were stopped mainly due to toxicity (in 73%); no one stopped because of disease progression.
Median progression-free survival overall was 13.5 months. Twenty-five patients (63%) had disease progression, after a median interval of 10 months. In eight of these patients (32%), progression occurred at sites that were not previously involved, but there was no evidence of rapid disease progression in any patient.
Seventeen patients with progression were treated with local and systemic therapies. The other eight patients "chose to continue expectant management given the low volume and pace of disease," the authors reported.
The 15 patients with no progression also continued to be managed expectantly.
The researchers conclude that in patients achieving at least stable disease on VEGF-targeted therapy, a select subset "can be observed off therapy."
More specifically, they said, "only more favorable Heng risk group" -- which takes into account anemia, thrombocytosis, neutrophilia, hypercalcemia, Karnofsky performance status and time from diagnosis to treatment -- "and achievement of a complete response prior to discontinuing therapy were independent predictors of a longer progression-free survival off therapy."
SOURCE: http://bit.ly/AlR8Gm
Cancer 2011.
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