ESMO 2017: SPAZO2 (SOGUG): Validation of the International Metastatic Database Consortium prognostic classification for targeted therapies as 2nd-line after 1st-line pazopanib in metastatic renal cell carcinoma

Madrid, Spain (UroToday.com) Dr. Pérez-Valderrama and Spanish colleagues presented their results of the IMDC validation for targeted therapies as second-line after first-line pazopanib in patients with metastatic renal cell carcinoma (mRCC) at the ESMO 2017 poster session. Only 2% of patients included in the IMDC prognostic model for second-line targeted agents for mRCC had received first-line pazopanib [1]. The objective of this study was to validate the IMDC model for this population of patients receiving first-line pazopanib.

SPAZO2 was a retrospective real-world study analyzing the effectiveness of first-line pazopanib and subsequent therapies in mRCC in several settings in every day practice. Data from 530 patients from April 2011-February 2016 treated with frontline pazopanib across 50 centers in Spain were collected by investigators, but monitored and entered in a database by an external contract research organization. There were 285 patients who received anti-VEGF or mTOR inhibitors as 2nd line therapy after first-line pazopanib (37.6% everolimus, 36% axitinib, 9.9% sunitinib, 8.3% sorafenib, 2.9% cabozantinib, 2.5% temsirolimus, 2.1% pazopanib, 0.4% bevacizumab-Interferon, 0.4% savolitinib), 242 after true progression and 43 due to other causes. Unlike in IMDC, no patients received first-line immunotherapy. The mean age was 66 years, 67.7% were male, 74.4% had undergone prior nephrectomy, and 12.3% were pure non-clear cell RCC. Metastatic sites were: lung 74%, lymph nodes 55%, bone 36%, soft tissue/skin 27%, liver 24.8%, CNS 7%, adrenal gland 5%, pleura/peritoneum 6%, pancreas 5%, kidney 3% and other organs 2%.

Classification of patients into the IMDC risk groups were: favorable (14.4%), intermediate (64.2%), or poor (21.4%). After a median follow-up since second-line therapy of 29 months, 67% of patients had progressed, 64% had received or subsequent lines of therapy, and 73% had died. Objective response rate (ORR), PFS and OS since second-line treatment were 14.6%, 5.1 months (95%CI 4-6), and 11.3 months (95%CI 9-13), respectively. Differences in PFS and OS were statistically significant among risk groups. The c-index of this prognostic predictive model was 0.635 (95%CI: 0.627–0.642).

The authors concluded that their results validate the use of the IMDC prognostic classification as a discrimination tool for predicting prognosis in patients receiving second-line targeted therapies after pazopanib in mRCC.

Speaker: Begona Pérez-Valderrama, Hospital Universitario Virgen del Rocio, Sevilla, Spain

Co-Authors: J. Arranz Arija (Madrid, Spain) I. Chirivella González (Valencia, Spain) U. Anido Herranz (Santiago de Compostela, Spain) J. Jurado García (Granada, Spain) C. Suarez Rodriguez (Barcelona, Spain) I. García Carbonero (Toledo, Spain) G. De Velasco (Madrid, Spain) R. García Domínguez (Salamanca, Spain) R. García Marrero (Santa Cruz de Tenerife, Spain) M. Gonzalez Del Alba Baamonde (Palma de Mallorca, Spain) C. Molins Palau (Valencia, Spain) M. Lazaro (Vigo, Spain) J. Munoz-Langa (Valencia, Spain) E. Martinez Ortega (Jaen, Spain) A. Hernández Jorge (Donostia, Spain) M. Campayo Guillaumes (Terrassa, Spain) M. Sereno Moyano (Madrid, Spain) R. Luque Caro (Granada, Spain) Á. Rodríguez Sánchez (Leon, Spain)

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain

References:

Ko JJ, Xie W, Kroeger N, et al. The International Metastatic Renal Cell Carcinoma Database Consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: A population-based study. Lancet Oncol 2015;16(3):293-300.
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