ADVANCES IN METASTATIC RENAL CANCER

*IL-2  (High dose) Response rate < 10% but with rare cures
* Medication approved
1. Sunitinib which was compred to Interferon to win approval
2. Avastin in combination to Interferon (not alone) was compared to interferon alone to win approval
3.Pazopanib was compared to placebo to win approval
4.Temsirolimus was compared to Interferon to win approval.
someone thought combining Interferon and Tensirolimus will give a higher response rate, well it did not.  But this bring back the notion that until the MTOR is really amplified, rushing into its inhibition may not bring result.  So timing suggested after failure of VEGF is critical.

5. Pazopanib was compared to Sunitinib, non inferiority proven although Pazopanib had PFS of 8.4 against a 9.5 months accomplished Sutent.  The statical referee came in not statistical difference depite the hair color change of Pazopanib recipient! The hematologic toxicitywere worse with Sutent!

6.New kids on the block (Tivozanib and anti-PD1)
-Tivozanib was compared to Nexavar and came up on top in terms of PFS.  OS not measure because of cross-over

ONE HAS VENTURED TO SUGGEST THAT
START WITH SUTENT
THAN AFINITOR
FOLLOWED BY AXITINIB
THAN ANTI-PD1
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BUT REMEMBER THAT HISTOLOGY MAY FORCE YOU TO SKIP SUNITINIB
AND INTERFERON-BEVACIZUMAB ARE ALSO SOLID OPTIONS, AND SO REMAINS HIGH DOSE IL-2.

7-AXITINIB (AN ANTI-VEGF(s) ) WAS ALSO MATCHED WITH SORAFENIB IN THE HUTSON ET AL STUDY.AND CAME UP ON TOP FOR PFS.  HOWEVER THE OBSERVERS ARE SAYING THAT IN THE LATEST PHASE III STUDY AXITINIB,ALTHOUGH ACTIVE, DID NOT MEET ITS PRIMARY END POINT.

8.EVEROLIMUS AGAINST PLACEBO WON BIG PFS, BUT NO OS!?