Lenvatinib, everolimus, and the combination in patients with
metastatic renal cell carcinoma: a randomised, phase 2,
open-label, multicentre trial

J 2015

Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial

MOTZER, Robert J.; Thomas E. HUTSON; Hilary GLEN; M. Dror MICHAELSON; Ana MOLINA et al.

Základní údaje

Originální název

Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial

Autoři

Vydání

Lancet Oncology, New York, Elsevier Science INC, 2015, 1470-2045

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30200 3.2 Clinical medicine

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 26.509

Označené pro přenos do RIV

Ano

Kód RIV

RIV/00216224:14110/15:00086819

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

ANTITUMOR ACTIVITIES; INTERFERON-ALPHA; III TRIAL; BEVACIZUMAB; INHIBITOR; GROWTH; E7080; TEMSIROLIMUS; SORAFENIB; TARGETS

Štítky

EL OK

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 26. 2. 2016 13:16, Ing. Mgr. Věra Pospíšilíková

Anotace

V originále

Background Currently, metastatic renal cell carcinoma is treated with sequential single agents targeting VEGF or mTOR. Here, we aimed to assess lenvatinib, everolimus, or their combination as second-line treatment in patients with metastatic renal cell carcinoma. Methods We did a randomised, phase 2, open-label, multicentre trial at 37 centres in five countries and enrolled patients with advanced or metastatic, clear-cell, renal cell carcinoma. We included patients who had received treatment with a VEGF-targeted therapy and progressed on or within 9 months of stopping that agent. Patients were randomised via an interactive voice response system in a 1:1:1 ratio to either lenvatinib (24 mg/day), everolimus (10 mg/day), or lenvatinib plus everolimus (18 mg/day and 5 mg/day, respectively) administered orally in continuous 28-day cycles until disease progression or unacceptable toxic effects. The randomisation procedure dynamically minimised imbalances between treatment groups for the stratification factors haemoglobin and corrected serum calcium. The primary objective was progression-free survival in the intention-to-treat population. This study is closed to enrolment but patients' treatment and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT01136733. Findings Between March 16, 2012, and June 19, 2013, 153 patients were randomly allocated to receive either the combination of lenvatinib plus everolimus (n=51), single-agent lenvatinib (n=52), or single-agent everolimus (n=50). Lenvatinib plus everolimus significantly prolonged progression-free survival compared with everolimus alone (median 14.6 months [95% CI 5.9-20.1] vs 5.5 months [3.5-7.1]; hazard ratio [HR] 0.40, 95% CI 0.24-0.68; p=0.0005), but not compared with lenvatinib alone (7.4 months [95% CI 5.6-10.2]; HR 0.66, 95% CI 0.30-1.10; p=0.12). Single-agent lenvatinib significantly prolonged progression-free survival compared with everolimus alone (HR 0.61, 95% CI 0.38-0.98; p=0.048). Grade 3 and 4 events occurred in fewer patients allocated single-agent everolimus (25 [50%]) compared with those assigned lenvatinib alone (41 [79%]) or lenvatinib plus everolimus (36 [71%]). The most common grade 3 or 4 treatment-emergent adverse event in patients allocated lenvatinib plus everolimus was diarrhoea (ten [20%]), in those assigned single-agent lenvatinib it was proteinuria (ten [19%]), and in those assigned single-agent everolimus it was anaemia (six [12%]). Two deaths were deemed related to study drug, one cerebral haemorrhage in the lenvatinib plus everolimus group and one myocardial infarction with single-agent lenvatinib. Interpretation Lenvatinib plus everolimus and lenvatinib alone resulted in a progression-free survival benefit for patients with metastatic renal cell carcinoma who have progressed after one previous VEGF-targeted therapy. Further study of lenvatinib is warranted in patients with metastatic renal cell carcinoma.

Citovat

MOTZER, Robert J.; Thomas E. HUTSON; Hilary GLEN; M. Dror MICHAELSON; Ana MOLINA; Timothy EISEN; Jacek JASSEM; Jakub ZOLNIEREK; Jose Pablo MAROTO; Begoña MELLADO; Bohuslav MELICHAR; Jiří TOMÁŠEK; Alton KREMER; Han-Joo KIM; Karen WOOD; Corina DUTCUS a James LARKIN. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. Lancet Oncology. New York: Elsevier Science INC, 2015, roč. 16, č. 15, s. 1473-1482. ISSN 1470-2045. Dostupné z: https://doi.org/10.1016/S1470-2045(15)00290-9.

@article{1337419,
   author = {Motzer, Robert J. and Hutson, Thomas E. and Glen, Hilary and Michaelson, M. Dror and Molina, Ana and Eisen, Timothy and Jassem, Jacek and Zolnierek, Jakub and Maroto, Jose Pablo and Mellado, Begoña and Melichar, Bohuslav and Tomášek, Jiří and Kremer, Alton and Kim, HanandJoo and Wood, Karen and Dutcus, Corina and Larkin, James},
   article_location = {New York},
   article_number = {15},
   doi = {https://doi.org/10.1016/S1470-2045(15)00290-9},
   keywords = {ANTITUMOR ACTIVITIES; INTERFERON-ALPHA; III TRIAL; BEVACIZUMAB; INHIBITOR; GROWTH; E7080; TEMSIROLIMUS; SORAFENIB; TARGETS},
   language = {eng},
   issn = {1470-2045},
   journal = {Lancet Oncology},
   title = {Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial},
   volume = {16},
   year = {2015}
}

TY  - JOUR
ID  - 1337419
AU  - Motzer, Robert J. - Hutson, Thomas E. - Glen, Hilary - Michaelson, M. Dror - Molina, Ana - Eisen, Timothy - Jassem, Jacek - Zolnierek, Jakub - Maroto, Jose Pablo - Mellado, Begoña - Melichar, Bohuslav - Tomášek, Jiří - Kremer, Alton - Kim, Han-Joo - Wood, Karen - Dutcus, Corina - Larkin, James
PY  - 2015
TI  - Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial
JF  - Lancet Oncology
VL  - 16
IS  - 15
SP  - 1473-1482
EP  - 1473-1482
PB  - Elsevier Science INC
SN  - 14702045
KW  - ANTITUMOR ACTIVITIES
KW  - INTERFERON-ALPHA
KW  - III TRIAL
KW  - BEVACIZUMAB
KW  - INHIBITOR
KW  - GROWTH
KW  - E7080
KW  - TEMSIROLIMUS
KW  - SORAFENIB
KW  - TARGETS
N2  - Background Currently, metastatic renal cell carcinoma is treated with sequential single agents targeting VEGF or mTOR. Here, we aimed to assess lenvatinib, everolimus, or their combination as second-line treatment in patients with metastatic renal cell carcinoma. Methods We did a randomised, phase 2, open-label, multicentre trial at 37 centres in five countries and enrolled patients with advanced or metastatic, clear-cell, renal cell carcinoma. We included patients who had received treatment with a VEGF-targeted therapy and progressed on or within 9 months of stopping that agent. Patients were randomised via an interactive voice response system in a 1:1:1 ratio to either lenvatinib (24 mg/day), everolimus (10 mg/day), or lenvatinib plus everolimus (18 mg/day and 5 mg/day, respectively) administered orally in continuous 28-day cycles until disease progression or unacceptable toxic effects. The randomisation procedure dynamically minimised imbalances between treatment groups for the stratification factors haemoglobin and corrected serum calcium. The primary objective was progression-free survival in the intention-to-treat population. This study is closed to enrolment but patients' treatment and follow-up is ongoing. This study is registered with ClinicalTrials.gov, number NCT01136733. Findings Between March 16, 2012, and June 19, 2013, 153 patients were randomly allocated to receive either the combination of lenvatinib plus everolimus (n=51), single-agent lenvatinib (n=52), or single-agent everolimus (n=50). Lenvatinib plus everolimus significantly prolonged progression-free survival compared with everolimus alone (median 14.6 months [95% CI 5.9-20.1] vs 5.5 months [3.5-7.1]; hazard ratio [HR] 0.40, 95% CI 0.24-0.68; p=0.0005), but not compared with lenvatinib alone (7.4 months [95% CI 5.6-10.2]; HR 0.66, 95% CI 0.30-1.10; p=0.12). Single-agent lenvatinib significantly prolonged progression-free survival compared with everolimus alone (HR 0.61, 95% CI 0.38-0.98; p=0.048). Grade 3 and 4 events occurred in fewer patients allocated single-agent everolimus (25 [50%]) compared with those assigned lenvatinib alone (41 [79%]) or lenvatinib plus everolimus (36 [71%]). The most common grade 3 or 4 treatment-emergent adverse event in patients allocated lenvatinib plus everolimus was diarrhoea (ten [20%]), in those assigned single-agent lenvatinib it was proteinuria (ten [19%]), and in those assigned single-agent everolimus it was anaemia (six [12%]). Two deaths were deemed related to study drug, one cerebral haemorrhage in the lenvatinib plus everolimus group and one myocardial infarction with single-agent lenvatinib. Interpretation Lenvatinib plus everolimus and lenvatinib alone resulted in a progression-free survival benefit for patients with metastatic renal cell carcinoma who have progressed after one previous VEGF-targeted therapy. Further study of lenvatinib is warranted in patients with metastatic renal cell carcinoma.
ER  -

MOTZER, Robert J.; Thomas E. HUTSON; Hilary GLEN; M. Dror MICHAELSON; Ana MOLINA; Timothy EISEN; Jacek JASSEM; Jakub ZOLNIEREK; Jose Pablo MAROTO; Begoña MELLADO; Bohuslav MELICHAR; Jiří TOMÁŠEK; Alton KREMER; Han-Joo KIM; Karen WOOD; Corina DUTCUS a James LARKIN. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: a randomised, phase 2, open-label, multicentre trial. \textit{Lancet Oncology}. New York: Elsevier Science INC, 2015, roč.~16, č.~15, s.~1473-1482. ISSN~1470-2045. Dostupné z: https://doi.org/10.1016/S1470-2045(15)00290-9.

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