Anti-VEGF therapy in mRCC: differences between Asian and non-Asian patients.

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Authors: Y Wang ; T K Choueiri ; J L Lee ; M H Tan ; S Y Rha ; S A North ; C K Kollmannsberger ; D F McDermott ; D Y C Heng

MeSH: Angiogenesis Inhibitors/adverse effects ; Angiogenesis Inhibitors/therapeutic use* ; Asian Continental Ancestry Group ; Carcinoma, Renal Cell/drug therapy* ; Carcinoma, Renal Cell/ethnology* ; Carcinoma, Renal Cell/pathology ; Cohort Studies ; Female ; Humans ; Kidney Neoplasms/drug therapy* ; Kidney Neoplasms/ethnology* ; Kidney Neoplasms/pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; Retrospective Studies ; Treatment Outcome ; Vascular Endothelial Growth Factor A/antagonists & inhibitors*

Keywords: sunitinib ; sorafenib ; ethnicity ; VEGF ; progression-free survival ; overall survival

Abstract: BACKGROUND: Several reports suggest that vascular endothelial growth factor (VEGF)-targeted therapy in metastatic renal cell carcinoma (mRCC) may be more toxic in Asian vs non-Asian populations. Comparative efficacy of these agents with respect to ethnicity is not well characterised.

METHODS: A multicentre, retrospective, cohort study using Asian and non-Asian centres which collected data on ethnicity, dose reductions and outcomes using the International mRCC Database Consortium.

RESULTS: This study included 1024 (464 Asian, 560 non-Asian) patients with a 29.4 months median follow-up. The percentage of dose modifications/reductions between non-Asians and Asians was similar (55% vs 61% P=0.1197). When adjusted for risk groups, there was no difference in overall or progression-free survival between non-Asians and Asians. Patients with dose reductions due to toxicity had longer treatment durations and overall survival than those who did not in both non-Asian (10.6 vs 5.0 months, P<0.0001; 22.6 vs 16.1 months, P=0.0016, respectively) and Asian populations (8.9 vs 5.4 months, P=0.0028; 28.0 vs 18.7 months, P=0.0069, respectively).

CONCLUSIONS: Adjusting for risk groups, there appears to be no difference in outcome between Asian vs non-Asian patients with mRCC treated with VEGF-targeted therapy. Judicious dose reductions may allow for better outcomes in both populations due to longer treatment durations, but direct comparisons are needed.