Axitinib for the first line therapy of renal cancer: failure of a trial or failure of a strategy?

摘要: The vascular endothelial growth factor (VEGF) pathway has been extensively studied in renal cell carcinoma (RCC) and represents the main target for systemic treatment of this disease. Over last 10 years, five different VEGF blocking agents were granted approval by FDA are currently available clinical practice. With an increased number agents, selection is a real challenge. While some known to inhibit receptor more effectively vitro , data needed demonstrate if will indeed translate into better outcomes. Axitinib potent tyrosine kinase inhibitor (TKI), approved second line metastatic RCC (mRCC). In editorial, we comment phase III trial conducted Hutson et al. which evaluates axitinib against sorafenib as first therapy mRCC. This had ambitious primary outcome 78% improvement progression free survival (PFS) with axitinib. 288 patients, failed achieve its endpoint was not superior compared sorafenib. favor axitinib, subgroup analysis showed prolongation PFS patients excellent performance status general acceptable safety profile. Although demonstrated relevant activity negative result may be part explained small sample size detect large magnitude benefit, these results challenged strategy bringing inhibitors clinic aim improving