Metastatic Renal Cancer

Predictors of short survival

Poor prognosis patients are defined as those with ≥ 3 predictors of short survival

- LDH level > 1.5 times upper limit of normal

- Hgb level < lower limit normal

- Corrected serum calcium level > 10mg/dl

- Interval of less than a year from original diagnosis to the start of systemic therapy

- Karnofsky PS ≤ 70

- ≥ 2 sites of organ metastasis

NCCN guideline 2013.

1) Sunitinib (Sutene)-clear cell type 경우

Sunitinib 50mg PO for 4weeks, 2weeks off every 6-week toxicity 시 감량: 37.5mg/day

Response Rate: 31% PFS:11months Ref> NEJM 2007;356:115-124

2) Sorafenib (Nexavar)-clear cell type 경우

Nexavar 400mg PO Bid (공복시 복용)

toxicity 시 감량: 400mg/day → 400mg EOD

PFS:5.5months vs 2.8month (sorafenib vs placebo)

RR: 10% vs 8%(sorafenib vs placebo Ref> NEJM 2007;356:125-134

3) Pazopanib (Votrient)-clear cell type 경우

800mg/day PO toxicity 시 감량: 400mg/day

Pazopanib vs. placebo 9.2 vs. 4.2months Ref> JCO 2010;28:1061

4) Temsirolimus (Torisel)-non clear cell type, poor prognosis in clear cell type

Temsirolimus 25mg iv for 30min weekly

overall survival:10.9month PFS:3.8month Response

Rate:8.6% Ref> NEJM 2007;356:2271-2281

5) Everolimus (Afinitor)-second line

10mg/day PO toxicity 시 감량: 5mg/day

mPFS: everolimus vs. placebo 4.0 vs. 1months

6) High dose IL-2

대상: ECOG PS 0-1, normal organ function

HD IL-2 (600,000 U/kg/dose IV every 8hrs on days 1 through 5 and 15 to 19 [maximum 28 doses]) every 12weeks

Ref> JCO 2005;23:133