Everolimus Versus Axitinib as Second-line Therapy in Metastatic Renal Cell Carcinoma: Experience From Institut Gustave Roussy

Microabstract We analyzed 126 patients with metastatic renal cancer treated with everolimus (n = 81) and axitinib (n = 45) after failure of first-line vascular endothelial growth factor-targeted therapy. Even if new therapies did in fact emerge, they are not widely available, and our results increase the knowledge of renal cancer. Background Everolimus (E) and axitinib (A) have been standard treatments for patients with metastatic renal cell carcinoma after failure of first-line therapy (1L) with vascular endothelial growth factor-targeted therapy. This study aims to compare both drugs in a large comprehensive cancer center. Methods Patient characteristics and outcome data from all patients with metastatic renal cell carcinoma who received E or A as second-line therapy at Gustave Roussy from April 2007 to May 2015 have been recorded. Results A total of 81 patients were treated with E and 45 patients with A. There were no major differences between the 2 groups. The most common 1L was sunitinib (79% in the E group and 82.2% in the A group). The median follow-up was 29 months; 26 months for A and 33 months for E (P =.046). The median overall survival (OS) was 21.5 months for E and 14.9 months for A (P =.23). The median progression-free survival (PFS) was 5.3 and 7.7 months for E and A, respectively (P =.39). Partial response was achieved in 4% and in 24% of patients (P =.002) in the E and A cohort, respectively. In the A group, the median PFS and OS were statistically different according to response, tumor burden, and 1L duration. No differences were found in the E arm. Conclusion In this series, there are no significant differences for PFS and OS with E and A. A appears to provide more objective response. A appears to be more effective in patients with small tumor burden, responders to 1L, and 1L therapy > 12 months.