Second Line Therapies After Tyrosine Kinase Inhibitory in Metastatic Renal Cell Carcinoma

Objective: Controversy exists over the choice of 2 nd -line drugs after the progression of 1 st -line tyrosine kinase inhibitors (TKIs) for patients unable to receive 1 st -line immunotherapy.We compared the efficacy of 2 nd -line treatments after the progression of 1 st -line TKI therapy and determined the factors predictive of its efficacy for the treatment of metastatic renal cell carcinoma (RCC).Material and Methods: Patients were divided into 3 groups according to 2 nd -line treatments: axitinib, everolimus, and nivolumab.The progression-free survival (PFS) rates for 2 nd -line treatments (PFS2) and overall survival (OS) rates were calculated.Cox regression analyses were conducted to determine the associations between PFS2 and OS rates and other explanatory variables.In addition, PFS2 was compared in patients whose PFS on 1 st -line TKI (PFS1) was 6 months (mn) with a <6-mn response for each of the 3 groups.Results: This study included 82 patients who were diagnosed with metastatic RCC.Fourty-one patients received axitinib, 30 patients received everolimus, and 11 patients received nivolumab as a 2 nd -line treatment.PFS2 and OS were statistically similar for all 3 groups.Patients who had PFS1 6 months responded significantly to 2 nd -line axitinib treatment compared with those with PFS1 <6 months.Multivariate analyses revealed that only PFS1 <6 months was correlated with poor OS. Conclusion:PFS2 and OS were statistically similar among second-line axitinib, everolimus, and nivolumab treatments.PFS1 <6 mn was correlated with poor PFS2 and OS.