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Open Access Research article

Intrinsic resistance to tyrosine kinase inhibitors is associated with poor clinical outcome in metastatic renal cell carcinoma

Jonas Busch1, Christoph Seidel2, Steffen Weikert1, Ingmar Wolff1, Carsten Kempkensteffen1, Lisa Weinkauf1, Stefan Hinz1, Ahmed Magheli1, Kurt Miller1 and Viktor Grünwald2*

Author Affiliations

1 Department of Urology, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany

2 Department of Hematology, Hemostases, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany

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BMC Cancer 2011, 11:295  doi:10.1186/1471-2407-11-295

Published: 14 July 2011

Abstract

Background

Data on sequential therapy in patients with metastatic renal cell carcinoma (mRCC) and intrinsic resistance to receptor tyrosine kinase inhibitor (rTKI) treatment remains vague.

Methods

We retrospectively studied treatment characteristics and outcome of mRCC patients refractory to first rTKI therapy.

Results

Thirty-five mRCC patients (male, 18; female, 11) with primary resistance to first rTKI therapy (sunitinib, n = 28; sorafenib, n = 7) and a median treatment interval of 2.4 months (1 - 4.6) were identified. In 22 patients, progressive disease (PD) was determined by a new metastatic lesion. Of these, 16 patients received subsequent therapy with 12 patients remaining refractory and 4 patients achieving disease stabilization. In 13 patients continuous growth of existing metastatic lesions determined PD. Of these, 9 received sequential therapy with 6 achieving disease stabilization. Altogether, 25 patients were treated sequentially (rTKI: n = 15; mTOR-inhibitor: n = 10) and achieved a median PFS of 3.2 months (range, 1-16.6). Fifteen patients failed to respond to either line of therapy. Disease control was not associated with type of subsequent therapy. Median OS was 14.9 months (CI: 5.5-24.4).

Conclusion

Intrinsic resistance to rTKI is associated with a low chance of response to sequential therapy and a poor prognosis in mRCC patients.