Targeted agents for mRCC: new trials require limited prescription in daily practice
Prof. J. Bellmunt
Tuesday, 30 June 2009- Targeted treatment for metastatic renal cell carcinoma should be administered as part of the many ongoing trials, as opposed to being handed out to patients within the routine urological practice, was one of the conclusions at the 4th ESU Masterclass on Medical treatment of urological cancer.
Organised by the European School of Urology, the masterclass aims to raise the level of urological practice in Europe by offering continuous education opportunities and providing essential updates on the latest developments in medical onco-urology. The meeting took place last weekend in Barcelona, Spain.
The issue of targeted agents was addressed by Prof. Joaquim Bellmunt of Hospital del Mar, Medical Oncology Service in Barcelona (Spain), in his lecture “Small molecules as novel anticancer agents: ‘Smart drugs’?”. He explained that though the field is developing at full speed, there are many blank spots in the understanding of how these drugs work and what their potential is.
“If urologists/medical oncologists feel that their patient might benefit from such treatment, they should refer this patient to one of the many ongoing or prospective trials,” Prof. Bellmunt told Urosource. “Often we receive patients after they fail two or more lines of treatment with targeted or other agents, meaning that in most cases they can no longer participate.”
“It is unfortunate that although very recently approved and on the market, targeted agents are being used increasingly outside of designated trials,” he added. “Soon it will become difficult to avoid contamination and find eligible patients for the necessary studies, and we do have a lot of research to conduct.”
In the last 18 months, four drugs have been approved for targeted treatment of mRCC, namely sorafenib, sunitinib, temsirolimus, bevacizumab, with four pivotal studies, investigating the efficacy of these drugs, published in the same year. The cytostatic properties of these drugs significantly improve progression free survival rates in patients with end-stage disease.
In his lecture Prof. Bellmunt gave a comprehensive review of the available data on all approved targeted agents and those that are still in Phase II or Phase III trials, also addressing the issue of sequential and combined therapy. He pointed out that the ongoing investigations on the efficacy of sequential treatment (a therapy in which patients receive a full dose of each drug) have so far yielded promising results, at the same time indicating that there are many challenges related to the design and feasibility of such studies.
“There are more question than answers in the field of targeted therapy, and we are eagerly awaiting the results of many trials,” he said. "It is not only combined therapy in the curative setting that we are interested in, these drugs may also prove efficient in an adjuvant setting or when integrated with nephrectomy in patients with high-or intermediate-risk cancer."
