nach oben

Drugs & Aging

Erschienen in:

01.08.2011 | Review Article

Systemic Therapies for Metastatic Renal Cell Carcinoma in Older Adults

verfasst von: Sumanta K. Pal, Ari Vanderwalde, Arti Hurria, Robert A. Figlin

Erschienen in: Drugs & Aging | Ausgabe 8/2011

Einloggen, um Zugang zu erhalten

Abstract

The introduction of targeted therapies has radically changed the treatment paradigm for metastatic renal cell carcinoma (mRCC). However, multiple clinical dilemmas have emerged. For instance, limited data are available to juxtapose the safety and efficacy profile of targeted therapies between older and younger adults. Herein, pivotal trials of vascular endothelial growth factor (VEGF)- and mammalian target of rapamycin (mTOR)-directed therapies are assessed in the context of their implications in treating older adults with mRCC. In general, subset analyses from these pivotal studies suggest similar efficacy of targeted therapies amongst older adults. Aging is accompanied by a multitude of physiological changes, as well as an increased prevalence of co-morbidities. The age-related toxicity profiles of targeted agents for mRCC are detailed to provide a framework for the risks and benefits of these therapies in older adults. Ultimately, tools such as the Comprehensive Geriatric Assessment (CGA) that account for physiological (as opposed to chronological) age may prove useful in the evaluation and treatment of older adults with mRCC.

National Comprehensive Cancer Network. Clinical practice guidelines: renal cell carcinoma [online]. Available from URL: http://www.nccn.org [Accessed 2009 Nov 29]

Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007; 356: 115–24PubMedCrossRef

Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 2010; 28: 1061–8PubMedCrossRef

Rini BI, Halabi S, Rosenberg JE, et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal cell carcinoma: final results of CALGB 90206. J Clin Oncol 2010; 28: 2137–43PubMedCrossRef

Escudier B, Bellmunt J, Negrier S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with me-tastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol 2010; 28: 2144–50PubMedCrossRef

Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 2007; 356: 125–34PubMedCrossRef

Motzer RJ, Escudier B, Oudard S, et al. Efficacy of ever-olimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 2008; 372: 449–56PubMedCrossRef

Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007; 356: 2271–81PubMedCrossRef

Pal SK, Figlin RA. Renal cell carcinoma therapy in 2010: many options with little comparative data. Clin Adv He-matol Oncol 2010; 8: 191–200

10.

Pal SK, Kortylewski M, Yu H, et al. Breaking through a plateau in renal cell carcinoma therapeutics: development and incorporation of biomarkers. Mol Cancer Ther 2010 Dec; 9(12): 3115–25PubMedCrossRef

11.

Heng DYC, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 2009; 27: 5794–9PubMedCrossRef

12.

Shayne M, Crawford J, Dale DC, et al. Predictors of reduced dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy. Breast Cancer Res Treat 2006; 100: 255–62PubMedCrossRef

13.

Safont MJ, Artal-Cortes A, Sirera R, et al. Retrospective study of efficacy and toxicity on patients older than 70 years within a randomized clinical trial oft wo cisplatin-based combinations in patients with small-cell lung cancer. Lung Cancer 2009; 63: 83–7PubMedCrossRef

14.

Fader AN, von Gruenigen V, Gibbons H, et al. Improved tolerance of primary chemotherapy with reduced-dose carboplatin and paclitaxel in elderly ovarian cancer patients. Gynecol Oncol 2008; 109: 33–8PubMedCrossRef

15.

Latagliata R, Breccia M, Carmosino I, et al. ‘Real-life’ results of front-line treatment with imatinib in older patients (≥65 years) with newly diagnosed chronic myelogenous leukemia. Leuk Res 2010; 34: 1472–5PubMedCrossRef

16.

Palumbo A, Gay F. How to treat elderly patients with multiple myeloma: combination of therapy or sequencing. Hematol Am Soc Hematol Educ Program 2009: 566–77

17.

Shayne M, Culakova E, Poniewierski MS, et al. Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy. Cancer 2007; 110: 1611–20PubMedCrossRef

18.

Lyman GH, Dale DC, Friedberg J, et al. Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol 2004; 22: 4302–11PubMedCrossRef

19.

Kondo K, Yao M, Yoshida M, et al. Comprehensive mutational analysis of the VHL gene in sporadic renal cell carcinoma: relationship to clinicopathological parameters. Genes Chromosomes Cancer 2002; 34: 58–68PubMedCrossRef

20.

Rodriguez A, Patard JJ, Lobel B. Renal cell carcinoma in young adults: incidence, disease outcome and review of the literature. Arch Esp Urol 2002; 55: 969–75PubMed

21.

Gillett MD, Cheville JC, Karnes RJ, et al. Comparison of presentation and outcome for patients 18 to 40 and 60 to 70 years old with solid renal masses. J Urol 2005; 173: 1893–6PubMedCrossRef

22.

Cao Y, Paner GP, Perry KT, et al. Renal neoplasms in younger adults: analysis of 112 tumors from a single institution according to the new 2004 World Health Organization classification and 2002 American Joint Committee on Cancer Staging System. Arch Pathol Lab Med 2005; 129: 487–91PubMed

23.

Bruder E, Passera O, Harms D, et al. Morphologic and molecular characterization of renal cell carcinoma in children and young adults. Am J Surg Pathol 2004; 28: 1117–32PubMedCrossRef

24.

Renshaw AA, Granter SR, Fletcher JA, et al. Renal cell carcinomas in children and young adults: increased incidence ofpapillary architecture and unique subtypes. Am J Surg Pathol 1999; 23: 795–802PubMedCrossRef

25.

Rainwater LM, Zincke H, Farrow GM, et al. Renal cell carcinoma in young and old patients: comparison of prognostic pathologic variables (cell type, tumor grade and stage, and DNA ploidy pattern) and their impact on disease outcome. Urology 1991; 38: 1–5PubMedCrossRef

26.

Abou El Fettouh HI, Cherullo EE, El-Jack M, et al. Sporadic renal cell carcinoma in young adults: presentation, treatment, and outcome. Urology 2002; 60: 806–10PubMedCrossRef

27.

Thompson RH, Ordonez MA, Iasonos A, et al. Renal cell carcinoma in young and old patients: is there a difference? J Urol 2008; 180: 1262–6PubMedCrossRef

28.

Townsley CA, Pond GR, Oza AM, et al. Evaluation of adverse events experienced by older patients participating in studies of molecularly targeted agents alone or in combination. Clin Cancer Res 2006; 12: 2141–9PubMedCrossRef

29.

Kantarjian H, Sawyers C, Hochhaus A, et al. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med 2002; 346: 645–52PubMedCrossRef

30.

Heinrich MC, Corless CL, Demetri GD, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol 2003; 21: 4342–9PubMedCrossRef

31.

Baker S, van Schaik R, Rivory L, et al. Factors affecting cytochrome P-450 activity in cancer patients. Clin Cancer Res 2004; 10: 8341–50PubMedCrossRef

32.

Sotaniemi EA, Arranto AJ, Pelkonen O, et al. Age and cytochrome P450-linked drug metabolism in humans: an analysis of 226 subjects with equal histopathologic conditions. Clin Pharmacol Ther 1997; 61: 331–9PubMedCrossRef

33.

Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J 2005; 11: 449–60PubMedCrossRef

34.

Vestal RE. Aging and pharmacology. Cancer 1997; 80: 1302–10PubMedCrossRef

35.

Go RS, Adjei AA. Review of the comparative pharmacology and clinical activity of cisplatin and carboplatin [letter]. J Clin Oncol 1999; 17: 409PubMed

36.

Toffoli G, Corona G, Sorio R, et al. Population phar-macokinetics and pharmacodynamics of oral etoposide. Br J Clin Pharmacol 2001; 52: 511–9PubMedCrossRef

37.

Yuen GJ. Altered pharmacokinetics in the elderly. Clin Geriatr Med 1990; 6: 257–67PubMed

38.

Baker SD, Grochow LB. Pharmacology of cancer chemotherapy in the older person. Clin Geriatr Med 1997; 13: 169–83PubMed

39.

Ando M, Minami H, Ando Y, et al. Pharmacological analysis of etoposide in elderly patients with lung cancer. Clin Cancer Res 1999; 5: 1690–5PubMed

40.

Fidias P, Supko JG, Martins R, et al. A phase II study of weekly paclitaxel in elderly patients with advanced non-small cell lung cancer. Clin Cancer Res 2001; 7: 3942–9PubMed

41.

Gauvin A, Pinguet F, Culine S, et al. Bayesian estimate of vinorelbine pharmacokinetic parameters in elderly patients with advanced metastatic cancer. Clin Cancer Res 2000; 6: 2690–5PubMed

42.

Hurria A, Fleming MT, Baker SD, et al. Pharmacokinetics and toxicity of weekly docetaxel in older patients. Clin Cancer Res 2006; 12: 6100–5PubMedCrossRef

43.

Lichtman SM, Hollis D, Miller AA, et al. Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: cancer and leukemia group B (CALGB 9762). J Clin Oncol 2006; 24: 1846–51PubMedCrossRef

44.

Sorio R, Robieux I, Galligioni E, et al. Pharmacokinetics and tolerance of vinorelbine in elderly patients with me-tastatic breast cancer. Eur J Cancer 1997; 33: 301–3PubMedCrossRef

45.

Yancik R, Ries LA. Aging and cancer in America: demographic and epidemiologic perspectives. Hematol Oncol Clin North Am 2000; 14: 17–23PubMedCrossRef

46.

Keating NL, Landrum MB, Klabunde CN, et al. Adjuvant chemotherapy for stage III colon cancer: do physicians agree about the importance of patient age and comor-bidity? J Clin Oncol 2008; 26: 2532–7PubMedCrossRef

47.

Hurria A, Wong FL, Villaluna D, et al. Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 2008; 26: 5386–92PubMedCrossRef

48.

Blanco JAG, Toste IS, Alvarez RF, et al. Age, comorbidity, treatment decision and prognosis in lung cancer. Age Ageing 2008; 37: 715–8PubMedCrossRef

49.

Chen HX, Cleck JN. Adverse effects of anticancer agents that target the VEGF pathway. Nat Rev Clin Oncol 2009; 6: 465–77PubMedCrossRef

50.

Rini BI, Cohen DP, Lu D, et al. Hypertension (HTN) as a biomarker of efficacy in patients (pts) with metastatic renal cell carcinoma (mRCC) treated with sunitinib [abstract no. 312]. Presented at the 2010 Genitourinary Cancers Symposium; 2010 Mar 5–7; San Francisco (CA)

51.

Pal SK, Figlin RA. Treatment options in metastatic renal cell carcinoma: focus on mTOR inhibitors. Clin Med Insights Oncol 2010; 4: 43–53PubMed

52.

Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management. J Clin Pharm Ther 2007; 32: 169–75PubMedCrossRef

53.

Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. Oncologist 2010; 15: 507–22PubMedCrossRef

54.

Flood KL, Carroll MB, Le CV, et al. Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit. Am J Geriatr Pharmacother 2009; 7: 151–8PubMedCrossRef

55.

Corcoran ME. Polypharmacy in the older patient with cancer. Cancer Control 1997; 4: 419–28PubMed

56.

US FDA. Approval letter for sorafenib [online]. Available from URL: http://www.accessdata.fda.gov/drugsatfda_docs/appletter/2005/021923ltr.pdf [Accessed 2010 Mar 24]

57.

Eisen T, Oudard S, Szczylik C, et al. Sorafenib for older patients with renal cell carcinoma: subset analysis from a randomized trial. J Natl Cancer Inst 2008; 100: 1454–63PubMedCrossRef

58.

Bukowski RM, Stadler WM, McDermott DF, et al. Safety and efficacy of sorafenib in elderly patients treated in the North American advanced renal cell carcinoma sorafenib expanded access program. Oncology 2010; 78: 340–7PubMedCrossRef

59.

Motzer RJ, Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 2009; 27: 3584–90PubMedCrossRef

60.

Gore ME, Porta C, Oudard S, et al. Sunitinib in metastatic renal cell carcinoma (mRCC): preliminary assessment of toxicity in an expanded access trial with subpopulation analysis. ASCO Meet Abstr 2007; 25: 5010

61.

Rini BI, Halabi S, Rosenberg JE, et al. Bevacizumab plus interferon alfa compared with interferon alfa mono-therapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol 2008; 26: 5422–8PubMedCrossRef

62.

Escudier B, Pluzanska A, Koralewski P, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet 2007; 370: 2103–11PubMedCrossRef

63.

Hutson TE, Osanto S, Calvo E, et al. Efficacy and safety of everolimus in elderly patients with metastatic renal cell carcinoma (mRCC) after disease progression on VEGFr-TKI therapy [abstract no. 11]. Presented at the 2010 Kidney Cancer Symposium; 2010 Oct 2; Chicago (IL)

64.

Dutcher JP, Szczylik C, Tannir N, et al. Correlation of survival with tumor histology, age, and prognostic risk group for previously untreated patients with advanced renal cell carcinoma (adv RCC) receiving temsirolimus (TEMSR) or interferon-alpha (IFN). J Clin Oncol (Meet Abstr) 2007; 25: 5033

65.

66.

McDermott DF, Ghebremichael MS, Signoretti S, et al. The high-dose aldesleukin (HD IL-2) ‘SELECT’ trial in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol (Meet Abst) 2010; 28: 4514

67.

Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol 1995; 13: 688–96PubMed

68.

Atzpodien J, Wandert T, Reitz M. Age does not impair the efficacy of immunochemotherapy in patients with meta-static renal carcinoma. Crit Rev Oncol/Hematol 2005; 55: 193–9CrossRef

69.

Prout Jr GR, Wesley MN, Yancik R, et al. Age and co-morbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer 2005; 104: 1638–47PubMedCrossRef

70.

Shariat SF, Sfakianos JP, Droller MJ, et al. The effect of age and gender on bladder cancer: a critical review of the literature. Br J Urol Int 2009; 105: 300–8CrossRef

71.

Mettlin CJ, Murphy GP, Cunningham MP, et al. The National Cancer Data Base report on race, age, and region variations inprostate cancer treatment. Cancer 1997; 80: 1261–6PubMedCrossRef

72.

Lichtman SM, Wildiers H, Chatelut E, et al. International Society of Geriatric Oncology Chemotherapy Taskforce: evaluation of chemotherapy in older patients - an analysis of the medical literature. J Clin Oncol 2007; 25: 1832–43PubMedCrossRef

73.

Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US food and drug administration. J Clin Oncol 2004; 22: 4626–31PubMedCrossRef

74.

Droz JP, Aapro M, Balducci L. Overcoming challenges associated with chemotherapy treatment in the senior adult population. Crit Rev Oncol Hematol 2008; 68Suppl. 1: S1–8PubMedCrossRef

75.

Extermann M, Albrand G, Chen H, et al. Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol 2003; 21: 3214–9PubMedCrossRef

76.

DeMichele A, Putt M, Zhang Y, et al. Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients. Cancer 2003; 97: 2150–9PubMedCrossRef

77.

Hall WH, Jani AB, Ryu JK, et al. The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer. Prostate Cancer Prostatic Dis 2005; 8: 22–30PubMedCrossRef

78.

Rao AV, Seo PH, Cohen HJ. Geriatric assessment and comorbidity. Semin Oncol 2004; 31: 149–59PubMedCrossRef

79.

Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–6PubMedCrossRef

80.

Freyer G, Geay J, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 2005; 16: 1795–800PubMedCrossRef

81.

Bernabei R, Venturiero V, Tarsitani P, et al. The comprehensive geriatric assessment: when, where, how. Crit Rev Oncol Hematol 2000; 33: 45–56PubMedCrossRef

82.

Monfardini S, Ferrucci L, Fratino L, et al. Validation of a multidimensional evaluation scale for use in elderly cancer patients. Cancer 1996; 77: 395–401PubMedCrossRef

83.

Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 2005; 104: 1998–2005PubMedCrossRef

84.

Tucci A, Ferrari S, Bottelli C, et al. A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer 2009; 115: 4547–53PubMedCrossRef

85.

Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective 500 patient multicenter study [abstract no. 9001]. J Clin Oncol 2010; 28 Suppl.: 15s

86.

Extermann M, Boler I, Reich R, et al. The chemotherapy risk assessment sclae for high-age patients (CRASH) score: design and validation [abstract no. 9000]. J Clin Oncol 2010; 28 Suppl.: 15s

87.

Extermann M, Aapro M, Bernabei R, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005; 55: 241–52PubMedCrossRef

88.

Balducci L, Cohen HJ, Engstrom PF, et al. Senior adult oncology clinical practice guidelines in oncology. J Natl Compr Canc Netw 2005; 3: 572–90PubMed

89.

Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 2007; 25: 1824–31PubMedCrossRef

90.

Maione P, Perrone F, Gallo C, et al. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the Multicenter Italian Lung Cancer in the Elderly Study. J Clin Oncol 2005; 23: 6865–72PubMedCrossRef

91.

Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291: 2441–7PubMedCrossRef

92.

Frasci G, Lorusso V, Panza N, et al. Gemcitabine plus vi-norelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 2000; 18: 2529–36PubMed

93.

Pallis AG, Fortpied C, Wedding U, et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 2010; 46: 1502–13PubMedCrossRef

94.

Ranpura V, Pulipati B, Chu D, et al. Increased risk ofhigh-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens 2010; 23: 460–8PubMedCrossRef

95.

Zhu X, Stergiopoulos K, Wu S. Risk of hypertension and renal dysfunction with an angiogenesis inhibitor sunitinib: systematic review and meta-analysis. Acta Oncol 2009; 48: 9–17PubMedCrossRef

96.

Wu S, Chen JJ, Kudelka A, et al. Incidence and risk of hypertension with sorafenib in patients with cancer: a systematic review and meta-analysis. Lancet Oncol 2008; 9: 117–23PubMedCrossRef

97.

Bellmunt J, Negrier S, Escudier B, et al. The medical treatment of metastatic renal cell cancer in the elderly: position paper of a SIOG Taskforce. Crit Rev Oncol Hematol 2009; 69: 64–72PubMedCrossRef

98.

Girardi F, Franceschi E, Brandes AA. Cardiovascular safety of VEGF-targeting therapies: current evidence and handling strategies. Oncologist 2010; 15: 683–94PubMedCrossRef

99.

Scappaticci FA, Skillings JR, Holden SN, et al. Arterial thromboembolic events in patients with metastatic carcinoma treated with chemotherapy and bevacizumab. J Natl Cancer Inst 2007; 99: 1232–9PubMedCrossRef

100.

Choueiri TK, Schutz FA, Je Y, et al. Risk of arterial thromboembolic events with sunitinib and sorafenib: a systematic review and meta-analysis of clinical trials. J Clin Oncol 2010; 28: 2280–5PubMedCrossRef

101.

Schmidinger M, Zielinski CC, Vogl UM, et al. Cardiac toxicity of sunitinib and sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 2008; 26: 5204–12PubMedCrossRef

102.

Sternberg CN, Szczylik C, Lee E, et al. A randomized, double-blind phase III study of pazopanib in treatment-naive and cytokine-pretreated patients with advanced renal cell carcinoma (RCC). J Clin Oncol (Meet Abstr) 2009; 27: 5021

103.

Zangari M, Fink LM, Elice F, et al. Thrombotic events in patients with cancer receiving antiangiogenesis agents. J Clin Oncol 2009; 27: 4865–73PubMedCrossRef

104.

Baldo P, Cecco S, Giacomin E, et al. mTOR pathway and mTOR inhibitors as agents for cancer therapy. Curr Cancer Drug Targets 2008; 8: 647–65PubMedCrossRef

105.

Osanto S, Hutson TE, Calvo E, et al. Efficacy and safety of everolimus in elderly patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol (Meet Abstr) 2010; 28: 4608

106.

Escudier B, Eisen T, Stadler WM, et al. Sorafenib for treatment of renal cell carcinoma: final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 2009; 27: 3312–8PubMedCrossRef

107.

Halabi S, Rini BI, Stadler WM, et al. Use of progressionfree survival (PFS) to predict overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol (Meet Abstr) 2010; 28: 4525

108.

Motzer RJ, Escudier B, Oudard S, et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 2010; 116: 4256–65PubMedCrossRef

109.

Pal SK, Reckamp KL. Targeted pathways in NSCLC and SCLC. In: Kernstine K, editor. A multidisciplinary approach to lung cancer. New York (NY): Demos Medical Publishers, 2010

Titel: Systemic Therapies for Metastatic Renal Cell Carcinoma in Older Adults
verfasst von: Sumanta K. Pal
Ari Vanderwalde
Arti Hurria
Robert A. Figlin
Publikationsdatum: 01.08.2011
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 8/2011
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.2165/11592880-000000000-00000

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

19.04.2024 | Vorhofflimmern | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Systemic Therapies for Metastatic Renal Cell Carcinoma in Older Adults

Abstract

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2011

Disease Modification in Parkinson’s Disease

Drug Trials and Older People

Is Antiarrhythmic Treatment in the Elderly Different?

Exclusion of Older People from Clinical Trials

Polymyalgia Rheumatica and Giant Cell Arteritis in Older Patients

The Challenges of Gout Management in the Elderly

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Parodontalbehandlung verbessert Prognose bei Katheterablation

Prostatakarzinom: EU initiiert neues Screeningkonzept

Blasenkarzinom – Biomarker statt Zytologie?

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Update Innere Medizin