Progression free survival will become the endpoint fortrials in advanced kidney cancer, predicted cancer expert Professor Ronald Bukowski at the first ever European Multidisciplinary Meetingon Urological Cancers last week in Barcelona, Spain.

“There is an issue in targeted therapy trials as patientshave access to other drugs and this contaminates the results.  Progression free survival will be thestandard as we advance,” Prof Bukowski, director of experimental therapeuticsat the Cleveland Clinical Foundation Taussing Cancer Center, told the meeting.

He added that while sunitinib (Pfizer's Sutent) is the standard of care infirst line therapy for renal cell carcinoma (RCC), questions remained such aswhat are suitable preclinical markers, how targeted therapies work innon-clear cell RCC, and optimum dose and duration of treatment.

“Sunitinib data show that in metastatic RCC there isincreasing response as exposure to the drug increases. This suggests that there is longersurvival with more drug and drug exposure may be important with tyrosine kinaseinhibitors,” said Prof Bukowski, who is also professor of medicine at CCFLerner College of Medicine of Case Western Reserve University in Cleveland.

Professor Cora Sternberg, La Sapienza University, and chiefof the department of medical oncology at the San Camillo and Forlanini Hospitals, Rome, concurred with Prof Bukowski’s assessment of how the treatmentlandscape was changing in RCC, which has the worst prognosis of all theurological cancers. 

Targeted treatments 'have changed the way we think about cancer'

“Targeted therapies have clearly changed the way we thinkabout the disease.  Before we had adisease in which almost nothing worked and now we have agents that are a majoradvance. But patients do not have a real response according to RECIST and whatwe see is stabilisation of the disease,” said Prof Sternberg.

Prof Sternberg added to the list of questions that neededanswers in relation to targeted therapies: how to measure response, howtargeted therapies affect primary tumours, potentials for treatment resistance,cross over to other therapies, sequencing therapies, combining therapies andthe influence targeted therapies may have on surgery. 

Professor Peter Mulders, Radboud University, Nijmegen, saidthe effect of targeted therapies on tumours and metastases was sometimes“spectacular”. “They are quick working and patients feel better after a shortperiod of time,” he said.

Professor Cezary Szczylik, head of the oncological clinic ofthe Military Institute of Health, Warsaw, highlighted quality of life when hepresented data from the sunitinib expanded access trial.  Describing the results as moreoptimistic than clinicians had previously thought, Prof Szczylik said:“Sunitinib can improve quality of life, increasing normal activities likeworking and walking.”

He noted that responses were seen in patients who had brainand bone metastases, the latter being particularly detrimental to quality oflife as they often led to fractures, which resulted in patients becomingbed-ridden.

“These results show we can broaden the indications for firstline treatment with sunitinib,” concluded Prof Szczylik.<i>By Maya Anaokar</i>