VEGF pathway-targeted therapy for advanced renal cell carcinoma: a meta-analysis of randomized controlled trials.

Abstract

Immunotherapy which has been in practice for more than 20 years proves effective for the treatment of metastatic renal cell carcinoma (mRCC). Anti-angiogenesis-targeted therapy has recently been identified as a promising therapeutic strategy for mRCC. This study was aimed to evaluate the effectiveness of vascular endothelial growth factor (VEGF) pathway-targeted therapy for mRCC by comparing its effectiveness with that of immunotherapy. The electronic databases were searched. Randomized controlled trials (RCTs) on comparison of VEGF inhibiting drugs (sorafenib, sunitinib and bevacizumab) with interferon (IFN) or placebo for mRCC treatment were included. Data were pooled to meta-analyze. A total of 7 RCTs with 3451 patients were involved. The results showed that anti-VEGF agents improved progression-free survival (PFS) and offered substantial clinical benefits to patients with mRCC. Among them, sunitinib had a higher overall response rate (ORR) than IFN (47% versus 12%, P<0.000001). Bevacizumab plus IFN produced a superior PFS [risk ratio (RR): 0.86, 95% confidence interval (CI): 0.76-0.97; P=0.01] and ORR (RR: 2.19; 95% CI: 1.72-2.78; P<0.00001) in patients with mRCC over IFN, but it yielded an increase by 31% in the risk of serious toxic effects (RR: 1.31; 95% CI: 1.20-1.43; P<0.00001) as compared with IFN. The overall survival (OS) was extended by sorafenib (17.8 months) and sunitinib (26.4 months) as compared with IFN (13 months). It was concluded that compared with IFN therapy, VEGF pathway-targeted therapies improved PFS and achieved significant therapeutic benefits in mRCC. However, the risk to benefit ratio of these agents needs to be further evaluated.

• Authors: Fei Liu, Xianguo Chen, Ejun Peng, Wei Guan, Youyuan Li, Zhiquan Hu, Zhangqun Ye, Qianyuan Zhuang
• Journal: Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban (J Huazhong Univ Sci Technolog Med Sci) Vol. 31 Issue 6 Pg. 799-806 (Dec 2011) ISSN: 1672-0733 [Print] China
• PMID: 22173502 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Antineoplastic Agents
• Indoles
• Phenylurea Compounds
• Pyrroles
• Vascular Endothelial Growth Factor A
• Niacinamide
• Bevacizumab
• Interferons
• Sorafenib
• Receptors, Vascular Endothelial Growth Factor
• Sunitinib

Topics

• Angiogenesis Inhibitors (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Bevacizumab
• Carcinoma, Renal Cell (drug therapy)
• Humans
• Indoles (therapeutic use)
• Interferons (therapeutic use)
• Kidney Neoplasms (drug therapy)
• Niacinamide (analogs & derivatives, therapeutic use)
• Phenylurea Compounds (therapeutic use)
• Pyrroles (therapeutic use)
• Randomized Controlled Trials as Topic
• Receptors, Vascular Endothelial Growth Factor (drug effects)
• Sorafenib
• Sunitinib
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)