Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma
- PMID: 17538086
- DOI: 10.1056/NEJMoa066838
Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma
Abstract
Background: Interferon alfa is widely used for metastatic renal-cell carcinoma but has limited efficacy and tolerability. Temsirolimus, a specific inhibitor of the mammalian _target of rapamycin kinase, may benefit patients with this disease.
Methods: In this multicenter, phase 3 trial, we randomly assigned 626 patients with previously untreated, poor-prognosis metastatic renal-cell carcinoma to receive 25 mg of intravenous temsirolimus weekly, 3 million U of interferon alfa (with an increase to 18 million U) subcutaneously three times weekly, or combination therapy with 15 mg of temsirolimus weekly plus 6 million U of interferon alfa three times weekly. The primary end point was overall survival in comparisons of the temsirolimus group and the combination-therapy group with the interferon group.
Results: Patients who received temsirolimus alone had longer overall survival (hazard ratio for death, 0.73; 95% confidence interval [CI], 0.58 to 0.92; P=0.008) and progression-free survival (P<0.001) than did patients who received interferon alone. Overall survival in the combination-therapy group did not differ significantly from that in the interferon group (hazard ratio, 0.96; 95% CI, 0.76 to 1.20; P=0.70). Median overall survival times in the interferon group, the temsirolimus group, and the combination-therapy group were 7.3, 10.9, and 8.4 months, respectively. Rash, peripheral edema, hyperglycemia, and hyperlipidemia were more common in the temsirolimus group, whereas asthenia was more common in the interferon group. There were fewer patients with serious adverse events in the temsirolimus group than in the interferon group (P=0.02).
Conclusions: As compared with interferon alfa, temsirolimus improved overall survival among patients with metastatic renal-cell carcinoma and a poor prognosis. The addition of temsirolimus to interferon did not improve survival. (ClinicalTrials.gov number, NCT00065468 [ClinicalTrials.gov].).
Copyright 2007 Massachusetts Medical Society.
Comment in
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Is temsirolimus more safe and effective than interferon alpha for the treatment of advanced renal cell carcinoma?Nat Clin Pract Urol. 2007 Nov;4(11):586-7. doi: 10.1038/ncpuro0915. Epub 2007 Sep 4. Nat Clin Pract Urol. 2007. PMID: 17768416 No abstract available.
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Temsirolimus for advanced renal-cell carcinoma.N Engl J Med. 2007 Sep 6;357(10):1050; author reply 1050-1. doi: 10.1056/NEJMc071868. N Engl J Med. 2007. PMID: 17804854 No abstract available.
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Temsirolimus for advanced renal-cell carcinoma.N Engl J Med. 2007 Sep 6;357(10):1050; author reply 1050-1. N Engl J Med. 2007. PMID: 17823993 No abstract available.
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Is advanced renal cell carcinoma best treated with temsirolimus, interferon alpha, or both?Nat Clin Pract Oncol. 2008 Jan;5(1):16-7. doi: 10.1038/ncponc0986. Epub 2007 Nov 6. Nat Clin Pract Oncol. 2008. PMID: 17984986 No abstract available.
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Words of wisdom. Re: Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf IG, Barbarash O, Gokmen E, O'Toole T, Lustgarten S, Moore L, Motzer RJ; Global ARCC Trial. N Engl J Med 2007;356:2271-81.Eur Urol. 2009 Jan;55(1):250-2. doi: 10.1016/j.eururo.2008.09.037. Eur Urol. 2009. PMID: 20050019 No abstract available.
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