Clinical experience with temsirolimus in the treatment of advanced renal cell carcinoma

Abstract

Temsirolimus is an inhibitor of the mammalian target of rapamycin (mTOR) kinase, a protein that has been shown to be particularly active in metastatic renal cell carcinoma (mRCC) with poor prognosis. Therefore, temsirolimus should be considered as the first-line treatment indicated in mRCC patients classified as poor risk. The benefits of temsirolimus are not limited to an increased survival but are also related to a better quality of life, which is certainly one of the most important aspects in the clinical management of these frail patients. Temsirolimus is a well-tolerated treatment, and the most frequent adverse events are manageable with supportive care. To this end, the identification of predictive factors of response to temsirolimus could help us to better select patients and obtain a more tailored clinical management of mRCC.

Keywords: mTOR inhibitors; renal cell carcinoma; targeted therapies; temsirolimus.

Figure 1.

Overall survival in the pivotal Advanced Renal Cell Carcinoma trial [Hudes et al. 2007].

Figure 2.

Overall survival among subgroups of patients in the phase III ARCC trial [Hudes et al. 2007]. ARCC, Advanced Renal Cell Carcinoma Trial; CI, confidence interval.

Figure 3.

PFS (panel A) and OS (panel B) in the second-line treatment with temsirolimus and sorafenib during the INTORSECT study [Hutson et al. 2014]. CI, confidence interval; HR, hazard ratio; OS, overall survival; PFS, progression-free survival.

Figure 4.

Exploratory subgroup analysis of OS for prespecified factors in the INTORSECT study [Hutson et al. 2014]. *Indicates p = 0.01. †Indicates p = 0.002. ‡Indicates p = 0.002. CI, confidence interval; HR, hazard ratio; MSKCC, Memorial Sloan-Kettering Cancer Center; OS, overall survival; PFS, progression-free survival.