Metastatic Renal Cell Carcinoma Rapidly Progressive to Sunitinib: What to Do Next? (European Urology Oncology)

1.Despite recent advances in the treatment of patients with metastatic renal cell carcinoma, patients with rapidly progressive disease (PD) on tyrosine kinase inhibitor (TKI) treatment represent a subset of patients with a very poor prognosis.2.What to do in second or subsequent treatment lines after a prior TKI still remains an actuarial issue?3.We analyzed the outcome of second-line treatment of patients rapidly progressing (within 24wk) on first-line sunitinib therapy, to determine whether the TKI rechallenge strategy or the mammalian target of rapamycin (mTOR) inhibition switch still has any clinical rationale.4.According to our results, the TKI or the mTOR switch strategy might not be superior to continued treatment with sunitinib in this setting. Physicians might consider changing the mechanism of action as the best management option for primary refractory patients to TKI.