A population-based overview of sequences of targeted therapy in metastatic renal cell carcinoma (mRCC).

387 Background: There are several types of targeted therapy (TT) available to treat mRCC and data on outcomes and different sequences of therapies are required. METHODS Consecutive series of patients with mRCC treated with TT were examined. Multivariable analysis was performed when significant differences on univariable analysis were seen. RESULTS 2106 patients were included with a median follow-up of 36 months. 907 (43%) and 318 (15%) patients received subsequent second-line and third-line TT, respectively. Baseline characteristics of the groups below were not different except there were more patients with non-clear cell histology in the VEGF to mTOR group compared to the VEGF to VEGF group. When adjusting for the Heng et al poor risk criteria and non-clear cell histology, the hazard ratio of death for the VEGF to mTOR group vs the VEGF to VEGF group was 0.833 (95%CI 0.669-1.037, p=0.1016). When adjusting for poor risk criteria, the hazard ratio of death for the sunitinib to everolimus vs sunitinib to temsirolimus sequences was 0.774 (0.52-1.153, p=0.2086). CONCLUSIONS The sequence of TT may not have a substantial effect on outcome but results of prospective randomized studies are awaited. [Table: see text].