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Predictors of short survival

Poor prognosis patients are defined as those with ≥ 3 predictors of short survival

- LDH level > 1.5 times upper limit of normal

- Hgb level < lower limit normal

- Corrected serum calcium level > 10mg/dl

- Interval of less than a year from original diagnosis to the start of systemic therapy

- Karnofsky PS ≤ 70

- ≥ 2 sites of organ metastasis

NCCN guideline 2013.

1) Sunitinib (Sutene)-clear cell type 경우
: Sunitinib 50mg PO for 4weeks, 2weeks off every 6-week toxicity 시 감량: 37.5mg/day
: Response Rate: 31% PFS:11months Ref> NEJM 2007;356:115-124
2) Sorafenib (Nexavar)-clear cell type 경우
: Nexavar 400mg PO Bid (공복시 복용)
: toxicity 시 감량: 400mg/day → 400mg EOD
: PFS:5.5months vs 2.8month (sorafenib vs placebo)
: RR: 10% vs 8%(sorafenib vs placebo Ref> NEJM 2007;356:125-134
3) Pazopanib (Votrient)-clear cell type 경우
: 800mg/day PO toxicity 시 감량: 400mg/day
: Pazopanib vs. placebo 9.2 vs. 4.2months Ref> JCO 2010;28:1061
4) Temsirolimus (Torisel)-non clear cell type, poor prognosis in clear cell type
: Temsirolimus 25mg iv for 30min weekly
: overall survival:10.9month PFS:3.8month Response
: Rate:8.6% Ref> NEJM 2007;356:2271-2281
5) Everolimus (Afinitor)-second line
: 10mg/day PO toxicity 시 감량: 5mg/day
: mPFS: everolimus vs. placebo 4.0 vs. 1months
6) High dose IL-2
: 대상: ECOG PS 0-1, normal organ function
: HD IL-2 (600,000 U/kg/dose IV every 8hrs on days 1 through 5 and 15 to 19 [maximum 28 doses]) every 12weeks
: Ref> JCO 2005;23:133