Salvage therapy with sorafenib plus vinblastine and fluorouracil for metastatic renal cell carcinoma.

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[3] Yuan F, Chen Y, Dellian M, Safabakhsh N, Ferrara N, Jain RK. Time-dependent vascular regression and permeability changes in established human tumor xenografts induced by an anti-vascular endothelial growth factor/vascular perme-ability factor antibody. Proc Natl Acad Sci USA 1996;/93:/

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patients with advanced solid tumors. J Clin Oncol 2007;/25:/

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93.

Salvage therapy with sorafenib plus vinblastine and fluorouracil

for metastatic renal cell carcinoma

CHENG-JENG TAI

Section of Hematology-Oncology, Taipei Medical University Hospital and Department of Medicine, Taipei Medical

University, Taipei, Taiwan

To the Editor,

Sorafenib is a multi-kinase inhibitor and is effective

in the treatment of metastatic renal cell carcinoma

(RCC) [1,2]. However, the median treatment

dura-tion for RCC in published articles is around

24 weeks [2]. But for responsive patients, no

pub-lished reports have discussed when sorafenib should

be discontinued. We report a patient with metastatic

RCC who responded to treatment with sorafenib

plus chemotherapy, and the treatment was

discon-tinued at his own insistence. Thirty months after the

first dose of sorafenib plus chemotherapy and

15 months after discontinuing treatment, he was

still alive without disease progression.

An 81-year-old man presented with severe pain in

his right hip joint and underwent hip joint

replace-ment in October 2006. A specimen from the resected

hip joint was sent for pathologic studies and was

diagnosed as metastatic renal cell carcinoma with

bony metastasis. A computed tomographic (CT) scan

(Figure 1) revealed a right kidney tumor and enlarged

calyx, so he was referred to our medical oncology

department for treatment. Because of the patient’s

age, sorafenib was administered at a reduced dosage

of 400 mg/day to avoid toxicity. One month later,

vinblastine (8 mg/m

) plus fluorouracil (500

mg/cy-cle) were given as conjunct medication and repeated

every two weeks. Bisphosphonate (pamidronate) was

also given with 90 mg/month. The patient tolerated

the treatment well and the disease remained stable

without further metastasis for 15 months, when he

Correspondence: Cheng-Jeng Tai, 252 Wu-Hsing St, Taipei 110, Taiwan, R.O.C. Tel: 886 2 27372181 ext 3903. Fax: 886 2 2736 3051. E-mail:

[email protected]

Sorafenib plus chemotherapy for metastatic renal cell carcinoma

931

(Received 25 April 2009; accepted 26 May 2009)

ISSN 0284-186X print/ISSN 1651-226X online # 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS) DOI: 10.1080/02841860903071351

Acta Oncol Downloaded from informahealthcare.com by Taipei Medical University on 05/30/11

insisted on stopping the medication. Fifteen months

later, we contacted him and he was healthy with an

ECOG performance status of 0
1.

One of the main problems of using targeted

therapy in metastatic cancer is whether the

medica-tion should be discontinued when the clinical status

is stable or the patient is in remission. In most cases,

patients are treated until disease progresses [3].

Therefore, it’s difficult to determine when and

whether to stop the medication. We also assumed

that the addition of chemotherapy to these targeted

medications might lead to better disease control

and longer progression free intervals [4]. The cost

of treatment is another problem. In metastatic RCC,

the costs for sorafenib are around US$30 000

40 000. This usually prevents a patient from taking

these medications without limit. Based on this case,

we are particularly interested in the cost-effectiveness

of treatment, an aspect which interests insurance

authorities the most.

Presently, the eradication of metastatic RCC by

available medications is still a long way off. Lower

costs and longer survivals with better control remain

the main goals of treatment.

References

[1] Ratain MJ, Eisen T, Stadler WM, Flaherty KT, Kaye SB, Rosner GL, et al. Phase II placebo-controlled randomized discontinuation trial of sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 2006;/24:/2505
12.

[2] Kane RC, Farrell AT, Saber H, Tang S, Williams G, Jee JM, et al. Sorafenib for the treatment of advanced renal cell carcinoma. Clin Cancer Res 2006;/12:/7271
8.

[3] Bracarda S, Caserta C, Sordini L, Rossi M, Hamzay A, Crino L. Protein kinase inhibitors in the treatment of renal cell carcinoma: Sorafenib. Ann Oncol 2007;/18(Suppl 6):/22
5.

[4] Gollob JA. Sorafenib: Scientific rationales for single-agent and combination therapy in clear-cell renal cell carcinoma. Clin Genitourin Cancer 2005;/4:/167
74.

Persistent hiccups as an adverse event to FLAG-IDA regimen for

leukemia

FABIO FORGHIERI

, MONICA MACCAFERRI

, MONICA MORSELLI

, LEONARDO

POTENZA

, FRANCESCO VOLZONE

, ELENA BANDIERI

, GIUSEPPE TORELLI

&

MARIO LUPPI

1

Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Azienda

Ospedaliera Policlinico, Modena, Italy and

Centro Valutazione Efficacia Assistenza Sanitaria, AUSL Modena, Italy.

Correspondence: Mario Luppi, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Azienda

Ospedaliera Policlinico, Via del Pozzo 71, 41100 Modena, Italy. Tel:39 059 4225570. Fax: 39 059 4224549. E-mail: [email protected]

932

F. Forghieri et al.

(Received 8 January 2009; accepted 11 January 2009)

ISSN 0284-186X print/ISSN 1651-226X online # 2009 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS) DOI: 10.1080/02841860902740931

Acta Oncol Downloaded from informahealthcare.com by Taipei Medical University on 05/30/11