The treatment landscape in metastatic renal cell carcinoma has changed fundamentally over the last decade by the development of anti-angiogenic agents, mTOR inhibitors, and immunotherapy. Outside of the context of a clinical trial the treatments are used sequentially. We describe results under real life conditions of a sequential treatment strategy, before the era of immunotherapy. All patients were treated according to their prognostic score (either MSKCC or IMDC) for advanced renal cell carcinoma. A treatment strategy involving 1 to 4 lines was determined including a rechallenge criterion for the repeat use of a treatment class. 344 patients were included over 3 years. Overall survival was 57 months in patients with good or intermediate prognosis and 19 months in patients with poor prognosis. In the former group, the proportions of patients treated with 2 to 4 treatment lines were 70%, 38% and 16% respectively. The best objective response rates for lines 1 to 4 were 46%, 36%, 16% and 17% respectively. Grade III/IV toxicity did not appear to be cumulative. The recommended strategy was followed in 68% of patients. A large proportion of patients with good or intermediate prognosis who progress after two lines of treatment still have a performance status good enough to receive a systemic treatment, which justifies such a strategy. Overall survival of patients with good and intermediate prognosis was long, suggesting a benefit from the applied approach. These results might be used as selection criterion for the treatment of patients in the era of immune checkpoint inhibitors. This article is protected by copyright. All rights reserved.

International journal of cancer. 2019 Jul 18 [Epub ahead of print]

E Voog, B Campillo-Gimenez, C Elkouri, F Priou, F Rolland, B Laguerre, C Elhannani, J Merrer, C Pfister, E Sevin, T L’Haridon, A Hasbini, L Moise, A Le Rol, J P Malhaire, R Delva, E Vauléon, O Cojocarasu, P Deguiral, I Cumin, C Cheneau, F Schlürmann, V Delecroix, E Boughalem, D Mollon, C Ligeza-Poisson, S Abadie-Lacourtoisie, E Monpetit, T Chatellier, H Desclos, E Coquan, F Joly, J Y Tessereau, S Dupuy, D Déniel Lagadec, F Marhuenda, F Grudé

Clinique Victor Hugo, Le Mans, France., Centre Eugène Marquis, Rennes, France., Hôpital Privé du Confluent, Nantes, France., Centre Hospitalier de La Roche/Yon, France., Institut de Cancérologie de l’Ouest, Angers, Nantes, France., Polyclinique du Parc, Cholet, France., Clinique Pasteur, Brest, France., Centre Hospitalier Universitaire, Rouen, France., Centre François Baclesse, Caen, France., Centre Hospitalier Intercommunal de Cornouaille, Quimper, France., Centre Hospitalier Universitaire Brest Morvan, France., Centre Hospitalier Le Mans, France., Clinique Mutualiste de l’Estuaire Saint-Nazaire, France., Centre Hospitalier Bretagne Sud Lorient, France., Hôpital Privé Océane, Vannes, France., Centre Hospitalier Saint-Malo, France.