Choueiri TK et al. (2007) Clinical factors associated with outcome in patients with metastatic clear-cell renal cell carcinoma treated with vascular endothelial growth factor-targeted therapy. Cancer 110: 543–550

Current treatment algorithms for patients with advanced renal cell carcinoma (RCC) were developed on the basis of patients treated with cytokines or chemotherapy; however, most patients now receive VEGF-targeted therapies. Choueiri et al. have identified five factors that can predict progression-free survival (PFS) in patients treated with anti-VEGF agents and used these factors to develop a prognostic model.

Data were reviewed for 120 patients with metastatic clear-cell RCC enrolled into one of the two compassionate-use studies or nine prospective trials conducted at the Cleveland Clinic Taussig Cancer Center, OH, between October 2003 and January 2006. These patients were treated with the anti-VEGF agents bevacizumab, sunitinib, sorafenib or axitinib, and no patient had previously received anti-VEGF therapy. Overall estimated median PFS was 13.8 months, and 34% of patients achieved an objective response according to the RECIST criteria. Through multivariate analysis, the following factors were identified and validated as independent adverse prognostic indicators of PFS: <2-year interval between diagnosis and current treatment; baseline platelet count >300 × 109/l; baseline neutrophils >4.5 × 109/l; baseline corrected serum calcium <8.5 mg/dl or >10 mg/dl (<2.1 mmol/l or >2.5 mmol/l); and initial ECOG performance status ≥1. These adverse prognostic factors were used to define three prognostic subgroups. Median PFS was 20.1 months in patients with 0–1 factor, 13 months in those with 2 factors, and only 3.9 months in those with >2 factors.

These prognostic factors can, say the authors, be easily incorporated into patient care and stratification schema for future clinical trials of novel, VEGF-targeted agents.