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Afinitor as Second Line Drug - Why is that?

todd121
Posts: 593
Joined: Dec 2012

Can anyone explain to me why afinitor is used only after the VEGF drugs have failed? I understand the FDA has approved it only this way, but why? Is it just a newer drug that came late to the party? I've seen charts showing it less effective, but I think those charts were all in a setting of being the second thing tried. Has it just not been tested yet as a first line?

I'm trying to compare the effectiveness of these two drugs, and it appears the data may not be there since the VEGF drugs like votrient and sunitib, etc. are all tried first.

Thanks,

Todd

KJones1969
Posts: 158
Joined: Mar 2012

My husband was given Afinitor as a second line drug in October. His doctor told us that it showed to maintain the cancer and stop additional growth when Votrient stopped working. Well it DIDN'T do anything but make my husband sick. For the first 10 days he was on 10mg and had mouth sores, a bad rash, swelling of the face and eyes and extreme fatigue. They took him off of that and his doctor wanted him to try 7.5 mg of it because once we shut the door on taking it he couldn't go back to it. Well a little less than 2 months into the lower dose we ended up in the ED with extreme shortness of breath. We found out then he had malignant pleural effusion but while he was there he had a cat scan and the Afinitor did NOTHING for him. His cancer had doubled in size on his right lung in a little less than 3 months.

Good luck if you are getting ready to start on it or have been on it. I hope it works better than it did my husband.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

We're each so different.  Afinitor may well work fine for the next man and his next treatment may well turn out to be just what your Husband needs - I pray that it will.

I wish I knew the answer to Todd's question and it will be good if someone better-informed can provide us with the answer.

KJones1969
Posts: 158
Joined: Mar 2012

It would be nice to know the results of each drug and how they are going to affect the patient. My husband ask this about his new drug, of course I knew the answer was I can't tell you how the side effects are because everyone is different. What works for one, may not work for the next person. I know Votrient was good to my hubs to start with when Afinitor was never good for him. Now let's pray Inlyta works well. :)

amonet
Posts: 7
Joined: Dec 2011

Hi Todd,

 

I asked the question why Afinitor for a 2nd line, but never received an answer, other than "because it's the second line". My mother was diagnosed with RCC in December 2011, she has metastic disease in the liver and lymph nodes. She was on Sutent from Aug-Dec, side effects were horrible and she had mixed results. She was switched to Affinitor in December and will have her first scan at the end of the week since starting this drug. Everyones experience is different, but my mother has been feeling very well on Affinitor. With Sutent, she had mouth sores, no appetite, fatigue, diahrrea! She has not had any of that with Affinitor. She is a close to "normal" as I have seen her in a while.

 

I pray that whatever your choice is it works for you. 

 

Keep the Faith!

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I thought I had part of the answer but wanted to confirm. 

I have it on the authority of  'a usually reliable source' that Afinitor isn't generally offered as a first-line treatment because for about 70% of patients it's not as good as the current crop of TKIs (Nexavar, Sutent, Votrient, Inlyta) and the principle is that with RCC you give it your probable best shot first. 

For that self-same reason it actually IS given as first-line in some cases, notably for some papillary RCC patients since for that sub-group (I don't know whether it applies equally to type I and type II pRCC)  it is often more effective.  I believe that this is because the mTOR pathway is a more important target in pRCC since pRCC is hypovascular, unlike the other RCC sub-types, where blood supply to the tumour is crucial.  So, the anti-angiogenic propensities of the TKIs, so useful in starving tumours in the other sub-types, isn't needed for pRCC.

todd121
Posts: 593
Joined: Dec 2012

Thanks for the info.

Since writing this post I've talked to 3 oncologists, and the answer seems to be that it came to the party late and has never been studied as a first line treatment. They have no data. I don't have an answer why it hasn't been studied as a first line except my oncologist said that there have been and were so many new TKI's that they couldn't study them all and they simply haven't done a study with Affinitor first. I've since found an article stating that they don't know the optimal ordering of these drugs and there's no study with them being given the other way around and that there is no data to know if Affinitor is or isn't more effective as a first line treatment for ccRCC, even though most oncologists *believe* it to be less effective, but without data to back that up.

It is being used as a first line in other conditions, but I didn't know it was used in pRCC. That's interesting.

I'm considering the two adjuvant drug trials still. One is with votrient (pazopanib) and the other with everolimus (affinitor). Two oncologists say the first is more effective, and two say nobody knows for certain. When you push the first two, it's based on studies which have always used the first drug first and the second drug only after the first failed. They all agree that you want to use the most effective drug you have for adjuvant therapy. It's the best chance to wipe out the cancer.

My oncologist believes that affinitor on average has less side effects and is more tolerable, and therefore would be easier for most patients to tolerate on the 1-year adjuvant therapy. His point is that patients that are otherwise healthy are more likely to come off the drug in an adjuvant setting if the side effects are intolerable which he thinks is the case with votrient.

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