VEGF vs mTOR Inhibitors

todd121

I know I've asked this before, but I'm still puzzling over this. When I was looking at clinical trials, I took a look at the drugs currently the standard in metastatic disease, and for the most part it was VEGF's until they don't work, then try an mTOR inhibitor. When I asked the oncologists I know why that was the case (2 were RCC specialists), the answer seemed to be, "...because we had/have all these VEGF's that came to market and got FDA approval and were effective while the mTOR inhibitor approval came later and had only really been studied as a treatment following VEGF failure." I looked for studies using mTOR inhibitors first, and there was only one, very small study. It did quite well in that one study, but the patient population was very small (I think only 60-something patients). When I sort of pushed on this with my oncologist, he basically said "We have a lot of drugs to study and we can't study them all so we have to choose which ones and which combinations. It's a complicated question."

Does anyone know why there wasn't a larger scale study done of everolimus as a first-line treatment? Is anyone aware of a study being done with everolimus as a first-line treatment? Or studies that might be done combining the two drugs?

I'm a little surprised the drug company that manufactures everolimus wouldn't push for a larger-scale study to see it's effectiveness head-to-head.

Or is anyone aware of why everolimus would be used after the VEGF drugs have failed, other than it has only been tested that way and it came to market later? It appears that once a drug is established as an approved treatment, there's a lot of resistance to trying other things. I suppose that makes sense.

Thanks,

Todd