Most metastatic renal cell carcinomas currently are being treated with VEGF-targeted therapy as first line. So we know that unfortunately most of these patients will progress, however there is a significant minority of the patients that will discontinue that treatment due to toxicity. So the issue is that currently we don’t really know how it’s going to be the outcome in second line based on the reason for the discontinuation. So what we did is we did an analysis of the outcome from second line looking at the reason of discontinuation.

What did you find?

The main finding probably is that the overall survival from starting second line was longer in the patients who discontinued first line due to toxicity: 17 months versus 11 months in the patients who discontinued due to progressing disease.

What could this mean?

There are some issues because we are doing a retrospective analysis so there is always some bias but probably the main thing is obviously that the patients who discontinued due to toxicity first line VEGF-targeted therapy have better outcomes in second line. Probably the most important thing is these findings should be taken into consideration for designing clinical trials in second line for metastatic RCC patients.