Case Study of the Month Salvage Therapy with Bevacizumab–Sunitinib Combination after Failure of Sunitinib Alone for Metastatic Renal Cell Carcinoma: A Case Series Jacques Medioni a,g , Eugeniu Banu a , Dominique Helley b,g,h , Florian Scotte a , Laure Fournier c , Arnaud Mejean d , Antoine Chedid e , Michel Azizi f,g , Jean-Marie Andrieu a,g , Ste ´phane Oudard a,g, * a Department of Oncology, Assistance Publique Ho ˆpitaux de Paris, Hoˆpital Europe ´en Georges Pompidou, Paris, France b Department of Biology, Assistance Publique Hoˆpitaux de Paris, Hoˆpital Europe ´en Georges Pompidou, Paris, France c Department of Radiology, Assistance Publique Ho ˆpitaux de Paris, Hoˆpital Europe ´en Georges Pompidou, Paris, France d Department of Urology, Assistance Publique Hoˆpitaux de Paris, Hoˆpital Europe ´en Georges Pompidou, Paris, France e Department of Vascular Medicine, Assistance Publique Hoˆpitaux de Paris, Ho ˆpital Europe ´en Georges Pompidou, Paris, France f Centre of Clinical Research, Assistance Publique Hoˆpitaux de Paris, Hoˆpital Europe ´en Georges Pompidou, Paris, France g Paris Descartes University, Paris, France h INSERM Unit 765, Paris, France 1. Case report Seven patients with metastatic renal cell carcinoma (mRCC) who had disease progression after treatment with sunitinib monotherapy were treated with salvage therapy of bevacizumab plus sunitinib beginning between June 2006 and May 2007 in an experimental setting at the Georges Pompidou European Hospital in Paris, France. Patients were offered combination therapy in place of best supportive care because no other treatments or entry into clinical trials were possible. Only patients with an absolute neutrophil count of >1500/mm 3 , a platelet count of >100 000/mm 3 ,a EUROPEAN UROLOGY 56 (2009) 207–211 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted January 2, 2009 Published online ahead of print on January 13, 2009 Keywords: Bevacizumab Renal cell carcinoma Salvage therapy Sunitinib Abstract We present a case series of seven patients with metastatic renal cell carcinoma treated with bevacizumab (10 mg/kg) in combination with sunitinib 25–50 mg as salvage therapy after disease progression under sunitinib monotherapy. Two patients had a partial response, four had stable disease, and one patient had disease progression. After a median follow-up of 17.2 mo, median progression- free survival and overall survival were 8.5 and 15.1 mo, respectively. Two patients experienced exacerbation of their preexisting hypertension; there were no grade 4 toxicities. The bevacizumab–sunitinib combination in sunitinib-refractory patients seems active and has a tolerable toxicity profile. Crown Copyright # 2009 Published by Elsevier B.V. on behalf of European Association of Urology. All rights reserved. * Corresponding author. Assistance Publique Ho ˆpitaux de Paris, Ho ˆpital Europe ´ en Georges Pompi- dou, De ´ partement d’oncologie me ´ dicale, 20 rue Leblanc, 75015 Paris, France. Tel. +33 1 56 09 27 81; Fax: +33 1 56 09 54 81. E-mail address: stephane.oudard@egp.aphp.fr (S. Oudard). 0302-2838/$ – see back matter . Crown Copyright # 2009 Published by Elsevier B.V. on behalf of European Association of Urology. All rights reserved. doi:10.1016/j.eururo.2009.01.001