Patient Types

TORISEL is a mammalian target of rapamycin (mTOR) inhibitor indicated for the treatment of advanced renal cell carcinoma (RCC)¹

TORISEL was specifically studied as a first-line treatment of advanced RCC in patients with multiple prognostic risk factors.¹

Patients with advanced RCC were eligible for the Global Advanced Renal Cell Carcinoma (ARCC) Study, a phase 3 pivotal trial, if they presented with 3 or more of the following preselected prognostic risk factors:

• Karnofsky performance status of 60 or 70
• > 1 metastatic organ site of disease
• Hemoglobin less than the lower limit of normal
• < 1 year from time of initial RCC diagnosis to randomization
• Corrected calcium > 10 mg/dL
• Lactate dehydrogenase > 1.5 times the upper limit of normal

Most patients (94%) had ≥ 3 of 6 prognostic risk factors at randomization.²

Median overall survival with TORISEL for patients with multiple risk factors was 10.9 months (95% CI, 8.6, 12.7), compared with 7.3 months (6.1, 8.8) with interferon-alpha (P=0.0078) (Hazard Ratio [95% CI]=0.73 [0.58, 0.92]).¹ Read more about TORISEL Efficacy.

The median duration of treatment in the TORISEL arm was 17 weeks (range 1-126 weeks)
The median duration of treatment in the IFN-α arm was 8 weeks (range 1-124 weeks)

TORISEL was studied in previously untreated patients with advanced RCC who had clear-cell or non-clear-cell tumor histologies¹

Overall survival results were achieved with TORISEL in patients regardless of clear-cell or non-clear-cell tumor histology.³

The different types of RCC histologies and their prevalence in RCC patients⁴:

Used with permission from Linehan WM, Walther MM, Zbar B. The genetic basis of cancer of the kidney. J Urol. 2003;170:2163-2172.

For more information on prognostic risk factors, read the Journal of Clinical Oncology article, Validation and Extension of the Memorial Sloan-Kettering Prognostic Factors Model for Survival in Patients With Previously Untreated Metastatic Renal Cell Carcinoma.

For more information on appropriate candidates for different types of kidney cancer treatment, visit the National Comprehensive Cancer Network (NCCN) Web site and click on "NCCN Clinical Practice Guidelines in Oncology™."

Important Safety Information

Important Safety Information

• TORISEL is contraindicated in patients with bilirubin >1.5 x ULN and should be used with caution when treating patients with mild hepatic impairment (bilirubin >1 – 1.5 x ULN or AST > ULN but bilirubin ≤ ULN). If TORISEL must be given to patients with mild hepatic impairment, reduce the dose of TORISEL to 15 mg/week. In a phase 1 study, the overall frequency of ≥ grade 3 adverse reactions and deaths, including deaths due to progressive disease, was greater in patients with baseline bilirubin > 1.5 x ULN.
• Hypersensitivity reactions manifested by symptoms, including, but not limited to anaphylaxis, dyspnea, flushing, and chest pain have been observed with TORISEL.
• Serum glucose, serum cholesterol, and triglycerides should be tested before and during treatment with TORISEL.
  • The use of TORISEL is likely to result in hyperglycemia and hyperlipemia. This may result in the need for an increase in the dose of, or initiation of, insulin and/or oral hypoglycemic agent therapy and/or lipid-lowering agents, respectively.
• The use of TORISEL may result in immunosuppression. Patients should be carefully observed for the occurrence of infections, including opportunistic infections.
• Cases of interstitial lung disease, some resulting in death, have occurred. Some patients were asymptomatic and others presented with symptoms. Some patients required discontinuation of TORISEL and/or treatment with corticosteroids and/or antibiotics.
• Cases of fatal bowel perforation occurred with TORISEL. These patients presented with fever, abdominal pain, metabolic acidosis, bloody stools, diarrhea, and/or acute abdomen.
• Cases of rapidly progressive and sometimes fatal acute renal failure not clearly related to disease progression occurred in patients who received TORISEL.
• Due to abnormal wound healing, use TORISEL with caution in the perioperative period.
• Patients with central nervous system tumors (primary CNS tumor or metastases) and/or receiving anticoagulation therapy may be at an increased risk of developing intracerebral bleeding (including fatal outcomes) while receiving TORISEL.
• Live vaccinations and close contact with those who received live vaccines should be avoided.
• Patients and their partners should be advised to avoid pregnancy throughout treatment and for 3 months after TORISEL therapy has stopped.
• The most common (incidence ≥30%) adverse reactions observed with TORISEL are: rash (47%), asthenia (51%), mucositis (41%), nausea (37%), edema (35%), and anorexia (32%). The most common laboratory abnormalities (incidence ≥30%) are anemia (94%), hyperglycemia (89%), hyperlipemia (87%), hypertriglyceridemia (83%), elevated alkaline phosphatase (68%), elevated serum creatinine (57%), lymphopenia (53%), hypophosphatemia (49%), thrombocytopenia (40%), elevated AST (38%), and leukopenia (32%).
• Most common grades 3/4 adverse events and laboratory abnormalities included asthenia (11%), dyspnea (9%), hemoglobin decreased (20%), lymphocytes decreased (16%), glucose increased (16%), phosphorus decreased (18%), and triglycerides increased (44%).
• Strong inducers of CYP3A4/5 (eg, dexamethasone, rifampin) and strong inhibitors of CYP3A4 (eg, ketoconazole, atazanavir) may decrease and increase concentrations of the major metabolite of TORISEL, respectively. If alternatives cannot be used, dose modifications of TORISEL are recommended.
• St. John’s Wort may decrease TORISEL plasma concentrations, and grapefruit juice may increase plasma concentrations of the major metabolite of TORISEL, and therefore both should be avoided.
• The combination of TORISEL and sunitinib resulted in dose-limiting toxicity (Grade 3/4 erythematous maculopapular rash, and gout/cellulitis requiring hospitalization).

Please see the full Prescribing Information for TORISEL.

TRS00099