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Prognostic and Predictive Value of Hematologic Parameters in Patients with Metastatic Renal Cell Carcinoma: Second Line Sunitinib Treatment Following IFN-alpha

  • Dirican, Ahmet (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Kucukzeybek, Yuksel (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Erten, Cigdem (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Somali, Isil (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Demir, Lutfiye (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Can, Alper (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Payzin, Kadriye Bahriye (Department of Hematology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Bayoglu, Ibrahim Vedat (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Akyol, Murat (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Yildiz, Yasar (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Koseoglu, Mehmet (Department of Biochemistry, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Alacacioglu, Ahmet (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital) ;
  • Tarhan, Mustafa Oktay (Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital)
  • Published : 2013.03.30

Abstract

Background: Long-term survival is a problem with locally advanced and metastatic renal cell carcinomas. Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor, but data on sunitinib use as a second line treatment in metastatic renal cell carcinoma (mRCC) are limited. Prognostic and predictive value of peripheral blood markers has been shown for many cancers. Materials and Methods: Efficacy and safety profiles of sunitinib after interferon alpha (IFN-${\alpha}$) were evaluated based on retrospective data for 23 patients with mRCC. Hematological parameters (neutrophils, lymphocytes, platelets, mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio) were recorded at the time of metastasis. It was evaluated whether hematological parameters were prognostic and predictive factors. Results: Median progression-free survival (PFS) time was 16.5 months (95%CI: 0-34.5). Median overall survival (OS) time was 25.7 months (95%CI: 10.8-40.0). Most common side effects were neutropenia (52.2%), stomatitis (26.1%) and hand-food syndrome (26.1%). PFS was found 3.13 vs 17.1 months in patients with neutrophil / lymphocyte ratio (NLR)>3 vs $NLR{\leq}3$ (p:0.012). Median OS was 6.96 vs 27.1 months in patients with NLR>3 vs $NLR{\leq}3$ (p:0.001).While 75% of patients who responded to sunitinib had $NLR{\leq}3$, in 72% of patients with no response to sunitinib NLR>3 was detected (p:0.036). The association between the Memorial Sloan-Kettering Cancer Center (MSKCC) criteria and NLR was statistically significant (p:0.022). Conclusions: Data on second line sunitinib treatment following cytokine in mRCC are limited. In our study, we observed second line sunitinib treatment following IFN-${\alpha}$ to be effective and tolerable. NLRappeared to have prognostic and predictive value.

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