DOI QR코드

DOI QR Code

Utilization of Sunitinib for Renal Cell Cancer: an Egyptian University hospital experience

  • Ezz El Din, M (Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University)
  • Published : 2016.07.01

Abstract

Background: Metastatic renal cell carcinoma (mRCC) status as poor prognosis improved with the introduction of tyrosine-kinase inhibitors, especially sunitinib. There is sparse data reporting from our region on use of sunitinib in metastatic RCC. Thus the present study explores sunitinib usage at our institute. Materials and Methods: An unselected population of patients with metastatic RCC receiving sunitinib was analyzed with respect to patient characteristics, response, toxicity, and outcomes. Results: Fourty-nine patients with a median age of 50.5 years (range 21-71 years) were included. Most were male (61.2%). Twenty‑one (42.9%) had metastatic disease at presentation. Sunitinib was first line therapy in 45. Conventional clear cell carcinoma was the most common pathology present (39 patients; 79.59 %). The most common site of metastasis was the lung (75.5%). Most patients (30) were started at a dose of 50 mg once a day for 4 weeks and then 2 weeks rest. Clinical benefit rate was 73.5% (n= 36), and 22.5% (n= 11) demonstrated progressive disease at first imaging evaluation within the first 3-6 months. The following objective response performed for patients was 48.9% (n=24) and progression at 24.5 % (n=12). The median follow‑up was 16 months (range, 4-34 months), the overall estimated median PFS was 9 months and the estimated median OS was 15 months. Conclusions: This study demonstrated sunitinib is tolerable and effective in advanced/metastatic RCC Egyptian patients and indicates we should further seek second and third lines to increase survival equivalence as reported in the worldwide literature.

Keywords

Metastatic;renal cell cancer;sunitinib;ethnic variation;tyrosine kinase inhibitors

References

  1. Beuselinck B, Vano YA, Oudard S, et al (2014). Prognostic impact of baseline serum C-reactive protein in patients with metastatic renal cell carcinoma (RCC) treated with sunitinib. BJU Int, 114, 81-9. https://doi.org/10.1111/bju.12494
  2. Dai J, Tang K, Xiao W, et al (2014). Prognostic significance of C-reactive protein in urological cancers: a systematic review and meta-analysis. Asian Pac J Cancer Prev, 15, 3369-75. https://doi.org/10.7314/APJCP.2014.15.8.3369
  3. Edesa WA, Abdelmalek RR (2015). Efficacy and toxicity of sunitinib in egyptian patients with metastatic renal cell carcinoma. Asian Pac J Cancer Prev, 16, 1971-76. https://doi.org/10.7314/APJCP.2015.16.5.1971
  4. Fujita T, Iwamura M, Ishii D, et al (2012). C-reactive protein as a prognostic marker for advanced renal cell carcinoma treated with sunitinib. Int J Urol, 19, 908-13. https://doi.org/10.1111/j.1442-2042.2012.03071.x
  5. Gore ME, Szczylik C, Porta C, et al (2009). Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: An expanded-access trial. Lancet Oncol, 10, 757-63. https://doi.org/10.1016/S1470-2045(09)70162-7
  6. Gore ME, Hariharan S, Porta C, et al (2011), Sunitinib in metastatic renal cell carcinoma patients with brain metastases. Cancer, 117, 501-9. https://doi.org/10.1002/cncr.25452
  7. Kawai Y, Osawa T, Kobayashi K, et al (2015). Factors prognostic for survival in Japanese patients treated with sunitinib as first-line therapy for metastatic clear cell renal cell cancer. Asian Pac J Cancer Prev, 16, 5687-90. https://doi.org/10.7314/APJCP.2015.16.14.5687
  8. Kim HS, Hong MH, Kim K, et al (2011). Sunitinib for Asian patients with advanced renal cell carcinoma: A comparable efficacy with different toxicity profiles. Oncol, 80, 395-405. https://doi.org/10.1159/000330361
  9. Krishna VM, Noronha V, Prabhash K, et al (2013). Sunitinib in metastatic renal cell carcinoma: A single center experience. Indian J Cancer, 50, 268-73. https://doi.org/10.4103/0019-509X.118725
  10. Miyake H, Harada K, Miyazaki A, Fujisawa M (2015). Improved health-related quality of life of patients with metastatic renal cell carcinoma treated with a 2 weeks on and 1 week off schedule of sunitinib. Med Oncol, 32, 78. https://doi.org/10.1007/s12032-015-0528-8
  11. Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999). Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol, 17, 2530-40. https://doi.org/10.1200/JCO.1999.17.8.2530
  12. Motzer RJ, Bukowski RM (2006). Targeted therapy for metastatic renal cell carcinoma. J Clin Oncol, 24, 5601-08. https://doi.org/10.1200/JCO.2006.08.5415
  13. Motzer RJ, Hutson TE, Tomczak P, et al (2007). Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med, 356, 115-24. https://doi.org/10.1056/NEJMoa065044
  14. Motzer RJ, Hutson TE, Tomczak P, et al (2009). Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol, 27, 3584-90. https://doi.org/10.1200/JCO.2008.20.1293
  15. Najjar YG, Mittal K, Elson P, et al (2014). A 2 weeks on and 1 week off schedule of sunitinib is associated with decreased toxicity in metastatic renal cell carcinoma. Eur J Cancer, 50, 1084-9. https://doi.org/10.1016/j.ejca.2014.01.025
  16. Negrier S, Escudier B, Lasset C, et al (1998). Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d'Immunotherapie. N Engl J Med, 338, 1272-78. https://doi.org/10.1056/NEJM199804303381805
  17. Pantuck AJ, Zeng G, Belldegrun AS, Figlin RA (2003). Pathobiology, prognosis, and targeted therapy for renal cell carcinoma: exploiting the hypoxia-induced pathway. Clin Cancer Res, 9, 4641-52.
  18. Pantuck AJ, Seligson DB, Klatte T, et al (2007). Prognostic relevance of the mTOR pathway in renal cell carcinoma: implications for molecular patient selection for targeted therapy. Cancer, 109, 2257-67. https://doi.org/10.1002/cncr.22677
  19. Powles T, Chowdhury S, Jones R, et al (2011). Sunitinib and other targeted therapies for renal cell carcinoma. Brit J Cancer, 104, 741-45. https://doi.org/10.1038/sj.bjc.6606061
  20. Schnadig IA, Hutson TE, Chung H, et al (2014). Dosing patterns, toxicity, and outcomes in patients treated with first-line sunitinib for advanced renal cell carcinoma in communitybased practices. Clinical Genitourinary Cancer, 12, 413-21. https://doi.org/10.1016/j.clgc.2014.06.015
  21. Siegel R, Ma J, Zou Z, Jemal A (2014). Cancer statistics. CA Cancer J Clin, 64, 9-29. https://doi.org/10.3322/caac.21208
  22. Wagstaff J, Jones R, Hawkins R, et al (2016). Treatment patterns and clinical outcomes in patients with renal cell carcinoma in the UK: insights from the RECCORD registry. Ann Oncol, 27, 159-65. https://doi.org/10.1093/annonc/mdv504