Advanced age should not preclude sunitinib use for mRCC

By Sara Freeman, medwireNews Reporter

Elderly kidney cancer patients benefit from sunitinib therapy just as much as their younger counterparts, a retrospective analysis of six clinical trials shows.

Median progression-free survival (PFS) and overall survival (OS) achieved in those aged 70 years or older was comparable to that seen in younger patients.

“[A]dvanced age alone should not be a deterrent to treating with sunitinib,” say Thomas Hutson (Baylor Sammons Cancer Center-Texas Oncology, Dallas, USA) and colleagues. “[I]n fact, elderly patients may achieve additional clinical benefit with sunitinib,” the researchers report in the British Journal of Cancer.

Huston and colleagues pooled data on 1059 patients with metastatic renal cell carcinoma (mRCC) who had been treated with sunitinib, 202 (19%) of whom were aged 70 years or older.

Sunitinib was given as the first-line mRCC treatment in 783 patients and following resistance to cytokine treatment in 276 patients.

For the former group, the median PFS was 9.9 months among patients younger than 70 years and 11.0 months among those aged 70 years and older. Median OS was 23.6 months and 25.6 months, respectively. In both cases, the difference was not significant.

In the cytokine-refractory setting, median PFS was 8.1 months and 8.4 months in younger and older patients, respectively, and median OS was a corresponding 20.2 months and 15.8 months. Again, there was no significant difference between the two age groups.

The drug’s efficacy was maintained in elderly patients regardless of whether it had been given in the first-line or refractory treatment setting, the researchers note.

They also considered data on 360 patients who were treated with interferon (IFN)- α in the first-line setting in one of the trials. Median PFS and OS were greater for sunitinib than for INF-α in both age groups, although this only reached statistical significance for PFS.

“The incidences of most treatment emergent AEs [adverse events] were similar in both age groups,” Hutson and team observe.

Older patients were significantly less likely than the younger patients to develop hand–foot syndrome (24 vs 32%). They were significantly more likely, however, to experience fatigue (69 vs 60%), cough (29 vs 20%), peripheral oedema (27 vs 17%), anaemia (25 vs 18%), decreased appetite (29 vs 13%) and thrombocytopenia (25 vs 16%).

“[I]mportantly, the increased incidences of certain AEs in our analysis did not impact on overall efficacy in the elderly population, despite observed trends for increased dosing interruptions, reductions, and treatment discontinuations,” the researchers comment.

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