Alternative sunitinib treatment schedules for mRCC may be worth the switch

By Afsaneh Gray, medwireNews Reporter

Some patients with metastatic renal cell carcinoma (mRCC) who are switched from a traditional sunitinib treatment schedule to an alternative schedule fare better on survival measures and suffer fewer adverse events, a Japanese study has found.

The switch from traditional to alternative schedules was recently found to be effective. But, “Japanese patients with mRCC experience substantially different [adverse events] than do patients in many other nations, presumably because of underlying genetic differences”, the authors write.

They retrospectively reviewed the medical records of 54 patients with mRCC who received sunitinib treatment as first-line therapy between May 2006 and June 2012.

Thirty-two patients received a traditional 4 weeks on, 2 weeks off (4/2) schedule of treatment, while 22 received an alternative schedule. The alternative schedule group included 17 patients who began therapy on the 4/2 schedule but changed because of adverse events soon after treatment initiation.

At the time of sunitinib administration, five patients were considered to have a favourable prognosis, as rated on the Memorial Sloan-Kettering Cancer Center risk classification, while 42 had intermediate prognoses and seven had poor prognoses.

The mean observation periods differed between the traditional and alternative schedule groups, with those on an alternative schedule having, on average, 20 months of follow-up compared with 16.3 months.

Survival measures were significantly improved in patients on alternative schedules, compared with those on traditional schedules, and adverse events were significantly less common, including many of the most serious treatment effects.

Median time to treatment failure was 11.6 months on the alternative schedule compared with 4.1 months on the traditional schedule, while median progression-free survival was 11.3 months versus 4.1 months and median overall survival was 32.1 months versus 12.0 months.

“Each of these measures was better in the group of patients who received an alternative treatment schedule, suggesting that individualized changes to the sunitinib administration schedule can be effective”, study researcher Takeshi Ueda (Chiba Cancer Center) and colleagues write in the International Journal of Urology.

They note that sunitinib has previously been shown to provide strong therapeutic effects in patients who initially experience adverse events, which may partly explain the better survival in the alternative schedule group.

“We believe that the switch to [alternative schedule] reduced [adverse events] and extended treatment periods, which could provide further benefits”, the researchers explain.

But they caution: “These results must be interpreted with care, and larger prospective studies should be carried out at other institutions to validate these findings.”

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