HRQoL benefit of alternative sunitinib dosing schedule in RCC patients

By Shreeya Nanda, Senior medwireNews Reporter

Patients with metastatic renal cell carcinoma (RCC) reported a marked improvement in their health-related quality of life (HRQoL) when given sunitinib on a 2 weeks on and 1 week off schedule compared with a 4 weeks on and 2 weeks off regimen, a Japanese study finds.

The researchers from Kobe University Graduate School of Medicine attribute the HRQoL benefits of schedule 2/1 to relief from sunitinib-related adverse events, in particular fatigue.

They report their findings from a review of the medical records of 45 patients who were switched from the standard 4/2 schedule to the alternative 2/1 schedule as a result of dose-limiting toxicities in Medical Oncology.

After median treatment intervals of 3.4 and 8.9 months on the 4/2 and 2/1 schedules, respectively, there was no significant difference in the relative dose intensities of sunitinib between the regimens.

The overall incidence of adverse events was comparable between the two schedules, but the incidence of grade 3 or more toxicities was significantly lower on schedule 2/1 than on the 4/2 regimen, at 48.9% versus 80.0%.

Moreover, diarrhoea, hand–foot syndrome, hypertension and fatigue of any grade, as well as thrombocytopenia of grade 3 or higher, occurred significantly less frequently when patients were on the 2/1 compared with the 4/2 schedule.

Using the Japanese version of the 36-Item Short Form survey, Hideaki Miyake and co-investigators noted improvements for all eight domains during the 2/1 versus the 4/2 schedule, with significant benefits in the general health perception and mental health items.

And multivariate analysis showed that only fatigue independently and significantly affected the general health perception and social function scales.

“Although further examinations in a prospective randomized setting are required to draw a definitive conclusion on the utility of schedule 2/1, this alternative dosing schedule may become a future standard regime of sunitinib for [metastatic renal cell carcinoma] patients”, the team concludes.

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