Experience with sunitinib treatment for metastatic renal cell carcinoma in a large cohort of Israeli patients: outcome and associated factors

The VEGFR/PDGFR inhibitor sunitinib was approved in Israel in 2008 for the treatment of metastatic renal cell carcinoma (mRCC), based on an international trial. However, the efficacy of sunitinib treatment in Israeli mRCC patients has not been previously reported. To report the outcome and associate...

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Bibliographic Details
Published in:The Israel Medical Association journal 2014-06, Vol.16 (6), p.347-351
Main Authors: Livne-Segev, Dana, Gottfried, Maya, Maimon, Natalie, Peer, Avivit, Neumann, Avivit, Hayat, Henry, Kovel, Svetlana, Sella, Avishay, Mermershtain, Wilmosh, Rouvinov, Keren, Boursi, Ben, Weitzen, Rony, Berger, Raanan, Keizman, Daniel
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - adverse effects
Antineoplastic Agents - therapeutic use
Carcinoma, Renal Cell - drug therapy
Carcinoma, Renal Cell - pathology
Cohort Studies
Disease-Free Survival
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Indoles - administration & dosage
Indoles - adverse effects
Indoles - therapeutic use
Israel
Kidney Neoplasms - drug therapy
Kidney Neoplasms - pathology
Male
Middle Aged
Multivariate Analysis
Neoplasm Metastasis
Pyrroles - administration & dosage
Pyrroles - adverse effects
Pyrroles - therapeutic use
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult
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Summary:The VEGFR/PDGFR inhibitor sunitinib was approved in Israel in 2008 for the treatment of metastatic renal cell carcinoma (mRCC), based on an international trial. However, the efficacy of sunitinib treatment in Israeli mRCC patients has not been previously reported. To report the outcome and associated factors of sunitinib treatment in a large cohort of Israeli mRCC patients. We conducted a retrospective study of an unselected cohort of mRCC patients who were treated with sunitinib during the period 2006-2013 in six Israeli hospitals. Univariate and multivariate analyses were performed to determine the association between treatment outcome and clinicopathologic factors. We identified 145 patients; the median age was 65 years, 63% were male, 80% had a nephrectomy, and 28% had prior systemic treatment. Seventy-nine percent (n = 115) had clinical benefit (complete response 5%, n = 7; partial response 33%, n = 48; stable disease 41%, n = 60); 21% (n = 30) were refractory to treatment. Median progression-free survival (PFS) was 12 months and median overall survival 21 months. Factors associated with clinical benefit were sunitinib-induced hypertension: [odds ratio (OR) 3.6, P = 0.042] and sunitinib dose reduction or treatment interruption (OR 2.4, P = 0.049). Factors associated with PFS were female gender [hazard ratio (HR) 2, P = 0.0041, pre-sunitinib treatment neutrophil-to-lymphocyte ratio < or = 3 (HR 2.19, P = 0.002), and active smoking (HR 0.19, P < 0.0001). Factors associated with overall survival were active smoking (HR 0.25, P < 0.0001) and sunitinib-induced hypertension (HR 0.48, P = 0.005). To minimize toxicity, the dose was reduced or the treatment interrupted in 39% (n = 57). The efficacy of sunitinib treatment for mRCC among Israeli patients is similar to that in international data.
ISSN:1565-1088