Abstract
Sunitinib is an oral multikinase inhibitor that blocks the vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR) alpha and beta, c-kit, and other receptors. These attributes have proven to be efficacious in the treatment of metastatic renal cell carcinoma (RCC) and unresectable gastrointestinal stromal tumors (GIST). Most side effects, including hypertension, hand–foot syndrome, and diarrhea are generally well manageable. Clinical trials are underway to determine the efficacy of sunitinib in other tumor types including metastatic breast, colorectal, and lung cancers. This chapter will detail the preclinical data leading to the results of the pivotal phase III clinical trials that have led to the widespread use of sunitinib in metastatic RCC and advanced GIST.
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References
Banks RE, Tirukonda P, Taylor C et al (2006) Genetic and epigenetic analysis of von hippel-lindau (VHL) gene alterations and relationship with clinical variables in sporadic renal cancer. Cancer Res 66:2000–2011
Biagi JJ, Oza AM, Grimshaw R et al (2008) A phase II study of sunitinib (SU11248) in patients (pts) with recurrent epithelial ovarian, fallopian tube or primary peritoneal carcinoma – NCIC CTG IND 185. J Clin Oncol 26:5522
Blanke CD, Rankin C, Demetri GD et al (2008) Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol 26:626–632
Brahmer JR, Govindan R, Novello S et al (2007) Efficacy and safety of continuous daily sunitinib dosing in previously treated advanced non-small cell lung cancer (NSCLC): results from a phase II study. J Clin Oncol 25:7542
Brauch H, Weirich G, Brieger J et al (2000) VHL alterations in human clear cell renal cell carcinoma: association with advanced tumor stage and a novel hot spot mutation. Cancer Res 60: 1942–1948
Bukowski RM, Kabbinavar FF, Figlin RA et al (2007) Randomized phase II study of erlotinib combined with bevacizumab compared with bevacizumab alone in metastatic renal cell cancer. J Clin Oncol 25:4536–4541
Burstein HJ, Elias AD, Rugo HS et al (2008) Phase II study of sunitinib malate, an oral multitargeted tyrosine kinase inhibitor, in patients with metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 26: 1810–1816
Coppin C, Le L, Porzsolt F, et al (2008) Targeted therapy for advanced renal cell carcinoma. Cochrane Database Syst Rev (2):CD006017
Coppin C, Porzsolt F, Awa A, et al (2005) Immunotherapy for advanced renal cell cancer. Cochrane Database Syst Rev (1):CD001425
Choueiri TK, Plantade A, Elson P et al (2008) Efficacy of sunitinib and sorafenib in metastatic papillary and chromophobe renal cell carcinoma. J Clin Oncol 26:127–131
Chow LQ, Eckhardt SG (2007) Sunitinib: from rational design to clinical efficacy. J Clin Oncol 25:884–896
Christensen JG (2007) A preclinical review of sunitinib, a multitargeted receptor tyrosine kinase inhibitor with anti-angiogenic and antitumour activities. Ann Oncol 18(Suppl 10):x3–x10
Clifford SC, Prowse AH, Affara NA et al (1998) Inactivation of the von hippel-lindau (VHL) tumour suppressor gene and allelic losses at chromosome arm 3p in primary renal cell carcinoma: evidence for a VHL-independent pathway in clear cell renal tumourigenesis. Genes Chromosomes Cancer 22:200–209
Cohen HT, McGovern FJ (2005) Renal-cell carcinoma. N Engl J Med 353:2477–2490
Cooney MM, Garcia J, Brell J et al (2007) A phase I study of bevacizumab in combination with sunitinib in advanced solid tumors. J Clin Oncol 25:15532
Corless CL, Fletcher JA, Heinrich MC (2004) Biology of gastrointestinal stromal tumors. J Clin Oncol 22:3813–3825
Dematteo RP, Gold JS, Saran L et al (2008) Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 112: 608–615
Demetri GD, van Oosterom AT, Garrett CR et al (2006) Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet 368:1329–1338
Demetri GD, von Mehren M, Blanke CD et al (2002) Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 347:472–480
Faivre S, Delbaldo C, Vera K et al (2006) Safety, pharmacokinetic, and antitumor activity of SU11248, a novel oral multitarget tyrosine kinase inhibitor, in patients with cancer. J Clin Oncol 24:25–35
Feldman DR, Kondagunta GV, Ronnen EA et al (2007) Phase I trial of bevacizumab plus sunitinib in patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 25:5099
Figlin RA, Hutson TE, Tomczak P et al (2008) Overall survival with sunitinib versus interferon (IFN)-alfa as first-line treatment of metastatic renal cell carcinoma (mRCC). J Clin Oncol 26: 5024
Foster K, Prowse A, van den Berg A et al (1994) Somatic mutations of the von hippel-lindau disease tumour suppressor gene in non-familial clear cell renal carcinoma. Hum Mol Genet 3: 2169–2173
George S, Blay JY, Casali PG et al (2008) Continuous daily dosing (CDD) of sunitinib (SU) in pts with advanced GIST: updated efficacy, safety, PK and pharmacodynamic analysis. J Clin Oncol 26: 10554
Gnarra JR, Tory K, Weng Y et al (1994) Mutations of the VHL tumour suppressor gene in renal carcinoma. Nat Genet 7:85–90
Goodman VL, Rock EP, Dagher R et al (2007) Approval summary: sunitinib for the treatment of imatinib refractory or intolerant gastrointestinal stromal tumors and advanced renal cell carcinoma. Clin Cancer Res 13:1367–1373
Gore ME, Porta C, Oudard S et al (2007) Sunitinib in metastatic renal cell carcinoma (mRCC): preliminary assessment of toxicity in an expanded access trial with subpopulation analysis. J Clin Oncol 25:5010
Heinrich MC, Corless CL, Demetri GD et al (2003) Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol 21:4342–4349
Heinrich MC, Maki RG, Corless CL et al (2008) Primary and secondary kinase genotypes correlate with the biological and clinical activity of sunitinib in imatinib-resistant gastrointestinal stromal tumor. J Clin Oncol 26:5352–5359
Heng DY, Bukowski RM (2007) Renal cell carcinoma: Evolving approaches to advanced non-clear cell carcinoma. Oncol Rev 1:170–176
Heng DY, Chi KN, Murray N et al (2009) A population-based study evaluating the impact of sunitinib on overall survival in the treatment of patients with metastatic renal cell cancer. Cancer 115:776–783
Houk BE, Bello CL, Michaelson MD et al (2007) Exposure-response of sunitinib in metastatic renal cell carcinoma (mRCC): a population pharmacokinetic/pharmacodynamic (PKPD) approach. J Clin Oncol 25:5027
Houk B, Garrett M, Bello C (2005) Population pharmacokinetics of SU011248 and its primary metabolite SU12662 in oncology patients and healthy volunteers. Presented at the EORTC/AACR/NCI Molecular Targets Meeting. Philadelphia, PA, November 14–18
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96
Kenck C, Wilhelm M, Bugert P et al (1996) Mutation of the VHL gene is associated exclusively with the development of non-papillary renal cell carcinomas. J Pathol 179:157–161
Kollmannsberger C, Heng DY, Murray N et al (2007a) A population-based study evaluating metastatic renal cell cancer (mRCC) patients treated with interferon (IFN) alone, first-line IFN then second-line sunitinib, or sunitinib alone. J Clin Oncol 25:15572
Kollmannsberger C, Soulieres D, Wong R et al (2007b) Sunitinib therapy for metastatic renal cell carcinoma: recommendations for management of side effects. Can Urol Assoc J 1:S41–S54
Kondo K, Yao M, Yoshida M et al (2002) Comprehensive mutational analysis of the VHL gene in sporadic renal cell carcinoma: relationship to clinicopathological parameters. Genes Chromosomes Cancer 34:58–68
Kovacs G, Akhtar M, Beckwith BJ et al (1997) The heidelberg classification of renal cell tumours. J Pathol 183:131–133
Laird AD, Vajkoczy P, Shawver LK et al (2000) SU6668 is a potent antiangiogenic and antitumor agent that induces regression of established tumors. Cancer Res 60:4152–4160
Maki RG, Fletcher JA, Heinrich MC et al (2005) Results from a continuation trial of SU11248 in patients (pts) with imatinib (IM)-resistant gastrointestinal stromal tumor (GIST). J Clin Oncol 23:9011
McDermott DF, Regan MM, Clark JI et al (2005) Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol 23:133–141
Mendel DB, Laird AD, Xin X et al (2003) In vivo antitumor activity of SU11248, a novel tyrosine kinase inhibitor targeting vascular endothelial growth factor and platelet-derived growth factor receptors: determination of a pharmacokinetic/pharmacodynamic relationship. Clin Cancer Res 9:327–337
Motzer RJ, Bacik J, Murphy BA et al (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20: 289–296
Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124
Motzer RJ, Michaelson MD, Redman BG et al (2006a) Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 24:16–24
Motzer RJ, Rini BI, Bukowski RM et al (2006b) Sunitinib in patients with metastatic renal cell carcinoma. JAMA 295:2516–2524
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: 1272–1278
Negrier S, Perol D, Ravaud A et al (2007) Medroxyprogesterone, interferon alfa-2a, interleukin 2, or combination of both cytokines in patients with metastatic renal carcinoma of intermediate prognosis: results of a randomized controlled trial. Cancer 110:2468–2477
Nowain A, Bhakta H, Pais S et al (2005) Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol 20:818–824
Rini BI, Choueiri TK, Elson P et al (2008) Sunitinib-induced macrocytosis in patients with metastatic renal cell carcinoma. Cancer 113: 1309–1314
Rini BI, Small EJ (2005) Biology and clinical development of vascular endothelial growth factor-targeted therapy in renal cell carcinoma. J Clin Oncol 23:1028–1043
Rini BI, Tamaskar I, Shaheen P et al (2007) Hypothyroidism in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst 99:81–83
Shuin T, Kondo K, Torigoe S et al (1994) Frequent somatic mutations and loss of heterozygosity of the von hippel-lindau tumor suppressor gene in primary human renal cell carcinomas. Cancer Res 54:2852–2855
Sun L, Liang C, Shirazian S et al (2003) Discovery of 5-[5-fluoro-2-oxo-1, 2- dihydroindol-(3Z)-ylidenemethyl]-2, 4- dimethyl-1H-pyrrole-3-carboxylic acid (2-diethylaminoethyl)amide, a novel tyrosine kinase inhibitor targeting vascular endothelial and platelet-derived growth factor receptor tyrosine kinase. J Med Chem 46: 1116–1119
Van Glabbeke M, Verweij J, Casali PG et al (2005) Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study. J Clin Oncol 23:5795–5804
Verweij J, Casali PG, Zalcberg J et al (2004) Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 364:1127–1134
Weisberg E, Griffin JD (2003) Resistance to imatinib (glivec): update on clinical mechanisms. Drug Resist Updat 6:231–238
Witteles RM, Telli ML, Fisher GA et al (2008) Cardiotoxicity associated with the cancer therapeutic agent sunitinib malate. J Clin Oncol 26: 9597
Wolter P, Stefan C, Decallonne B et al (2008) The clinical implications of sunitinib-induced hypothyroidism: a prospective evaluation. Br J Cancer 99:448–454
Wong E, Rosen LS, Mulay M et al (2007) Sunitinib induces hypothyroidism in advanced cancer patients and may inhibit thyroid peroxidase activity. Thyroid 17:351–355
Yang JC, Sherry RM, Steinberg SM et al (2003) Randomized study of high-dose and low-dose interleukin-2 in patients with metastatic renal cancer. J Clin Oncol 21:3127–3132
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Heng, D.Y.C., Kollmannsberger, C. (2010). Sunitinib. In: Martens, U. (eds) Small Molecules in Oncology. Recent Results in Cancer Research, vol 184. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01222-8_6
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