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Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Dose escalation can maximize therapeutic potential of sunitinib in patients with metastatic renal cell carcinoma

Authors: Anikó Maráz, Adrienn Cserháti, Gabriella Uhercsák, Éva Szilágyi, Zoltán Varga, János Révész, Renáta Kószó, Linda Varga, Zsuzsanna Kahán

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

In patients with metastatic renal cell cancer, based on limited evidence, increased sunitinib exposure is associated with better outcome. The survival and toxicity data of patients receiving individualized dose escalated sunitinib therapy as compared to standard management were analyzed in this study.

Methods

From July 2013, the data of metastatic renal cell cancer patients with slight progression but still a stable disease according to RECIST 1.1 criteria treated with an escalated dose of sunitinib (first level: 62.5 mg/day in 4/2 or 2 × 2/1 scheme, second level: 75 mg/day in 4/2 or 2 × 2/1 scheme) were collected prospectively. Regarding characteristics, outcome, and toxicity data, an explorative retrospective analysis of the register was carried out, comparing treatments after and before July 1, 2013 in the study (selected patients for escalated dose) and control (standard dose) groups, respectively.

Results

The study involved 103 patients receiving sunitinib therapy with a median overall and progression free survival of 25.36 ± 2.62 and 14.2 ± 3.22 months, respectively. Slight progression was detected in 48.5% of them. First and second-level dose escalation were indicated in 18.2% and 4.1% of patients, respectively. The dosing scheme was modified in 22.2%. The median progression free survival (39.7 ± 5.1 vs 14.2 ± 1.3 months (p = 0.037)) and the overall survival (57.5 ± 10.7 vs 27.9 ± 2.5 months (p = 0.044)) were significantly better in the study group (with dose escalation) than in the control group. Patients with nephrectomy and lower Memorial Sloan Kettering Cancer Center (MSKCC) scores showed more favorable outcomes. After dose escalation, the most common adverse events were worsening or development of fatigue, hypertension, stomatitis, and weight loss of over 10%.

Conclusions

Escalation of sunitinib dosing in selected patients with metastatic renal cell cancer, especially in case of slight progression, based on tolerable toxicity is safe and improves outcome. Dose escalation in 12.5 mg steps may be recommended for properly educated patients.
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Metadata
Title
Dose escalation can maximize therapeutic potential of sunitinib in patients with metastatic renal cell carcinoma
Authors
Anikó Maráz
Adrienn Cserháti
Gabriella Uhercsák
Éva Szilágyi
Zoltán Varga
János Révész
Renáta Kószó
Linda Varga
Zsuzsanna Kahán
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4209-9

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