title: Feasibility of sequential use of sunitinib and temsirolimus in advanced renal cell carcinoma.
abstract: Targeted agents sunitinib and temsirolimus are effective in advanced renal cell carcinoma. Treatment algorithms for single-agent use have been proposed in order to optimize timing and type of therapy. The aim of this study was to investigate the tolerability and adverse event profile of patients who received sunitinib and temsirolimus in sequence. We performed a retrospective analysis of patients with advanced renal cell carcinoma who received temsirolimus after disease progression under sunitinib therapy. Dosages of both drugs were in accordance with the recommendations given by the respective manufacturers. Temsirolimus was provided before its official approval within a compassionate use program. Adverse event assessment followed the National Cancer Institute Common Toxicity Criteria. Thirteen patients receiving temsirolimus after progression under sunitinib were identified. Overall treatment time with targeted drugs (sunitinib/temsirolimus) was 34.8 (17-78) weeks, treatment with sunitinib was 28.6 (12-72), and with temsirolimus 6.2 (2-16) weeks, respectively, whereas mean therapy interruption time between both approaches was 4.4 (2-12) weeks. Under sunitinib, we observed 52 transient adverse events, 49 (94.2%) were of grade I/II, whereas 3 (5.8%) were of grade III. Under temsirolimus 36 adverse events, only grade I/II in nature were remarked. Sequential use of temsirolimus after progression under sunitinib seems to be feasible and results in a predictable, medically manageable side effect profile. Further evaluation is necessary to define the oncological validity of this sequencing approach.
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany. holger.gerullis@gmx.net
authors.forename: Holger
authors.initials: H
authors.lastname: Gerullis
authors.forename: Lothar
authors.initials: L
authors.lastname: Bergmann
authors.forename: Luise
authors.initials: L
authors.lastname: Maute
authors.forename: Thorsten Holger
authors.initials: TH
authors.lastname: Ecke
authors.forename: Christoph
authors.initials: C
authors.lastname: Eimer
authors.forename: Jens Willem
authors.initials: JW
authors.lastname: Bagner
authors.forename: Thomas
authors.initials: T
authors.lastname: Otto
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D057176:Compassionate Use Trials; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000008:administration & dosage*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077210:Sunitinib
chemical_list: D007211:Indoles; D011758:Pyrroles; C401859:temsirolimus; D000077210:Sunitinib; D020123:Sirolimus