Response of renal lesions during systemic treatment with sunitinib in patients with metastatic renal cell carcinoma: a single center experience with 14 patients.
OBJECTIVE
The tyrosine kinase inhibitor (TKI) sunitinib induces partial remissions (PR) in a substantial proportion of patients with metastatic renal cell carcinoma (mRCC). Only little is known about the activity of sunitinib in renal lesions in patients with metastatic disease, as most patients with synchronous metastases receive palliative nephrectomy.


METHODS
Fourteen patients with clear cell mRCC with renal lesions and sunitinib therapy (50 mg OD, 4/2 scheme) were retrieved retrospectively from clinic records. Tumor assessment consisted of CT scans at least every two cycles, analyzed according to RECIST. In 5 of 14 patients, renal tumors were considered as the primary tumor, while the remaining patients had kidney metastases. In total, 65 target lesions were evaluated.


RESULTS
The median progression-free survival (PFS) of sunitinib was 8.7 months (range: 2.7-40.2). Median overall survival (OS) from initiation of TKI therapy was 26 months (range: 3-55). Best response according to RECIST consisted of partial remission (PR) in 4 patients, stable disease (SD) in 7 patients, a complete remission (CR) in 1 patient, and 2 patients with progressive disease (PD). Analyzing the response of renal lesions only, 1 patient had PD, 8 patients had SD, 4 patients had PR, and 1 had a CR. Palliative nephrectomy was performed after two courses of sunitinib in 2 patients.


CONCLUSIONS
In our cohort, similar responses of renal tumors and peripheral metastases were achieved with sunitinib treatment. Our results support the use of sunitinib to control renal tumor lesions in metastatic patients.
Department of Hematology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
C
C
Seidel
M
M
Fenner
A S
AS
Merseburger
C
C
Reuter
P
P
Ivanyi
F
F
Länger
A
A
Ganser
V
V
Grünwald
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010166:Palliative Care; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077210:Sunitinib; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D011505:Protein-Tyrosine Kinases; D000077210:Sunitinib
Eur J Cancer. 2009 Jan;45(2):228-47
19097774
BJU Int. 2010 Nov;106(9):1266-9
20346042
Lancet. 2007 Dec 22;370(9605):2103-11
18156031
Cancer. 1986 Sep 15;58(6):1231-5
3742449
N Engl J Med. 1996 Sep 19;335(12):865-75
8778606
Curr Med Chem. 2008;15(12):1166-74
18473811
J Clin Oncol. 2009 Sep 1;27(25):4076-81
19636008
Cancer. 2009 May 15;115(10 Suppl):2355-60
19402066
Oncologist. 2009 Jan;14(1):52-9
19147692
J Urol. 2009 Feb;181(2):518-23; discussion 523
19100579
J Clin Oncol. 2010 Feb 20;28(6):1061-8
20100962
J Natl Compr Canc Netw. 2009 Jun;7(6):645-56
19555586
N Engl J Med. 2007 Jan 11;356(2):115-24
17215529
Clin Cancer Res. 2008 Apr 15;14(8):2431-6
18413834
Lancet. 2001 Sep 22;358(9286):966-70
11583750
N Engl J Med. 2001 Dec 6;345(23):1655-9
11759643
Cancer Control. 2002 Jul-Aug;9(4):293-304
12228755