title: Hypertension as a predictive factor for survival outcomes in patients with metastatic renal cell carcinoma treated with sunitinib after progression on cytokines.
abstract: OBJECTIVE
  This retrospective analysis compared progression-free survival (PFS) in 111 patients who developed or had preexisting hypertension with those who did not during treatment with second-line sunitinib. Secondary objectives included overall survival (OS) and safety.
  
  
  METHODS
  Patients with metastatic renal cell carcinoma (mRCC) received sunitinib 50 mg orally once daily in 6-week cycles according to a 4-week on/2-week off treatment schedule. Treatment was continued until disease progression, unacceptable toxicity, withdrawal of consent, or death. Resting blood pressure (BP) was monitored by clinic and home measurements. Hypertension was defined as systolic BP ≥140 and/or diastolic BP ≥90 mm Hg. Subsequent antihypertensive treatment was empirical, depending on the patient.
  
  
  RESULTS
  Fifty-four (48.6%) patients experienced elevated BP related to sunitinib. Of these, 10 had preexisting hypertension. Patients who developed hypertension related to sunitinib treatment experienced significantly longer PFS and OS compared to those who did not (p < 0.00001). Patients who required at least 3 antihypertensive drugs had the longest PFS (p = 0.00002) and OS (p = 0.00001).
  
  
  CONCLUSIONS
  The development of hypertension during sunitinib treatment was a positive predictive factor associated with a significantly longer PFS and OS in patients with mRCC.
authors.affiliation: Department of Oncology, Military Institute of Medicine, Warsaw, Poland. s.szmit@gmail.com
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szmit
authors.forename: Przemysław
authors.initials: P
authors.lastname: Langiewicz
authors.forename: Jakub
authors.initials: J
authors.lastname: Złnierek
authors.forename: Paweł
authors.initials: P
authors.lastname: Nurzyński
authors.forename: Magdalena
authors.initials: M
authors.lastname: Zaborowska
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.forename: Cezary
authors.initials: C
authors.lastname: Szczylik
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D015331:Cohort Studies; D016207:Cytokines; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality*; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016207:Cytokines; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib