title: Prognostic and predictive value of hematologic parameters in patients with metastatic renal cell carcinoma: second line sunitinib treatment following IFN-alpha.
abstract: BACKGROUND
  Long-term survival is a problem with locally advanced and metastatic renal cell carcinomas. Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor, but data on sunitinib use as a second line treatment in metastatic renal cell carcinoma (mRCC) are limited. Prognostic and predictive value of peripheral blood markers has been shown for many cancers.
  
  
  METHODS
  Efficacy and safety profiles of sunitinib after interferon alpha were evaluated based on retrospective data for 23 patients with mRCC. Hematological parameters (neutrophils, lymphocytes, platelets, mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio) were recorded at the time of metastasis. It was evaluated whether hematological parameters were prognostic and predictive factors.
  
  
  RESULTS
  Median progression-free survival (PFS) time was 16.5 months (95%CI: 0-34.5). Median overall survival (OS) time was 25.7 months (95%CI: 10.8-40.0). Most common side effects were neutropenia (52.2%), stomatitis (26.1%) and hand-food syndrome (26.1%). PFS was found 3.13 vs 17.1 months in patients with neutrophil / lymphocyte ratio (NLR)>3 vs NLR≤3 (p:0.012). Median OS was 6.96 vs 27.1 months in patients with NLR>3 vs NLR≤3 (p:0.001).While 75% of patients who responded to sunitinib had NLR≤3, in 72% of patients with no response to sunitinib NLR>3 was detected (p:0.036). The association between the Memorial Sloan-Kettering Cancer Center (MSKCC) criteria and NLR was statistically significant (p:0.022).
  
  
  CONCLUSIONS
  Data on second line sunitinib treatment following cytokine in mRCC are limited. In our study, we observed second line sunitinib treatment following IFN-alpha to be effective and tolerable. NLR appeared to have prognostic and predictive value.
authors.affiliation: Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Tarhan, Turkey. ahmetdirican@yahoo.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dirican
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Kucukzeybek
authors.forename: Cigdem
authors.initials: C
authors.lastname: Erten
authors.forename: Isil
authors.initials: I
authors.lastname: Somali
authors.forename: Lutfiye
authors.initials: L
authors.lastname: Demir
authors.forename: Alper
authors.initials: A
authors.lastname: Can
authors.forename: Kadriye Bahriye
authors.initials: KB
authors.lastname: Payzin
authors.forename: Ibrahim Vedat
authors.initials: IV
authors.lastname: Bayoglu
authors.forename: Murat
authors.initials: M
authors.lastname: Akyol
authors.forename: Yasar
authors.initials: Y
authors.lastname: Yildiz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Koeseoglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alacacioglu
authors.forename: Mustafa Oktay
authors.initials: MO
authors.lastname: Tarhan
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D016898:Interferon-alpha / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077210:Sunitinib; D015996:Survival Rate
chemical_list: D020533:Angiogenesis Inhibitors; D000998:Antiviral Agents; D014408:Biomarkers, Tumor; D007211:Indoles; D016898:Interferon-alpha; D011758:Pyrroles; D000077210:Sunitinib