Sorafenib and sunitinib for elderly patients with renal cell carcinoma.
BACKGROUND
Sunitinib and sorafenib are small-molecule tyrosine kinase inhibitors with known antitumor activity in advanced renal cell carcinoma.


METHODS
We retrospectively assess the response and tolerance of elderly patients with renal cell carcinoma to these two agents. Data of patients aged ≥70years receiving sorafenib or sunitinib at the Centre Léon Bérard were analyzed. Forty-eight patients received sorafenib or sunitinib as a first line treatment, 8 received sorafenib followed by sunitinib and 4 received the reverse sequence. Objective responses (ORs), stable disease (SD), toxicity, overall survival (OS) and progression-free survival (PFS) were reported.


RESULTS
Sorafenib and sunitinib achieved similar OR+SD rates (79% vs. 71% respectively). Median PFS was 6months in first-line sorafenib treated patients and 5months in the sunitinib group. Median OS was 16months in first-line sorafenib-treated patients and 15months in the sunitinib group. In patients receiving sorafenib followed by sunitinib, median PFS was 11.5months, and median OS was 13.1months. With the reverse sequence, median PFS was 8.1months and median OS was 15months. Treatment modifications were more frequent in sunitinib-treated patients, in first or second line (75% vs. 50%). Limitations are the retrospective design of the study and the small number of patients.


CONCLUSIONS
First-line sunitinib and sorafenib seem equally efficient in elderly patients treated for advanced renal carcinomas, but sunitinib is less well tolerated. Sequential treatment with sorafenib followed by sunitinib seems to be better tolerated. These results should be confirmed in a larger prospective study.
Department of Medical Oncology, Centre Léon-Bérard, Lyon, France. Electronic address: olfa.derbel@lyon.unicancer.fr.
Olfa
O
Derbel Miled
Christine
C
Dionne
Catherine
C
Terret
Céline
C
Segura-Ferlay
Aude
A
Flechon
Eve-Marie
EM
Neidhart
Sylvie
S
Negrier
Jean-Pierre
JP
Droz
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001247:Asthenia / Q000139:chemically induced; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D009503:Neutropenia / Q000139:chemically induced; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D000077210:Sunitinib; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007211:Indoles; D010671:Phenylurea Compounds; D011758:Pyrroles; D009536:Niacinamide; D000077157:Sorafenib; D000077210:Sunitinib