Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer.
OBJECTIVE
Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated.


METHODS
We reviewed the clinical records of 181 patients with mRCC aged ≥70 years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL.


RESULTS
Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P < 0.0001 and P = 0.023, respectively).


CONCLUSIONS
Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.
IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy. Electronic address: u.degiorgi@irst.emr.it.
Ugo
U
De Giorgi
Santa Maria della Misericordia Hospital, Udine, Italy.
Karim
K
Rihawi
CROB, Rionero in Vulture, Italy.
Michele
M
Aieta
Santa Maria degli Angeli Hospital, Pordenone, Italy.
Giovanni
G
Lo Re
Borgo Trento Hospital, Verona, Italy.
Teodoro
T
Sava
University Hospital, Modena, Italy.
Cristina
C
Masini
Oncologia 2 - AOU Careggi, Florence, Italy.
Valentina
V
Baldazzi
Humanitas Hospital, Milan, Italy.
Fabio
F
De Vincenzo
Versilia Hospital, Lido di Camaiore, Italy.
Andrea
A
Camerini
IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
Giuseppe
G
Fornarini
University Hospital, Ancona, Italy.
Luciano
L
Burattini
Ca' Foncello Hospital, Treviso, Italy.
Giovanni
G
Rosti
Belcolle Hospital, Viterbo, Italy.
Luca
L
Moscetti
Fazzi Hospital, Lecce, Italy.
Vincenzo E
VE
Chiuri
San Salvatore Hospital, Pesaro, Italy.
Stefano
S
Luzi Fedeli
Spedali Civili, Brescia, Italy.
Vittorio
V
Ferrari
IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy.
Emanuela
E
Scarpi
IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy.
Dino
D
Amadori
Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy.
Umberto
U
Basso
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D003967:Diarrhea / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D008231:Lymphopenia / Q000139:chemically induced*; D008297:Male; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced*; D011379:Prognosis; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D000077210:Sunitinib; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
Elderly; Lymphopenia; Metastatic renal cell cancer; Prognosis; Sunitinib