title: Macrocytosis during sunitinib treatment predicts progression-free survival in patients with metastatic renal cell carcinoma.
abstract: Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, is a first-line treatment for metastatic renal cell carcinoma (mRCC) in patients in 'low' and 'intermediate' Memorial Sloan Kettering Cancer Center and Heng risk groups. Disruptions of hematopoiesis, such as anemia, neutropenia, and thrombocytopenia, are typically observed during sunitinib treatment. When it comes to RBC parameters, an increase in mean cell volume (MCV) tends to occur, meeting the criteria for macrocytosis in some patients (MCV > 100 fL). We examined changes in RBC parameters of 27 mRCC patients treated with sunitinib (initial dose of 50 mg/day, 6-week treatment: 4 weeks on, 2 weeks off) and correlated them with progression-free survival time (PFS). Patients who had macrocytosis after 3 treatment cycles had significantly longer PFS than those whose MCV stayed less than 100 fL (not reached vs. 11.2 months, p < 0.001). We also found a correlation between MCV values after the first and third treatment cycles and the risk of progression: HR of 0.9 (0.81-0.99) and 0.76 (0.65-0.90) per 1 fL increase in MCV, respectively. The mechanism of MCV elevation during sunitinib treatment has not yet been fully explained. One of the probable causes is sunitinib's inhibitory influence on c-Kit kinase, as is the case with imatinib. For mRCC patients, this phenomenon could help predict PFS, but since our sample was small, further studies are essential.
authors: Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, Michalowskiego 12, 31-126, Kraków, Poland. jakub.kucharz@uj.edu.pl.
authors: Jakub
authors: J
authors: Kucharz
authors: Department of Hematology, Jagiellonian University Medical College, Kopernika 17, 31-501, Kraków, Poland.
authors: Agnieszka
authors: A
authors: Giza
authors: Department of Medical Diagnostics, Jagiellonian University Medical College, Medyczna 9, 30-688, Kraków, Poland.
authors: Paulina
authors: P
authors: Dumnicka
authors: Department of Nephrology, Jagiellonian University Medical College, Kopernika 15, 31-501, Kraków, Poland.
authors: Marek
authors: M
authors: Kuzniewski
authors: Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kopernika 15A, 31-501, Kraków, Poland.
authors: Beata
authors: B
authors: Kusnierz-Cabala
authors: Students Scientific Society, Jagiellonian University Medical College, Sw. Anny 12, 31-008, Kraków, Poland.
authors: Pawel
authors: P
authors: Bryniarski
authors: Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, Wielicka 265, 30-663, Kraków, Poland.
authors: Roma
authors: R
authors: Herman
authors: Department of Oncology, University Hospital in Krakow, Sniadeckich 10, 31-531, Kraków, Poland.
authors: Aneta Lidia
authors: AL
authors: Zygulska
authors: Department of Oncology, University Hospital in Krakow, Sniadeckich 10, 31-531, Kraków, Poland.|Department of Oncology, Jagiellonian University Medical College, Sniadeckich 10, 31-531, Kraków, Poland.
authors: Krzysztof
authors: K
authors: Krzemieniecki
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D004909:Erythrocyte Indices / Q000187:drug effects; D004912:Erythrocytes / Q000187:drug effects; D004913:Erythrocytes, Abnormal / Q000187:drug effects; D005260:Female; D006402:Hematologic Diseases / Q000097:blood / Q000139:chemically induced; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: MCV; Macrocytosis; Metastatic renal cell carcinoma (mRCC); Predictive factors; Progression-free survival (PFS)