title: Assessment of ethnic differences in sunitinib outcome between Caucasian and Asian patients with metastatic renal cell carcinoma: a meta-analysis.
abstract: BACKGROUND
  An increasing number of studies have reported ethnic differences in sunitinib outcome in metastatic renal cell carcinoma (mRCC) patients. However, a comprehensive analysis is still lacking. Therefore, we systematically collected available published data and performed a meta-analysis to compare sunitinib efficacy and toxicity in Asian and Caucasian mRCC patients.
  
  
  METHODS
  Data were extracted from published results from clinical trials, expanded access program and real-world clinical practice. Progression-free survival (or time to tumor progression), overall survival, objective response rate and adverse events were used as endpoints to evaluate the differences of sunitinib outcome between the two ethnicities. For adverse events, we focused the following clinically relevant side effects: diarrhea, fatigue, mucositis/stomatitis, hand-foot syndrome, hypertension, leukopenia, neutropenia and thrombocytopenia.
  
  
  RESULTS
  A total of 33 publications including 9977 patients were available for meta-analysis. The efficacy of sunitinib in Asian patients was similar to that in Caucasian patients. However, Asian patients showed a higher incidence of all grades toxicity of hand-foot syndrome, > grade 2 fatigue, > grade 2 hand-foot syndrome and > grade 2 thrombocytopenia.
  
  
  CONCLUSIONS
  Ethnic differences in adverse events of sunitinib in mRCC patients existed and dose adjustment in Asian patients may be considered.
authors.affiliation: a Department of Clinical Pharmacy and Toxicology , Leiden University Medical Center , Leiden , The Netherlands.|b Institute of Clinical Pharmacology , Qilu Hospital of Shandong University , Jinan , China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.affiliation: c Department of Medical Statistics and Bioinformatics , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: a Department of Clinical Pharmacy and Toxicology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Swen
authors.affiliation: a Department of Clinical Pharmacy and Toxicology , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: Guchelaar
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D044466:Asian People / Q000208:ethnology; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D018572:Disease-Free Survival; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D011758:Pyrroles / Q000627:therapeutic use*; D000077210:Sunitinib; D016896:Treatment Outcome; D044465:White People / Q000208:ethnology
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib