title: Managing metastatic renal cell carcinoma-challenges, pitfalls, and outcomes in the real world.
abstract: BACKGROUND
  Renal cell carcinoma (RCC) is the most common cancer of the kidney accounting for 85% of renal tumors. Metastatic RCC (mRCC) had a poor prognosis and with the introduction of tyrosine-kinase inhibitors, such as sunitinib, pazopanib the outcomes improved. There is only one study reported from India on the use of sunitinib in mRCC. We present our analysis of mRCC and use of sunitinib at our institute over 5 years.
  
  
  METHODS
  All patients with mRCC receiving sunitinib were analyzed with respect to patient characteristics, response, toxicity, and outcomes.
  
  
  RESULTS
  A total of 108 patients were seen during the study period. The male to female ratio was 9.8:1. The median age of patients at presentation was 58 years (range: 15-80 years). Of the 108 patients, 68.51% had metastatic disease at initial presentation. The most common sites of metastases were lung followed by bone. Of the 97 patients eligible for sunitinib, only 76 received at least one cycle of sunitinib, out of which only 48 received further cycles (range: 2-36). The median progression-free survival (PFS) and overall survival (OS) in our patients were 10.2 and 28.2 months, respectively. The most common adverse effect noticed in our population was mucositis followed by hand-foot syndrome.
  
  
  CONCLUSIONS
  Sunitinib is an option for the treatment of mRCC and shows a good PFS in Indian patients. Median OS and PFS in this study are similar to other reported studies despite the presence of poor risk factors in the patient population. The pitfall in this study is significant attrition due to poor compliance to treatment and follow-up, which is a major factor in the clinic thereby compromising outcomes.
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Karnam Ashok
authors.initials: KA
authors.lastname: Kumar
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Gundeti
authors.initials: G
authors.lastname: Sadashivudu
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: K V
authors.initials: KV
authors.lastname: Krishnamani
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Vijay Gandhi
authors.initials: VG
authors.lastname: Linga
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Lakshmi Srinivas
authors.initials: LS
authors.lastname: Maddali
authors.affiliation: Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Raghunadha Rao
authors.initials: RR
authors.lastname: Digumarti
keywords: Metastatic renal cell carcinoma; outcomes; sunitinib