Sunitinib therapy for metastatic renal cell carcinoma – the Mersey experience


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Anna Mullard1, Simon Purcell1, Judith Carser1, Richard Griffiths1
1Clatterbridge Cancer Centre, Merseyside, UK

Background

Sunitinib is widely used as the first line drug of choice in metastatic renal cell carcinoma. In the landmark trial of Sunitinib versus Interferon alpha, 50% of patients in the Sunitinib arm required dose reductions due to toxicities(1). Data suggests that increased exposure to Suntinib results in better prognostic outcomes for patients, thus dose reductions should be minimised (2). The subsequent compassionate use trial of Sunitinib is widely accepted as being a more realistic yardstick for local practice. This trial reported dose reductions in 33% of cases (3).

Method

Aims - To compare local experience and management of Sunitinib therapy with the expanded access data.

Method - Retrospective audit of all patients prescribed Sunitinib for advanced/metastatic renal cell carcinoma in the Mersey and Cheshire Cancer Network from August 2010 to 2011.

Results

Analysis included 42 patients, with a median age of 61 years. 91% had a performance status of 0-1. 50% of patients had at least one dose reduction, 14% patients received >1 reduction. Toxicity was the cause of these reductions in 86% of cases (50% grade 1-2 and 50% grade 3-4). Although the majority of patients terminated treatment due to progressive disease (54%) a significant proportion did so due to ongoing toxicities (29%). The mean number of cycles was 5 (range 1-11), with 38% of patients only receiving one cycle before having their reduction.

Conclusion

High rates of dose reductions were recorded in this audit, the rationale being low grade toxicities (grade 1-2) in 50% of cases. Most dose reductions occurred early on in the patients treatment programme.

Recommendations - To increase patient support in the early stage of treatment in order to improve symptom recognition and thus minimise dose reductions.