Efficacy and safety of sunitinib in elderly patients with advanced renal cell carcinoma

Fujita,Tetsuo; Hirayama,Takahiro; Ishii,Daisuke; Matsumoto,Kazumasa; Yoshida,Kazunari; Iwamura,Masatsugu

doi:10.3892/mco.2018.1684

Efficacy and safety of sunitinib in elderly patients with advanced renal cell carcinoma

Authors:
- Tetsuo Fujita
- Takahiro Hirayama
- Daisuke Ishii
- Kazumasa Matsumoto
- Kazunari Yoshida
- Masatsugu Iwamura
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Affiliations: Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0374, Japan
Published online on: July 26, 2018 https://doi.org/10.3892/mco.2018.1684
Pages: 394-398

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Abstract

Elderly individuals represent a consistent proportion of all cancer patients. However, they are under-represented in clinical trials. The present study evaluated the actual tolerability of sunitinib in elderly Japanese patients with advanced renal cell carcinoma (RCC). A total of 56 consecutive patients with advanced RCC treated with sunitinib were enrolled. Patients were divided into two groups according to their age at the time of sunitinib initiation: i) elderly cohort (≥70 years); and ii) younger cohort (<70 years). Disease control rate, progression-free survival, overall survival and relative dose intensity (RDI) were compared between the two cohorts. The elderly cohort comprised of 14 patients (25.0%), and the younger cohort included 42 patients (75.0%). The elderly cohort had a significantly higher Charlson comorbidity index than the younger cohort (mean, 9.7 vs. 7.9; P<0.0001). Disease control rate, progression-free survival, and overall survival were not significantly different. The elderly cohort had a significantly lower RDI than the younger cohort (mean, 51.7 vs. 65.0%; P=0.0340). Thus, treatment with sunitinib is feasible and effective in elderly Japanese patients with advanced RCC. However, the RDI of elderly patients was significantly lower, and a relatively low dose of sunitinib provided optimal therapeutic efficacy.

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1	Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, et al: Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 356:115–124. 2007. View Article : Google Scholar : PubMed/NCBI
2	Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, Negrier S, Szczylik C, Pili R, Bjarnason GA, et al: Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 27:3584–3590. 2009. View Article : Google Scholar : PubMed/NCBI
3	Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, et al: EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 67:913–924. 2015. View Article : Google Scholar : PubMed/NCBI
4	Berger DA, Megwalu II, Vlahiotis A, Radwan MH, Serrano MF, Humphrey PA, Piccirillo JF and Kibel AS: Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology. 72:359–363. 2008. View Article : Google Scholar : PubMed/NCBI
5	Coebergh JW, Janssen-Heijnen ML, Post PN and Razenberg PP: Serious co-morbidity among unselected cancer patients newly diagnosed in the southeastern part of The Netherlands in 1993–1996. J Clin Epidemiol. 52:1131–1136. 1999. View Article : Google Scholar : PubMed/NCBI
6	Coebergh JW, Janssen-Heijnen ML and Razenberg PP: Prevalence of co-morbidity in newly diagnosed patients with cancer: A population-based study. Crit Rev Oncol Hematol. 27:97–100. 1998. View Article : Google Scholar : PubMed/NCBI
7	Repetto L, Venturino A, Vercelli M, Gianni W, Biancardi V, Casella C, Granetto C, Parodi S, Rosso R and Marigliano V: Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions. Cancer. 82:760–765. 1998. View Article : Google Scholar : PubMed/NCBI
8	Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ, Housman MG and Escarce JJ: Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 21:1383–1389. 2003. View Article : Google Scholar : PubMed/NCBI
9	Surbone A: Ethical considerations in conducting clinical trials for elderly cancer patients. Aging Health. 4:253–260. 2008. View Article : Google Scholar
10	Charlson ME, Pompei P, Ales KL and MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 40:373–383. 1987. View Article : Google Scholar : PubMed/NCBI
11	Brunello A, Basso U, Sacco C, Sava T, De Vivo R, Camerini A, Barile C, Roma A, Maruzzo M, Falci C, et al: Safety and activity of sunitinib in elderly patients (≥ 70 years) with metastatic renal cell carcinoma: A multicenter study. Ann Oncol. 24:336–342. 2013. View Article : Google Scholar : PubMed/NCBI
12	Hutson TE, Bukowski RM, Rini BI, Gore ME, Larkin JM, Figlin RA, Barrios CH, Escudier B, Lin X, Fly K, et al: Efficacy and safety of sunitinib in elderly patients with metastatic renal cell carcinoma. Br J Cancer. 110:1125–1132. 2014. View Article : Google Scholar : PubMed/NCBI
13	Gore ME, Szczylik C, Porta C, Bracarda S, Bjarnason GA, Oudard S, Hariharan S, Lee SH, Haanen J, Castellano D, et al: Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: An expanded-access trial. Lancet Oncol. 10:757–763. 2009. View Article : Google Scholar : PubMed/NCBI
14	Kawashima A, Tsujimura A, Takayama H, Arai Y, Nin M, Tanigawa G, Yasunaga Y, Mukai M, Uemura M, Nakai Y, et al: Osaka Renal Cell Carcinoma Clinical Study Collaboration: Importance of continuing therapy and maintaining one-month relative dose intensity in sunitinib therapy for metastatic renal cell carcinoma. Med Oncol. 29:3298–3305. 2012. View Article : Google Scholar : PubMed/NCBI
15	Kato R, Kato Y, Matsuura T, Kanehira M, Takata R and Obara W: Characteristics of early-onset hematotoxicity of sunitinib in Japanese patients with renal cell carcinoma. BMC Cancer. 17:2142017. View Article : Google Scholar : PubMed/NCBI
16	Meehan B, Appu S, St Croix B, Rak-Poznanska K, Klotz L and Rak J: Age-related properties of the tumour vasculature in renal cell carcinoma. BJU Int. 107:416–424. 2011. View Article : Google Scholar : PubMed/NCBI
17	Yildiz E, Ayan S, Goze F, Gokce G and Gultekin EY: Relation of microvessel density with microvascular invasion, metastasis and prognosis in renal cell carcinoma. BJU Int. 101:758–764. 2008. View Article : Google Scholar : PubMed/NCBI
18	Denzinger S, Otto W, Burger M, Hammerschmied C, Junker K, Hartmann A, Wieland WF and Walter B: Sporadic renal cell carcinoma in young and elderly patients: Are there different clinicopathological features and disease specific survival rates? World J Surg Oncol. 5:162007. View Article : Google Scholar : PubMed/NCBI
19	Verhoest G, Veillard D, Guillé F, De La Taille A, Salomon L, Abbou CC, Valéri A, Lechevallier E, Descotes JL, Lang H, et al: Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol. 51:1298–1304; discussion 1304–1305. 2007. View Article : Google Scholar : PubMed/NCBI
20	Karakiewicz PI, Jeldres C, Suardi N, Hutterer GC, Perrotte P, Capitanio U, Ficarra V, Cindolo L, de La Taille A, Tostain J, et al: Age at diagnosis is a determinant factor of renal cell carcinoma-specific survival in patients treated with nephrectomy. Can Urol Assoc J. 2:610–617. 2008. View Article : Google Scholar : PubMed/NCBI
21	Jung EJ, Lee HJ, Kwak C, Ku JH and Moon KC: Young age is independent prognostic factor for cancer-specific survival of low-stage clear cell renal cell carcinoma. Urology. 73:137–141. 2009. View Article : Google Scholar : PubMed/NCBI
22	Aapro MS, Köhne CH, Cohen HJ and Extermann M: Never too old? Age should not be a barrier to enrollment in cancer clinical trials. Oncologist. 10:198–204. 2005. View Article : Google Scholar : PubMed/NCBI
23	Akaza H, Naito S, Ueno N, Aoki K, Houzawa H, Lowenthal Pitman S and Lee SY: Real-world use of sunitinib in Japanese patients with advanced renal cell carcinoma: Efficacy, safety and biomarker analyses in 1689 consecutive patients. Jpn J Clin Oncol. 45:576–583. 2015. View Article : Google Scholar : PubMed/NCBI