1
|
Lakra R, Grewal US, Beedupalli K. Lenvatinib-Associated Erythrocytosis. Am J Ther 2024; 31:e201-e203. [PMID: 36989234 DOI: 10.1097/mjt.0000000000001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Rachaita Lakra
- Department of Internal Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA
| | - Udhayvir Singh Grewal
- Department of Hematology and Oncology, University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center Iowa City, IA
| | - Kavitha Beedupalli
- Department of Hematology and Oncology and Feist Weiller Cancer Center, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA
| |
Collapse
|
2
|
Legros L, Pascale A, Guettier C, Eftekhari P, Merabet YB, Stang M, Bossevot R, Goldschmidt E, Ulusakarya A, Morisset S, Lewin M, Samuel D, Rosmorduc O. Progressive erythrocytosis under lenvatinib treatment in patients with advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 2023; 91:337-344. [PMID: 36961524 PMCID: PMC10068666 DOI: 10.1007/s00280-023-04519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE This manuscript reports on the occurrence of early and frequent erythrocytosis in advanced hepatocellular carcinoma (HCC) patients treated with lenvatinib. METHODS A cohort of 23 patients with advanced HCC, treated with this antiangiogenic drug for at least one month, was retrospectively analyzed. RESULTS These patients (82.7% men, median age 58.3, cirrhosis in 60.8%) were treated between October 2019 and September 2020 with lenvatinib, as first-line systemic therapy for 82.6% of them. For 20 patients (87%), an early and significant increase in hemoglobin (Hb) level, up to 1.41 g/dL (p < 0.001) was reported and remained elevated. Ten patients (43.5%), all men, reached erythrocytosis (Hb > 16.5 g/dL), 7 were treated with low-dose aspirin for primary thromboprophylaxis and 2 needed phlebotomy. None underwent thromboembolic complications. A significant Hb decrease was observed after treatment discontinuation (p < 0.05). Erythropoietin (EPO) serum levels also increased, which was attributed to HCC after immunostaining for EPO in liver biopsies. The Naranjo adverse drug reaction probability scale documented the relationship between erythrocytosis and lenvatinib and regression at treatment discontinuation. Erythrocytosis was hypothesized to be a class effect of anti-VEGF therapies, the magnitude of which might depend on the IC50 value of each molecule. CONCLUSION This report documents the frequent occurrence of erythrocytosis during lenvatinib treatment for advanced HCC, likely secondary to EPO secretion by tumor cells through the antiangiogenic activity levatinib. An early and close monitoring of hematologic parameters is, thus, recommended, together with thromboprophylaxis by low-dose aspirin and phlebotomy in case of symptomatic erythrocytosis.
Collapse
Affiliation(s)
- Laurence Legros
- Department of Clinical Hematology, Hôpital Bicêtre, AP-HP, 78 Rue du Général Leclerc 94270, Le Kremlin-Bicêtre, France.
- INSERM UMRS-MD-1197, Université Paris-Saclay, Villejuif, France.
- France Intergroupe Syndromes Myéloprolifératifs (FIM), Paris, France.
| | - Alina Pascale
- Hepato-Biliary Department, Hôpital Paul Brousse, AP-HP, 12-14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Catherine Guettier
- Hepato-Biliary Department, Hôpital Paul Brousse, AP-HP, 12-14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
- Anatomic Pathology Department, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
- INSERM U1193, Université Paris-Saclay, Villejuif, France
| | - Pirayeh Eftekhari
- Department of Clinical Hematology, Hôpital Bicêtre, AP-HP, 78 Rue du Général Leclerc 94270, Le Kremlin-Bicêtre, France
| | - Yasmina Ben Merabet
- Hepato-Biliary Department, Hôpital Paul Brousse, AP-HP, 12-14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Maryse Stang
- Medical Oncology Department, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Rachel Bossevot
- Medical Oncology Department, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Emma Goldschmidt
- Medical Oncology Department, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Ayhan Ulusakarya
- Medical Oncology Department, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | | | - Maïté Lewin
- Radiology Department, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Didier Samuel
- Hepato-Biliary Department, Hôpital Paul Brousse, AP-HP, 12-14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France
- INSERM U1193, Université Paris-Saclay, Villejuif, France
| | - Olivier Rosmorduc
- Hepato-Biliary Department, Hôpital Paul Brousse, AP-HP, 12-14 Avenue Paul Vaillant Couturier, 94800, Villejuif, France.
- INSERM U1193, Université Paris-Saclay, Villejuif, France.
- Sorbonne Université, Paris, France.
| |
Collapse
|
3
|
Tommasi C, Scartabellati G, Giannarelli D, Giorgi UD, Brighi N, Fornarini G, Rebuzzi SE, Puglisi S, Caffo O, Kinspergher S, Mennitto A, Cattrini C, Santoni M, Verzoni E, Rametta A, Stellato M, Malgeri A, Roviello G, Brunelli M, Buti S. The role of mean corpuscular volume and red cell distribution width in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors: the MARECAP retrospective study. Ther Adv Urol 2023; 15:17562872231187216. [PMID: 37492625 PMCID: PMC10363886 DOI: 10.1177/17562872231187216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Background Tyrosine-kinase inhibitors (TKIs) and immunotherapy represent the backbone treatment for metastatic renal cell carcinoma (mRCC) patients. The aim of the present study was to describe mean corpuscular volume (MCV) and red cell distribution width (RDW) in mRCC patients treated with pazopanib or cabozantinib, and to explore their potential impact on oncological outcomes. Materials and methods We conducted a multicenter retrospective observational study in mRCC patients treated with pazopanib or cabozantinib between January 2012 and December 2020 in nine Italian centers. Descriptive statistics, univariate, and multivariate analyses were performed. Objectives The primary endpoints were the incidence and trend over time of anemia, macrocytosis (elevated MCV), and anisocytosis (elevated RDW). The secondary endpoints were the correlations of MCV and RDW with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Results A total of 301 patients were enrolled; mean Hb value was 12.5 g/dl, a mean increase of 1 g/dl was observed at day 15 and maintained at 3 months. Most patients had baseline macrocytosis (MCV levels > 87 fl), with a significant mean increase after 3 months of treatment. At univariate analysis patients with macrocytosis had better ORR, longer PFS, and OS. About one third of patients had baseline anisocytosis (RDW > 16%), with a significant mean increase after 3 months of treatment. At univariate analysis, patients with RDW values ⩽ 16% had higher ORR, longer PFS, and OS. At multivariate analysis, baseline macrocytosis was significantly associated with better PFS in patients treated with pazopanib and baseline anisocytosis with shorter OS in all patients. Conclusions mRCC patients treated with pazopanib or cabozantinib may have baseline macrocytosis and anisocytosis. A significant increase of Hb, MCV, and RDW after TKIs start was observed. Baseline macrocytosis is positively correlated with PFS in patients treated with pazopanib and baseline anisocytosis affects survival of patients treated with TKIs.
Collapse
Affiliation(s)
| | | | - Diana Giannarelli
- Facility Epidemiology and Biostatistic, G-Step, Fondazione Policlinico Universitario A. Gemelli, Scientific Direction, IRCCS, Rome, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Nicole Brighi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Silvia Puglisi
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | | | - Alessia Mennitto
- Division of Oncology, University Hospital ‘Maggiore della Carità’, Novara, Italy
| | - Carlo Cattrini
- Division of Oncology, University Hospital ‘Maggiore della Carità’, Novara, Italy
| | | | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Rametta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Stellato
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Andrea Malgeri
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Matteo Brunelli
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma, Italy
| |
Collapse
|
4
|
Krečak I, Holik H, Zekanović I, Morić Perić M, Marketin T, Coha B, Gverić-Krečak V, Vodanović M, Lucijanić M. Thrombotic risk in secondary polycythemia resembles low-risk polycythemia vera and increases in specific subsets of patients. Thromb Res 2021; 209:47-50. [PMID: 34864474 DOI: 10.1016/j.thromres.2021.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia.
| | - Hrvoje Holik
- Department of Internal Medicine, "Dr. Josip Benčević" General Hospital, Slavonski Brod, Croatia; School of Medicine, University of Osijek, Osijek, Croatia
| | - Ivan Zekanović
- Department of Internal Medicine, General Hospital Zadar, Zadar, Croatia
| | | | - Tina Marketin
- Department of Internal Medicine, General Hospital Zadar, Zadar, Croatia
| | - Božena Coha
- Department of Internal Medicine, "Dr. Josip Benčević" General Hospital, Slavonski Brod, Croatia
| | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia
| | - Marijo Vodanović
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marko Lucijanić
- Department of Hematology, University Hospital Dubrava, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
5
|
Fanelli M, Caputo F, Cerma K, Gelsomino F, Bari A, Dominici M, Pozzi S. Pazopanib-related secondary polycythemia in metastatic myxofibrosarcoma: A case report and review of the literature. J Oncol Pharm Pract 2020; 27:766-770. [PMID: 32838682 DOI: 10.1177/1078155220950440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pazopanib, a tyrosine kinase inhibitor (TKI), is a standard treatment for various tumours, including metastatic non-adipocytic soft-tissue sarcomas. In literature, erythrocytosis has been described as a TKI-related condition. CASE REPORT A 59-year-old man underwent surgical removal of a sub-scapular mass consistent with myxofibrosarcoma. After distant relapse, he first started chemotherapy, and then Pazopanib. He was found to have increased levels of hemoglobin (Hb) and hematocrit (Hct). He was asymphtomatic, with no history of pulmonary disease nor smoking habit. Erythropoietin (EPO) level was higher than normal. A polycythemia vera was ruled out.Management & outcome: The patient started a prophylactic therapy with lysine acetylsalicylate, and we observed a reduction of Hb, but not Hct. Due to disease progression, we interrupted Pazopanib. After a week from drug discontinuation, Hb levels got back to the normal range, Hct was lowering. We decided not to perform phlebotomy, considering the declining trend in Hb and Hct values and the absence of symptoms. DISCUSSION We postulated a Pazopanib-related secondary erythrocytosis, since Hb and Hct levels increased from baseline during treatment, then normalized when Pazopanib was discontinued. We used the Naranjo Nomogram to assess the correlation between the adverse effect and Pazopanib, the correlation was "Probable", a score of 5. To the best of our knowledge, this is the first case report of Pazopanib-related secondary polycythemia in a patient with sarcoma. It is important to pay attention to blood count and to any symptoms potentially related to erythrocytosis in patients treated with TKIs.
Collapse
Affiliation(s)
- Martina Fanelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesco Caputo
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Krisida Cerma
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Alessia Bari
- Unit of Target Therapy in Onco-Hematology and Osteoncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Samantha Pozzi
- Unit of Target Therapy in Onco-Hematology and Osteoncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
6
|
Bukhari N, Winquist E. Case: Secondary polycythemia due to pazopanib in patients with metastatic renal cell carcinoma. Can Urol Assoc J 2017; 11:E449-E450. [PMID: 29072563 DOI: 10.5489/cuaj.4519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Clear-cell renal cell carcinoma (RCC) is the most common primary malignant renal neoplasm. Up to 30% of patients have metastatic disease at the time of initial diagnosis.1 Small molecule inhibitors of vascular endothelial growth factor receptor tyrosine kinase (VEGFR TKIs) are used as first-line treatment for most patients with incurable RCC. Pazopanib is a TKI inhibiting VEGFR,1-3 as well as plateletderived growth factor receptors (PDGFRs) α and β and stem cell receptor c-kit. The most common side effects of pazopanib are diarrhea, hypertension, changes in hair colour, anorexia, nausea, and vomiting. Severe hepatic toxicity is the adverse effect of greatest concern,but is uncommon. Myelosuppressive effects are also noted, such as anemia, thrombocytopenia, and leukopenia, and are presumably mediated through c-kit inhibition. Erythrocytosis is a wellrecognized paraneoplastic syndrome associated with RCC; however, erythrocytosis due to pazopanib therapy has only recently been described. We report two cases and review of the literature related to this phenomenon.
Collapse
Affiliation(s)
- Nedal Bukhari
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Eric Winquist
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| |
Collapse
|
7
|
Johnson AC, Matias M, Boyle H, Escudier B, Molinier A, Laguerre B, Helissey C, Brachet PE, Dugué AE, Mourey L, Coquan E, Joly F. Haemoglobin level increase as an efficacy biomarker during axitinib treatment for metastatic renal cell carcinoma: a retrospective study. BMC Cancer 2017; 17:355. [PMID: 28532444 PMCID: PMC5440993 DOI: 10.1186/s12885-017-3312-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Axitinib is used after failure of first line treatment for metastatic renal cell carcinoma (mRCC). A known side effect is the increase of haemoglobin level (HbL) during treatment with a suspected correlation with better outcome. Our objective was to examine whether HbL increase during the first three months of axitinib treatment is associated with better prognosis. Methods Retrospective multicentre analysis including patients with mRCC treated with axitinib for at least three months from 2012 to 2014. Progression-free survival (PFS) was analysed by a Cox model according to gender, International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic score, high blood pressure (hBP), and maximum increase in HbL within the first three months of treatment. Results Ninety-eight patients were analysed (71% men; median age at treatment initiation: 62 years; IMDC: 24%, 50%, and 26% in the favourable, intermediate, and poor-risk group, respectively). Patients received axitinib for a median of 8 months. During the first three months, the median increase of HbL was +2.3 g/dL (−1.1; 7.2). Fifty-six (57%) patients developed hBP. In multivariate analysis, after adjustment for performance status (P < 0.0001) and gender (P = 0.0041), the combination of HbL increase ≥2.3 g/dL and any grade hBP was significantly associated with longer PFS (HR = 0.40, 95%CI [0.24; 0.68]). Conclusions Early HbL increase during axitinib treatment combined with hBP is an independent predictive factor of PFS. These results require validation in a prospective setting.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Loic Mourey
- Institut Claudius Regaud, F-31000, Toulouse, France
| | | | | |
Collapse
|
8
|
Bilir C, Yıldız İ, Bilici A, Ucar M, Berk V, Yıldız Y, Yazıcı O, İmamoğlu Gİ, Karadurmuş N, Pilancı KN, Arpacı E, Tanrıverdi Ö, Karcı E, Temiz S, Nayır E, Oktay E, Dal P, Petekkaya İ, Varım C, Cinemre H. Is Change in Hemoglobin Level a Predictive Biomarker of Tyrosine Kinase Efficacy in Metastatic Renal Cell Carcinoma? A Turkish Oncology Group Study. Cancer Invest 2017; 35:248-255. [PMID: 28333566 DOI: 10.1080/07357907.2017.1292518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are insufficient predictive markers for renal cell carcinoma (RCC). METHODS A total of 308 metastatic RCC patients were analyzed retrospectively. RESULTS The increased hemoglobin (Hb) group had significantly higher progression-free survival and overall survival (OS) compared with the decreased Hb group at 11.5 versus 6.35 months (p < .001) and 21.0 versus 11.36 months (p < .001) respectively. The 1- and 3-year OS rates were higher in the Hb increased group, i.e., 84% versus 64% and 52% versus 35% respectively. CONCLUSIONS The present study showed that increased Hb levels after tyrosine kinase inhibitor therapy could be a predictive marker of RCC.
Collapse
Affiliation(s)
- Cemil Bilir
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
| | | | - Ahmet Bilici
- c Department of Medical Oncology , Medipol University School of Medicine , Istanbul , Turkey
| | - Mahmut Ucar
- d Department of Medical Oncology , Erciyes University School of Medicine , Kayseri , Turkey
| | - Veli Berk
- d Department of Medical Oncology , Erciyes University School of Medicine , Kayseri , Turkey
| | - Yaşar Yıldız
- e Department of Medical Oncology , Izmir Katip Çelebi University School of Medicine , Izmir , Turkey
| | - Ozan Yazıcı
- f Department of Medical Oncology , Ankara Numune Teaching and Education Hospital , Ankara , Turkey
| | - Gökşen İnanç İmamoğlu
- g Department of Medical Oncology , Dışkapı Teaching and Education Hospital , Ankara , Turkey
| | - Nuri Karadurmuş
- h Department of Medical Oncology , Gulhane School of Medicine , Ankara , Turkey
| | - Kezban Nur Pilancı
- i Department of Medical Oncology , Haseki Teaching and Education Hospital , Istanbul , Turkey
| | - Erkan Arpacı
- j Department of Medical Oncology , Bülent Ecevit University School of Medicine , Zonguldak , Turkey
| | - Özgür Tanrıverdi
- k Department of Medical Oncology , Mugla Sıtkı Koçman University School of Medicine , Mugla , Turkey
| | - Ebru Karcı
- l Department of Medical Oncology , Ankara University School of Medicine , Ankara , Turkey
| | | | - Erdinc Nayır
- n Department of Medical Oncology , Kahramanmaras Necip Fazil City Hospital , Kahramanmaras , Turkey
| | - Esin Oktay
- o Department of Medical Oncology , Adnan Menderes University Faculty of Medicine , Aydin , Turkey
| | - Pınar Dal
- p Department of Medical Oncology , Eskisehir Osman Gazi University School of Medicine , Eskişehir , Turkey
| | | | - Ceyhun Varım
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
| | - Hakan Cinemre
- a Department of Internal Medicine and Medical Oncology , Sakarya University School of Medicine , Sakarya , Turkey
| |
Collapse
|
9
|
Tripathi A, Jacobus S, Feldman H, Choueiri TK, Harshman LC. Prognostic Significance of Increases in Hemoglobin in Renal Cell Carcinoma Patients During Treatment With VEGF-directed Therapy. Clin Genitourin Cancer 2016; 15:396-402. [PMID: 28040423 DOI: 10.1016/j.clgc.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increases in hemoglobin have been reported in renal cell carcinoma (RCC) patients treated with vascular endothelial growth factor (VEGF) pathway-targeted therapies and have been associated with increased progression-free survival (PFS). We retrospectively evaluated its significance as a predictive biomarker of clinical response in RCC. PATIENTS AND METHODS Patients with advanced RCC treated with VEGF receptor tyrosine kinase inhibitors (TKIs) or bevacizumab as a first-line therapy were identified. Hemoglobin levels were retrieved at baseline and then at monthly intervals for 6 months. Absolute and percentage increases over baseline were evaluated as predictors of objective response rate, PFS, time to treatment failure, and overall survival. Cox regression was used to estimate change status hazard ratios (HR) in univariate and multivariable models. RESULTS Among the 71 eligible patients, elevations in hemoglobin were observed in 83%, with a median time to increase of 2.4 weeks since treatment initiation. Changes in hemoglobin at time of response were not associated with objective response rate. Landmark analysis at 3 months showed that increases in hemoglobin were associated with worse PFS (8.0 vs. 19.4 months; HR = 2.29; 95% confidence interval, 1.01-5.16; P = .05) and time to treatment failure (6.4 vs. 18.1 months; HR = 2.14; 95% confidence interval, 0.99-4.60, P = .05). Patients with greater increases (15% or more) had significantly shorter PFS (5.5 vs. 13.6 months) and overall survival (20.8 vs. 30.4 months) compared to those with lesser degree of elevations. CONCLUSION Contrary to prior reports, elevation in hemoglobin on VEGF-directed therapy was associated with worse clinical outcomes, and the greater the degree of elevation, the poorer the prognosis.
Collapse
Affiliation(s)
- Abhishek Tripathi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Susanna Jacobus
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Hope Feldman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA.
| |
Collapse
|