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Bolzacchini E, Pinotti G, Bertù L, Verusio C, Galli L, Mumoli N, Barbara C, Danova M, Bregni M, Artale S, Rossini C, Nigro O, Antonuzzo A, Derosa L, Torchio M, Barzaghi S, Ricci I, Suter M, Ballerio A, Vallini I, Dentali F. On-target Toxicities Predictive of Survival in Metastatic Renal Cell Carcinoma (mRCC) Treated With Sunitinib: A Multicenter Retrospective Study. Clin Genitourin Cancer 2019; 18:e145-e156. [PMID: 31889670 DOI: 10.1016/j.clgc.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preliminary studies suggested that selected drug-related toxicities of sunitinib may correlate with a better prognosis. PATIENTS AND METHODS From January 2006 through December 2015, we retrospectively analyzed data of 145 patients with metastatic renal cell carcinoma treated with sunitinib as a first-line therapy in 7 different Italian oncology departments. Hypertension, hypothyroidism, thrombocytopenia, neutropenia, and anemia were evaluated. Overall survival (OS) and progression-free survival (PFS) were calculated. OS and PFS were compared in patients who developed and who did not develop a drug-related toxicity. A multivariate analysis using the Cox regression model was performed. RESULTS We evaluated 145 patients (92 males; median age, 70 years); 105 (62.4%) patients experienced at least 1 toxicity: 66 (45.5%) patients developed hypothyroidism, 41 (28.3%) thrombocytopenia, 39 (26.9%) hypertension that required medical therapy, 22 (15.2%) anemia, and 11 (7.6%) neutropenia. The median PFS of patients who developed hypertension was 12 months (95% confidence interval [CI], 9-21 months) versus 9 months (95% CI, 7-12 months) in patients who did not develop toxicity; the median OS was 36 months (95% CI, 22 months to not reached) versus 26 months (95% CI, 18-34 months). For neutropenia, the median PFS was 17.5 months (95% CI, 9-65 months) versus 10 months (95% CI, 8-12 months); the median OS was 23 months (95% CI, 13 months to not reached) versus 28 months (95% CI, 22-35 months). At univariate and multivariate analysis, we observed a protective effect of hypertension and neutropenia on tumor progression (hazard ratio, 0.47; 95% CI, 0.28-0.78 and hazard ratio, 0.26; 95% CI, 0.09-0.76, respectively). CONCLUSIONS Many patients developed toxicities during treatment with sunitinib; hypertension and neutropenia were related to longer PFS in our cohort.
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Affiliation(s)
- Elena Bolzacchini
- U.O. Oncologia, Ospedale Sant'Anna, ASST-LARIANA, Como, Italy; Università degli studi dell'Insubria di Varese, Varese, Italy.
| | | | - Lorenza Bertù
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
| | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Luca Galli
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Mumoli
- Medicina Interna, Azienda USL6 Livorno - Presidio Ospedaliero di Livorno, Livorno, Italy
| | | | - Marco Danova
- Medicina Interna ad indirizzo Oncologico, Ospedale di Vigevano, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Marco Bregni
- Oncologia Medica, Ospedale di Busto Arsizio - ASST Valle Olona, Busto Arsizio, Italy
| | - Salvatore Artale
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Chiara Rossini
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Olga Nigro
- Oncologia Medica, Ospedale di Circolo, Varese, Italy
| | - Andrea Antonuzzo
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lisa Derosa
- Oncologia Medica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Martina Torchio
- Medicina Interna ad indirizzo Oncologico, Ospedale di Vigevano, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - Sabrina Barzaghi
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Isabella Ricci
- Oncologia Medica, Azienda Ospedaliera S. Antonio Abate di Gallarate, Gallarate, Italy
| | - Matteo Suter
- Oncologia Medica, Ospedale di Circolo, Varese, Italy
| | - Alice Ballerio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Francesco Dentali
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria di Varese, Varese, Italy
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