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

Abstract

Background:We retrospectively analyzed sunitinib outcome as a function of age in metastatic renal cell carcinoma (mRCC) patients.Methods:Data were pooled from 1059 patients in six trials. Kaplan–Meier estimates of progression-free survival (PFS) and overall survival (OS) were compared by log-rank test between patients aged <70 (n=857; 81%) and ⩾70 (n=202; 19%) years.Results:In first-line patients, median PFS was comparable in younger and older patients, 9.9 vs 11.0 months, respectively (HR, 0.89; 95% CI: 0.73–1.09; P=0.2629), as was median OS, 23.6 vs 25.6 months (HR, 0.93; 95% CI: 0.74–1.18; P=0.5442). Similarly, in cytokine-refractory patients, median PFS was 8.1 vs 8.4 months (HR, 0.79; 95% CI: 0.49–1.28; P=0.3350), while median OS was 20.2 vs 15.8 months (HR, 1.14; 95% CI: 0.73–1.79; P=0.5657). Some treatment-emergent adverse events were significantly less common in younger vs older patients, including fatigue (60% vs 69%), cough (20% vs 29%), peripheral edema (17% vs 27%), anemia (18% vs 25%), decreased appetite (13% vs 29%), and thrombocytopenia (16% vs 25% all P<0.05). Hand–foot syndrome was more common in younger patients (32% vs 24%).Conclusions:Advanced age should not be a deterrent to sunitinib therapy and elderly patients may achieve additional clinical benefit.

Overall survival in renal cell carcinoma after introduction of targeted therapies: a Norwegian population-based study

“…However, our study indicated that treatment with targeted therapy would likely lead to better clinical outcomes in elderly mRCC patients, consistent with findings reported by others 31–34. Although safety and tolerability of targeted agents in elderly patients were not reviewed in our study, others have reported that they were generally similar to those in younger patients 31,33–35. Therefore, although retrospective in nature, our study, as well as other available data, supports the clinical benefit of using targeted therapy in elderly mRCC patients.…”

Clinical outcome of advanced and metastatic renal cell carcinoma treated with targeted therapy: is there a difference between young and old patients?

“…During our preparation for this study, another retrospective data analysis from six trials revealed a slightly better, but not significant, median PFS (11.0 vs 9.9 months) and median OS (25.6 vs 23.6 months) in older, as opposed to younger, mRCC patients receiving first-line sunitinib treatment. Adverse effects occurred more often in older than in younger patients 12. Likewise, our study found that older patients with advanced RCC and mRCC in the People’s Republic of China could benefit from targeted therapy, with even better clinical outcomes.…”

“…To the best of our knowledge, research focusing on response to targeted therapy among RCC patients of different ages is currently lacking. Hutson and colleagues have reported that median progression-free survival (PFS) and overall survival (OS) are comparable in younger and older (≥70 years) mRCC patients receiving sunitinib, suggesting that elderly patients may achieve additional clinical benefit 12. Similar results were found from the data of another group of patients treated with sorafenib 13.…”

Ageing-related responses to antiangiogenic effects of sunitinib in atherosclerosis-prone mice

“…This condition is not recapitulated in standard mouse experiments and we have previously characterized C57BL/6 ApoE-/-mouse strain as an informative, humanlike model of age-related vascular changes, which impact tumor progression (Klement, St, Milsom, May, Guo, Yu, Klement, and Rak 2007). Using this approach we interrogated the effects of sunitinib, an antiangiogenic agent given to patients with metastatic cancers, essentially irrespectively of their vascular ageing status (Vazquez, Leon, Fernandez, Lazaro, Grande, and Aparicio 2012;Escudier, Albiges, and Sonpavde 2013;Hutson et al 2014).…”