Can individualized sunitinib dose and schedule changes optimize outcomes for kidney cancer patients?

Abstract

The recommended starting dose and schedule for sunitinib is 50 mg daily for 28 days, followed by a 14-day break with significant dose reductions to 37.5 mg (75% of starting dose), and then 25 mg (50% of starting dose) on the same schedule (four/two schedule). There are several reasons why these dose and scheduling recommendations may not be optimal for most patients, as outlined below.

Management of advanced kidney cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2021

“…52,53 The dose and schedule of sunitinib should be individualized for each patient to derive the optimal benefit. 54 It is still recommended to start with the monograph standard of four weeks on at 50 mg per day per six-week cycle. After evaluation of type and timing of toxicities, patients may require adjustments to the schedule and/or dose.…”

“…Bjarnason and colleagues published a single-institution, retrospective review of patients treated with alternate dose and schedule of sunitinib compared to product monograph-recommended dosing; they found improved PFS and OS compared to the standard dosing group. 54 A prospective clinical trial conducted across Canada examined the same individualized dose titration scheme among 117 patients with metastatic clearcell RCC. 55 Subjects in this study were started on sunitinib 50 mg/day with the aim to treat for 28 days.…”

Management of Advanced Kidney Cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2019

“…51,52 The dose and schedule of sunitinib should be individualized for each patient in order to derive the optimal benefit. 53 It is still recommended to start with the monograph standard of four-week on/two-week off dosing schedule. After evaluation of type and timing of toxicities, patients may require adjustments to the schedule and/or dose.…”

“…Bjarnason and colleagues have published a single-institution, retrospective review of patients treated with alternate dose and schedule of sunitinib compared to product monograph recommended dosing; they found improved PFS and OS compared to the standard dosing group. 53 A prospective clinical trial conducted across Canada examined the same individualized dose titration scheme among 117 patients with metastatic clear-cell RCC. 54 Subjects in this study were started on sunitinib 50 mg/day with the aim to treat for 28 days.…”

Management of advanced kidney cancer: Canadian Kidney Cancer Forum (CKCF) consensus update 2017

“…21,22 The dose and schedule of sunitinib should be optimized for each patient in order to derive the most benefit. 23 It is still recommended to start with the monograph standard of four-week-on/two-week-off dosing schedule. After evaluation of type and timing of toxicities, patients may require adjustments to the schedule and/or dose.…”