Targeted Therapy for Renal Cell Carcinoma: a Prospective study

Authors

  • Robin Joshi Kathmandu Medical College, Kathmandu, Nepal.
  • Sudhir Rawal Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.

DOI:

https://doi.org/10.31729/jnma.2767

Keywords:

metastatic renal cell carcinoma; sunitinib; tyrosine kinase inhibitor.

Abstract

Introduction: Our study aims to evaluate the use of targeted therapy in metastatic renal cell carcinoma.

Methods: This is a prospective study done over three years from December 2010 to December, 2013. Out of Forty seven patients of metastatic renal cell carcinoma 8(neo-adjuvant cases) were excluded and 39 were included in this study. All patients received Tyrosine kinase inhibitor, sunitinib therapy (50 mg OD, 4/2 scheme). All 39 patients underwent radical nephrectomy prior to sunitinib therapy. Patients were followed up every cycle for their clinical symptoms following sunitinib therapy and every 3 months with chest X-ray, ultra-sonography and bone scan. CT scan was done if needed. A RECIST criterion was used to evaluate the complete, partial and no tumor response.

Results: The median survival was 28.5 months (CI 9.253-47.7) and progression free survival (PFS) was 9.16 months(CI 6.08-12.23).According to RECIST, stable disease was found in 6 patients till date and a complete response in two patients. Clear cell histology was found in 30(76.9%) patients, papillary variety in 6(15.39%) patients, chromophobe type was seen in one patient and rest had mixed sarcomatoid papillary and rhabdoid clear cell variety. Twenty four patients (61.5%) had multiple metastases. Most frequent metastasis was seen in lungs in 14 patients (36%) and bone in 12 patients (31%).Metastases were also seen in draining lymph nodes, adrenals, omentum,skin, liver, and brain.

Conclusions: In our cohort, use of sunitinib showed similar outcome to previously published articles. Our study supports the use of sunitinib in metastatic renal cell carcinoma. 

Keywords: metastatic renal cell carcinoma; sunitinib; tyrosine kinase inhibitor.

References

Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C.
Epidemiologic and socioeconomic burden of metastatic renal
cell carcinoma (mRCC): a literature review. Cancer treatment
reviews. 2008 May;34(3):193-205.
2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer
statistics, 2009. CA: a cancer journal for clinicians. 2009 Jul-
Aug;59(4):225-49.
3. Basso M, Cassano A, Barone C. A survey of therapy for
advanced renal cell carcinoma. Urologic oncology. 2010 Mar-
Apr;28(2):121-33.
4. NCCN clinical practice guide line in oncology. Kidney
cancer V. 2, 2010, National comprehensive cancer network
website. http //www.nccn.org/professionals/physicians/
pdfkidneypdf.accessed feb 2010
5. Motzer RJ, Bacik J, Mazumdar M. Prognostic factors for
survival of patients with stage IV renal cell carcinoma:
memorial sloan-kettering cancer center experience. Clinical
cancer research : an official journal of the American Association
for Cancer Research. 2004 Sep 15;10(18 Pt 2):6302S-3S.
6. Ather MH, Masood N, Siddiqui T. Current management
of advanced and metastatic renal cell carcinoma. Urology
journal. 2010 Winter;7(1):1-9.
7. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski
RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic
renal-cell carcinoma. The New England journal of medicine.
2007 Jan 11;356(2):115-24.
8. Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance
after radical or partial nephrectomy for localized renal
cell carcinoma and management of recurrent disease. The
Urologic clinics of North America. 2003 Nov;30(4):843-52.
9. Lane BR, Rini BI, Novick AC, Campbell SC. Targeted
molecular therapy for renal cell carcinoma. Urology. 2007
Jan;69(1):3-10.
10. Bex A, Jonasch E, Kirkali Z, Mejean A, Mulders P, Oudard S,
et al. Integrating surgery with targeted therapies for renal cell
carcinoma: current evidence and ongoing trials. European
urology. 2010 Dec;58(6):819-28.
11. Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C,
Bracarda S, et al. Efficacy of everolimus in advanced renal cell
carcinoma: a double-blind, randomised, placebo-controlled
phase III trial. Lancet. 2008 Aug 9;372(9637):449-56.
12. Slaton JW, Inoue K, Perrotte P, El-Naggar AK, Swanson
DA, Fidler IJ, et al. Expression levels of genes that regulate
metastasis and angiogenesis correlate with advanced
pathological stage of renal cell carcinoma. The American
journal of pathology. 2001 Feb;158(2):735-43.
13. Szczylik C, Porta C, Bracarda S, et al.(2008) Sunitinib in
patients with or without prior nephrectomy in an expanded
access trial of metastatic renal cell carcinoma(mRCC). J
ClinOnc 2008; 26 May 20 Suppl. Abstr 5124.
14. Jonasch E, Wood CG, Matin SF, Tu SM, Pagliaro LC, Corn PG,
et al. Phase II presurgical feasibility study of bevacizumab
in untreated patients with metastatic renal cell carcinoma.
Journal of clinical oncology : official journal of the American
Society of Clinical Oncology. 2009 Sep 1;27(25):4076-81.

Seidel C, Fenner M, Merseburger AS, Reuter C, Ivanyi P,
Langer F, et al. Response of renal lesions during systemic
treatment with sunitinib in patients with metastatic renal cell
carcinoma: a single center experience with 14 patients. World
journal of urology. 2011 Jun;29(3):355-60.
16. Motzer RJ, Michaelson MD, et al. Phase 2 trials of SU11248
show antitumor activity in second line therapy for patients
with metastatic renal cell carcinoma (RCC). Proc AM
SocClinOncol 2005 ; 23:4508
17. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent
D, Ford R, et al. New response evaluation criteria in solid
tumours: revised RECIST guideline (version 1.1). European
journal of cancer. 2009 Jan;45(2):228-47.
18. Gore ME, Szczylik C, Porta C, Bracarda S, Bjarnason GA,
Oudard S, et al. Safety and efficacy of sunitinib for metastatic
renal-cell carcinoma: an expanded-access trial. The Lancet
Oncology. 2009 Aug;10(8):757-63.
19. Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding
G, Figlin RA, et al. Activity of SU11248, a multitargeted
inhibitor of vascular endothelial growth factor receptor and
platelet-derived growth factor receptor, in patients with
metastatic renal cell carcinoma. Journal of clinical oncology :
official journal of the American Society of Clinical Oncology.
2006 Jan 1;24(1):16-24.
20. Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M.
Interferon-alfa as a comparative treatment for clinical trials of
new therapies against advanced renal cell carcinoma. Journal
of clinical oncology : official journal of the American Society
of Clinical Oncology. 2002 Jan 1;20(1):289-96.

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Published

2015-06-30

How to Cite

Joshi, R., & Rawal, S. (2015). Targeted Therapy for Renal Cell Carcinoma: a Prospective study. Journal of Nepal Medical Association, 53(198), 83–88. https://doi.org/10.31729/jnma.2767

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