Outcome of patients with renal cell carcinoma metastatic to the brain treated with sunitinib without local therapy.

OBJECTIVE: To assess the response of brain metastases to sunitinib in patients with renal cell carcinoma (RCC) who did not undergo prior surgical resection or radiation to the brain.
METHODS: We retrospectively reviewed the medical records of adult RCC patients who had metastases to the brain and received sunitinib.
RESULTS: Six patients with clear-cell RCC were identified between March 2006 and August 2009. All patients had ≥3 metastatic sites including the brain. Five patients received upfront sunitinib; 1 received sorafenib followed by sunitinib. Four patients had a solitary brain lesion, 1 patient had 2 lesions, and 1 patient had multiple subcentimeter lesions with the largest measuring 1.5 cm. Two patients achieved a near complete response to therapy with sunitinib and continue on treatment without recurrence in the brain for 47 and 23 months. One patient died of systemic disease without relapse in the brain. Two patients had disease progression in the brain and were salvaged with radiation therapy. One patient progressed systemically and in the brain after initial improvement in the brain.
CONCLUSIONS: Clear-cell RCC patients with small asymptomatic supratentorial metastases without hemorrhage or herniation safely received sunitinib as initial therapy with good response.