Georg A Bjarnason1, Bishoy Khalil2, John M Hudson3, Ross Williams3, Laurent M Milot4, Mostafa Atri5, Alex Kiss6, Peter N Burns3. 1. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada. Electronic address: georg.bjarnason@sunnybrook.ca. 2. Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada. 3. Imaging Research, Sunnybrook Research Institute, Toronto and Dept Medical Biophysics, University of Toronto, Canada. 4. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada. 5. Joint Department of Medical Imaging, University of Toronto Health Network, Toronto, Canada. 6. Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada.
Abstract
BACKGROUND: Increased sunitinib exposure (area under the curve) is associated with better outcome in metastatic renal cell cancer. Recommendations for dose modification do not take this into account. A treatment strategy, based on individual patient toxicity, was developed to maximize dose and minimize time without therapy for patients who could not tolerate the standard sunitinib schedule of 50mg given for 28 days with a 14-day break (50mg, 28/14). METHODS: A single-center retrospective review was conducted on patients with metastatic renal cell cancer treated from October 2005 to March 2010. Dose/schedule modifications (DSM) were done to keep toxicity (hematological, fatigue, skin, and gastrointestinal) at ≤ grade 2. DSM-1 was 50mg, 14 days on/7 days off with individualized increases in days on treatment. DSM-2 was 50mg, 7 days on/7 days off with individualized increase in days on treatment. DSM-3 was 37.5mg with individualized 7-day breaks. DSM-4 was 25mg with individualized 7-day breaks. Multivariable analysis was performed for outcome as a function of patient and treatment variables. RESULTS: Overall, 172 patients were included in the analysis. Most patients had clear cell histology (79.1%) with sunitinib given as a first-line therapy in 59%. The DSM-1 and 2 and DSM-3 and 4 groups had a progression-free survival (PFS) (10.9-11.9 mo) and overall survival (OS) (23.4-24.5 mo) that was significantly better than the PFS (5.3 mo; P<0.001) and OS (14.4 mo; P = 0.03 and 0.003) for the standard schedule (50mg, 28/14). DCE-US in a subset of patients showed that maximum antiangiogenic activity was achieved after 14 days on therapy. CONCLUSIONS: Individualized sunitinib scheduling based on toxicity may improve PFS and OS. This hypothesis is supported by several other respective data that are reviewed. A confirmatory prospective trial is ongoing.
BACKGROUND: Increased sunitinib exposure (area under the curve) is associated with better outcome in metastatic renal cell cancer. Recommendations for dose modification do not take this into account. A treatment strategy, based on individual patienttoxicity, was developed to maximize dose and minimize time without therapy for patients who could not tolerate the standard sunitinib schedule of 50mg given for 28 days with a 14-day break (50mg, 28/14). METHODS: A single-center retrospective review was conducted on patients with metastatic renal cell cancer treated from October 2005 to March 2010. Dose/schedule modifications (DSM) were done to keep toxicity (hematological, fatigue, skin, and gastrointestinal) at ≤ grade 2. DSM-1 was 50mg, 14 days on/7 days off with individualized increases in days on treatment. DSM-2 was 50mg, 7 days on/7 days off with individualized increase in days on treatment. DSM-3 was 37.5mg with individualized 7-day breaks. DSM-4 was 25mg with individualized 7-day breaks. Multivariable analysis was performed for outcome as a function of patient and treatment variables. RESULTS: Overall, 172 patients were included in the analysis. Most patients had clear cell histology (79.1%) with sunitinib given as a first-line therapy in 59%. The DSM-1 and 2 and DSM-3 and 4 groups had a progression-free survival (PFS) (10.9-11.9 mo) and overall survival (OS) (23.4-24.5 mo) that was significantly better than the PFS (5.3 mo; P<0.001) and OS (14.4 mo; P = 0.03 and 0.003) for the standard schedule (50mg, 28/14). DCE-US in a subset of patients showed that maximum antiangiogenic activity was achieved after 14 days on therapy. CONCLUSIONS: Individualized sunitinib scheduling based on toxicity may improve PFS and OS. This hypothesis is supported by several other respective data that are reviewed. A confirmatory prospective trial is ongoing.
Authors: Sara Nazha; Simon Tanguay; Anil Kapoor; Michael Jewett; Christian Kollmannsberger; Lori Wood; G A Georg Bjarnason; Daniel Heng; Denis Soulières; Martin Neil Reaume; Naveen Basappa; Eric Lévesque; Alice Dragomir Journal: Clin Drug Investig Date: 2018-12 Impact factor: 2.859
Authors: Aly-Khan A Lalani; Haocheng Li; Daniel Y C Heng; Lori Wood; Austin Kalirai; Georg A Bjarnason; Hao-Wen Sim; Christian K Kollmannsberger; Anil Kapoor; Sebastien J Hotte; Marie Vanhuyse; Piotr Czaykowski; M Neil Reaume; Denis Soulieres; Peter Venner; Scott North; Naveen S Basappa Journal: Can Urol Assoc J Date: 2017 Mar-Apr Impact factor: 1.862
Authors: S Nazha; S Tanguay; A Kapoor; M Jewett; C Kollmannsberger; L Wood; G Bjarnason; D Heng; D Soulières; N Reaume; N Basappa; E Lévesque; A Dragomir Journal: Curr Oncol Date: 2018-12-01 Impact factor: 3.677
Authors: Scott A North; Naveen Basappa; Joan Basiuk; Georg Bjarnason; Rodney Breau; Christina Canil; Daniel Heng; Michael A S Jewett; Anil Kapoor; Christian Kollmannsberger; Kylea Potvin; M Neil Reaume; J Dean Ruether; Peter Venner; Lori Wood Journal: Can Urol Assoc J Date: 2015 May-Jun Impact factor: 1.862