Ugo De Giorgi1, Karim Rihawi2, Michele Aieta3, Giovanni Lo Re4, Teodoro Sava5, Cristina Masini6, Valentina Baldazzi7, Fabio De Vincenzo8, Andrea Camerini9, Giuseppe Fornarini10, Luciano Burattini11, Giovanni Rosti12, Luca Moscetti13, Vincenzo E Chiuri14, Stefano Luzi Fedeli15, Vittorio Ferrari16, Emanuela Scarpi17, Dino Amadori17, Umberto Basso18. 1. IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy. Electronic address: u.degiorgi@irst.emr.it. 2. Santa Maria della Misericordia Hospital, Udine, Italy. 3. CROB, Rionero in Vulture, Italy. 4. Santa Maria degli Angeli Hospital, Pordenone, Italy. 5. Borgo Trento Hospital, Verona, Italy. 6. University Hospital, Modena, Italy. 7. Oncologia 2 - AOU Careggi, Florence, Italy. 8. Humanitas Hospital, Milan, Italy. 9. Versilia Hospital, Lido di Camaiore, Italy. 10. IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy. 11. University Hospital, Ancona, Italy. 12. Ca' Foncello Hospital, Treviso, Italy. 13. Belcolle Hospital, Viterbo, Italy. 14. Fazzi Hospital, Lecce, Italy. 15. San Salvatore Hospital, Pesaro, Italy. 16. Spedali Civili, Brescia, Italy. 17. IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy. 18. Istituto Oncologico Veneto, IOV - IRCCS, Padova, Italy.
Abstract
OBJECTIVE: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. PATIENTS AND METHODS: We reviewed the clinical records of 181 patients with mRCC aged ≥70 years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. RESULTS: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P < 0.0001 and P = 0.023, respectively). CONCLUSIONS: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.
OBJECTIVE:Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. PATIENTS AND METHODS: We reviewed the clinical records of 181 patients with mRCC aged ≥70 years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. RESULTS: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P < 0.0001 and P = 0.023, respectively). CONCLUSIONS:Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.
Authors: M Mego; H Gao; E N Cohen; S Anfossi; A Giordano; T Sanda; T M Fouad; U De Giorgi; M Giuliano; W A Woodward; R H Alvarez; V Valero; N T Ueno; G N Hortobagyi; M Cristofanilli; J M Reuben Journal: J Cancer Date: 2016-06-03 Impact factor: 4.207
Authors: Furong Kou; Zhihao Lu; Jian Li; Xiaotian Zhang; Ming Lu; Jun Zhou; Xicheng Wang; Jifang Gong; Jing Gao; Jie Li; Yan Li; Lin Shen Journal: Cancer Med Date: 2016-01-26 Impact factor: 4.452