Alexandr Poprach1, Radek Lakomy1, Zbynek Bortlicek2, Bohuslav Melichar3, Tomas Pavlik2, Ondrej Slaby1, Rostislav Vyzula1, Marek Svoboda1, Igor Kiss1, Hana Studentova3, Milada Zemanova4, Ondrej Fiala5,6, Katerina Kubackova7, Ladislav Dusek2, Jana Hornova8, Tomas Buchler9. 1. Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk Memorial Cancer Institute and Masaryk University, Brno, Czech Republic. 2. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic. 3. Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic. 4. Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 5. Department of Oncology and Radiotherapy, University Hospital, Pilsen, Czech Republic. 6. Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic. 7. Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. 8. Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, Prague, 140 59, Czech Republic. 9. Department of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, Prague, 140 59, Czech Republic. tomas.buchler@ftn.cz.
Abstract
BACKGROUND: Although a significant proportion of patients with metastatic renal cell carcinoma (mRCC) are elderly, the data on the outcomes of targeted therapies in this population are limited. The aim of the present retrospective registry-based study was to analyse efficacy and toxicity of sunitinib as the first-line targeted therapy of elderly mRCC patients. PATIENTS AND METHODS: The national RENal information system registry of mRCC patients treated with targeted agents in the Czech Republic was used as the data source. Of the 1315 patients treated with sunitinib as first-line targeted therapy, 1016 and 299 patients were aged <70 and ≥70 years, respectively. RESULTS: Elderly patients had a significantly longer interval from diagnosis to the initiation of therapy. Median progression-free survival was 10.8 months (95 % confidence interval 9.8-11.8) and 8.8 months (7.2-10.4) for patients aged <70 and ≥70 years, respectively (p = 0.321). Median overall survival was 31.9 months (27.9-35.9) and 26.3 months (21.3-31.2), respectively (p = 0.044). Significantly more elderly patients started on a reduced dose of sunitinib or discontinued the treatment prior to progression because of adverse events. CONCLUSIONS: The differences in patient profile and dose-reduction rates point to a different approach in the management of older and younger patients in daily clinical practice. The lower dose intensity of sunitinib in the elderly population may have translated into inferior survival.
BACKGROUND: Although a significant proportion of patients with metastatic renal cell carcinoma (mRCC) are elderly, the data on the outcomes of targeted therapies in this population are limited. The aim of the present retrospective registry-based study was to analyse efficacy and toxicity of sunitinib as the first-line targeted therapy of elderly mRCC patients. PATIENTS AND METHODS: The national RENal information system registry of mRCC patients treated with targeted agents in the Czech Republic was used as the data source. Of the 1315 patients treated with sunitinib as first-line targeted therapy, 1016 and 299 patients were aged <70 and ≥70 years, respectively. RESULTS: Elderly patients had a significantly longer interval from diagnosis to the initiation of therapy. Median progression-free survival was 10.8 months (95 % confidence interval 9.8-11.8) and 8.8 months (7.2-10.4) for patients aged <70 and ≥70 years, respectively (p = 0.321). Median overall survival was 31.9 months (27.9-35.9) and 26.3 months (21.3-31.2), respectively (p = 0.044). Significantly more elderly patients started on a reduced dose of sunitinib or discontinued the treatment prior to progression because of adverse events. CONCLUSIONS: The differences in patient profile and dose-reduction rates point to a different approach in the management of older and younger patients in daily clinical practice. The lower dose intensity of sunitinib in the elderly population may have translated into inferior survival.
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