転移性腎細胞癌に対する1st-line sunitinib 治療: 投与スケジュールと効果の検討

Abstract

The objective of this study was to determine whether alternative sunitinib schedules (AS) could prolong survival of patients with advanced renal cell carcinoma (RCC) compared to the traditional 4-weeks-on/2- weeks-off schedule (TS). Between August 2008 and December 2014, 58 patients with advanced RCC were treated with sunitinib. We retrospectively reviewed the records of the patients who received first-line sunitinib. The progression-free survival, overall survival, relative dose intensity and toxicity in the AS and TS groups were compared. A total of 38 patients were included in the analysis. AS was used for 22 patients who started to receive sunitinib beginning in December 2012. For these patients, sunitinib was administered with a 2-weeks-on/1-week-off, 2-weeks-on/2-weeks-off or 2-weeks-on/3-weeks-off schedule according to the adverse events and clinical characteristics of each patient. The median progression-free survival was 5 months (95% CI : 3-7) for TS compared to 12 months (95% CI : 7-17) for AS (p＝0.0020). The median overall survival was 17 months (95% CI : 10-20) for TS compared to 57 months (95% CI : 25-57) for AS (p＝0.0006). There was no significant difference between the TS and AS groups (64% versus 71%). The incidence of Grade ≥3 thrombocytopenia in the AS group was smaller than that in the TS group (44% versus 27%). Treatment with sunitinib using AS may provide a better outcome than that with TS. Prospective, randomized trials should be conducted to confirm this speculation.