Efficacy of Sunitinib in Elderly Patients with Metastatic Renal Cell Carcinoma: Data from Real-World Clinical Practice
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.
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.
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.
KeywordsOverall Survival Renal Cell Carcinoma Sunitinib Metastatic Renal Cell Carcinoma Memorial Sloan Kettering Cancer Center
We would like to thank the following heads of the comprehensive cancer centres for the permission to use data of patients from their respective regional networks: Dr Martina Chodacka, Chomutov Hospital and Masaryk Hospital, Usti nad Labem; Dr Vaclav Janovsky, Ceske Budejovice Hospital, Ceske Budejovice; Dr Otakar Bednarik, University Hospital, Brno; Dr Jana Prausova, Motol University Hospital, Prague; Dr David Feltl, University Hospital, Ostrava; Professor Jindrich Finek, University Hospital, Pilsen; Professor Jiri Petera, University Hospital, Hradec Kralove; Dr Lubomir Slavicek, Jihlava Hospital, Jihlava; Dr Jana Katolicka, St. Anna University Hospital, Brno; Professor Rostislav Vyzula, Masaryk Memorial Institute of Oncology, Brno; Dr Jiri Bartos, County Hospital, Liberec; Dr Martin Safanda, Na Homolce Hospital, Prague; Dr Renata Soumarova, Novy Jicin Hospital, Novy Jicin; Professor Jitka Abrahamova, Thomayer Hospital, Prague; Professor Lubos Petruzelka, General University Hospital, Prague; Dr Milan Kohoutek, T Bata Memorial Hospital, Zlin. We are also indebted to all physicians who provided data for the RENIS registry.
Compliance with Ethical Standards
Supported by Grant NV15-34678A, Ministry of Health Research Programme 2015–2022. The RENIS registry is funded in part by pharmaceutical companies producing targeted agents for renal cancer (Pfizer, Bayer, Glaxo Smith Kline, Roche, and Novartis).
Conflict of interest
Tomas Buchler received honoraria for advisory boards and lectures from Novartis, Pfizer, and Roche. Bohuslav Melichar received honoraria for advisory boards and/or lectures from Novartis, Pfizer, Glaxo Smith Kline, Roche and Bayer. Alexandr Poprach received honoraria for lectures from Novartis, Roche and Bayer. Katerina Kubackova received honoraria for lectures from Novartis and travel grants from Pfizer and Bayer. Milada Zemanova received honoraria for advisory boards and/or lectures from Novartis and Glaxo Smith Kline and travel grants from Bayer and Novartis. Hana Studentova received honoraria for lectures from Novartis and Glaxo Smith Kline. All other authors declare no conflict of interest.
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