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Annals of Oncology
847P CLINICAL EFFICACY OF SUNITINIB AS POST-OPERATIVE
ADJUVANT THERAPY IN PATIENTS WITH HIGH-RISK RENAL
CELL CARCINOMA
X. Zhang 1 , J.Y. Yuan 2 , L. Wang 2 , L. Chen 3 ,J.Pan 4 ,L.Ye 5 , X. Xiao 6 , J. Qiu 7 ,
K. Zhang 8 ,G.Ye 9
1 Urology Department, The General Hospital of the People’s Liberation Army,
Beijing, CHINA, 2 Urology Department, Xijin Hospital, the Fourth Military Medical
University, Xian, CHINA, 3 Urology Department, 307 Hospital of PLA, Beijing,
CHINA, 4 Urology Department, Southwest Hospital, the Third Military Medical
University, Chongqing, CHINA, 5 Urology Department, 304 Hospital of PLA,
Beijing, CHINA, 6 Urology Department, General Hospital of Armed Police Forces,
Beijing, CHINA, 7 Urology Department, Bethune International Peace Hospital of
PLA, Jilin, CHINA, 8 Urology Department, Daping Hospital, the Third Military
Medical University, Chongqing, CHINA, 9 Urology Department, Xinqiao Hospital,
the Third Military Medical University, Chongqing, CHINA
Objective: To evaluate the efficacy and safety of Sunitinib as post-operative adjuvant
therapy in patients with high-risk renal cell carcinoma (RCC).
Methods: A total of 60 patients with resected, histologically confirmed clear cell RCC
were enrolled in this study. Patients received orally Sunitinib either at a dose of 50mg
on treatment schedule 4/2 (once daily for 4 weeks followed by 2 weeks off) or at a
dose of 37.5mg once daily for three 6-week cycles from 1 month after surgery.
Results: All 60 patients tolerated Sunitinib treatment well and no patient
discontinued treatment due to adverse events. Most adverse events were grade I to II.
The most frequently reported adverse events were neutropenia (56.7%),
thrombocytopenia (53.3%), leucopenia (48.3%), hand-foot syndrome (46.7%) and
hypertension (36.7%). The most frequently reported grade 3 or 4 toxicities were
thrombocytopenia (25%), neutropenia (15%), hand-foot syndrome (11.7%) and
leucopenia (8.3%). The majority of adverse events occurred within the first 1-2 cycles
of Sunitinib treatment, and was ameliorated 1 month after 3 cycles finished. No
irreversible adverse event was observed. As of April 5, 2012, no recurrence occurred
in patients except one death due to cerebrovascular accident unrelated to treatment,
with both 6-month and 9-month disease-free survival (DFS) rate of 100%.
Conclusion: Myelosuppression occurred less frequently in high-risk RCC patients
treated with Sunitinib as operative adjuvant therapy than in advanced RCC patients,
with a better benefit trend. However, long-term follow-up data are needed to further
confirm the efficacy of Sunitinib in the adjuvant setting.
Disclosure: All authors have declared no conflicts of interest.
848P OVERALL SURVIVAL (OS) IN METASTATIC RENAL CELL
CARCINOMA (MRCC): A COMPARISON BETWEEN SORAFENIB
(SO) AND BEST SUPPORTIVE CARE (BSC) AFTER FIRST LINE
TREATMENT WITH SUNITINIB (SU) IN SWEDEN
P. Sandström 1 , R. Sandin 2 , J. Kowalski 3 , T. Wahlgren 4 , M. Jakobsson 4 ,
S. Lundstam 5 , B. Ljungberg 6 , U. Harmenberg 1
1 Department of Oncology-pathology, Karolinska University Hospital and
Karolinska Institutet, Stockholm, SWEDEN, 2 Global Health Economics and
Outcomes Research, Onology, Pfizer AB, Sollentuna, SWEDEN, 3 Department of
Clinical Science, Intervention and Technology, Karolinska University Hospital
Huddinge and Karolinska Institutet, Stockholm, SWEDEN, 4 Oncology, Pfizer AB,
Sollentuna, SWEDEN, 5 Department of Urology, University Hospital, and the
Sahlgrenska Academy, Gothenburg, SWEDEN, 6 Department of Surgical and
Perioperative Sciences, Urology and Andrology, Umeå University, Umeå,
SWEDEN
Background: There is a paucity of efficacy data after first line treatment with SU in
mRCC. This retrospective register study compared OS in patients treated with SO
and BSC after first line treatment with SU in Sweden.
Methods: Three Swedish national health registers were used: the Swedish Cancer
register (diagnosis and death), the National Patient Register (in-/out-patient data),
and the Swedish Prescribed Drug Register. 135 patients identified with mRCC,
diagnosed no later than 2009, were recorded as having received 1st-line treatment
with SU; 59 patients received SO and 76 patients received BSC. Multivariate analysis
was performed using the Cox proportional hazards model including estimation of
adjusted OS. The regression model included the covariates: age, gender,
nephrectomy, time since diagnosis and metastatic disease, time since mRCC
diagnoses and start of systemic therapy, geographical region, institutional size, and
duration of first line SU treatment. Sensitivity analysis with combinations of
explanatory variables, was performed to test the robustness of the results.
Results: Patients characteristics differed between the SO and BSC patients, but
available information did not indicate a clear advantage in favor of any treatment
arm. OS for patients prescribed with SO was improved compared with OS for BSC
patients. Including all covariates, median adjusted OS was 9,9 vs. 6,6 months,
respectively for patients treated with SO and BSC (HR = 0.652, 95% CI: 0.412, 1.030;
P < 0.067). Sensitivity analysis showed a robust and significant reduction in risk of
death for patients treated with SO; range of 29-42% (HR: 0,58-0,71). In all models,
nephrectomy was independently associated with significantly improved OS. Other
individual covariates were generally not statistically significant, likely due to a low
number of observations.
Conclusion: An improved OS for mRCC patients was seen in patients receiving
SO compared to BSC after first line treatment with SU. Some caution should be
taken with interpreting the results as confounding due to unmeasured covariates
may exist.
Disclosure: P. Sandström: Has had an advisory role for Pfizer, Roche, GSK, Novartis,
and Bayer, has received honoraria from Pfizer, Roche, bayer, GSK and Novartis and
has received research funding from Pfizer and Bayer. R. Sandin: Rickard Sandin is an
employee of Pfizer AB and owns Pfizer stock. J. Kowalski: Jan Kowalski is concultant
and received compensation from Pfizer for the statistical work for the abstract.
T. Wahlgren: Thomas Wahlgren is an employee of Pfizer AB and owns Pfizer stock.
M. Jakobsson: Maria Jakobsson is an employee of Pfizer AB and owns Pfizer stock.
S. Lundstam: Has had an advisory board role for GSK and Bayer, has received
honoraria from Pfizerand GSK, and has received research funding from Pfizer.
B. Ljungberg: Has had an advisory role for Pfizer, GSK, Novartis, Astellas and Bayer,
and has received honoraria from Pfizer, Novartis, GSK and Bayer. U. Harmenberg:
Has had an advisory role for Pfizer, Roche, GSK, Novartis, and Bayer, has received
honoraria from Pfizer, Roche, and Novartis and has received research funding from
Pfizer, GSK and Novartis.
849P SUNITINIB RECHALLANGE IN METASTATIC RENAL CELL
CARCINOMA PATIENTS
K. Nagyivanyi1 , K. Bíró2 , F. Gyergyay2 , Z. Küronya2 , H. Nemeth2 , L. Géczi2 1
Chemotherapy C, National Institute of Oncology, Budapest, HUNGARY,
2
Chemotherapy C and Clinical Pharmacology, National Institute of Oncology,
Budapest, HUNGARY
Background: Sunitinib is an active agent in the first line treatment of metastatic clear
cell kidney cancer, based on the result of a global phase III study. However, complete
remission is rarely seen and multiply sequential therapies are used in this patient
population. Since options in third line setting are limited, we assessed the clinical
activity of sunitinib rechallenge after failure on other therapies.
Methods: 323 kidney cancer patients were treated with sunitinib from November
2005 to January 2012 in our department. Retrospective data were collected for those
9 patients who we rechallenged with sunitinib failing to at least two previous
therapies, including sunitinib. Patient characteristics, objective response based on
RECIST criteria and progression-free survival (PFS) were analysed. Tumor
assessment was performed every 2nd cycle of sunitinib or every 3 months
Results: Data of 8 men and 1 woman of median age (at sunitinib challenge 59 years,
at sunitinib rechallenge 63 years) with metastatic clear cell cancer of the kidney were
analysed. All patients had nephrectomy prior treatment. Initial treatment with
sunitinib was associated with a median progression free survival (PFS) of 13,7
months. Objective response was partial remissions (PR) as best response. At the time
of re-exposure patients again showed clinical benefit which was associated with a
median PFS of 6,8 months and consisted of 1 (11%) PR and 5 (55%) disease
stabilizations. PD was seen in 3 (33%) patients.
Conclusions: In sunitinib-responsive patients, re-challenge with sunitinib has been
successful and was well tolerated either after an other TKI or mTOR inhibitor and it
seems to be a valid option as a third line treatment.
Disclosure: All authors have declared no conflicts of interest.
850P GENETIC POLYMORPHISMS AND SUNITINIB TOXICITY IN
METASTATIC RENAL-CELL CARCINOMA
J. Sepulveda Sanchez 1 , C. Farfan 2 , F. Villacampa 3 , G. Velasco 4 , J. Benitez 5 ,
C. Rodriguez 6 , M. Calderon 2 , I. Cañamares 7 , H. Cortes-Funes 1 ,
D.E. Castellano 1
1 Servicio De Oncologia Medica, University Hosptial 12 De Octubre Medical
Oncology, Madrid, SPAIN, 2 Medical Oncology, Hospital Universitario 12 de
Octubre, Madrid, SPAIN, 3 Urology- Urooncology Unit, Hospital Universitario 12
de Octubre, Madrid, SPAIN, 4 Medical Oncology, Hopital 12 de Octubre, Madrid,
SPAIN, 5 Clinical Pharmacology & Pharmacogenetics, University of Extremadura
Medical School & Infanta Cristina University Hospital, Badajoz, SPAIN, 6 Biology,
Centro Nacional de Investigaciones Científicas, Madrid, SPAIN, 7 Pharmacy,
Hospital Universitario 12 de Octubre, Madrid, SPAIN
Background: Sunitinib (SU) is a multi-targeted receptor tyrosine kinase inhibitor
that is approved for the treatment of renal cell carcinoma (RCC). However, several
patients either do not respond to treatment or they experience significant toxicity.
Our study aims to find genetic markers of toxicity and efficacy using a commercially
available DNA microarray genotyping system.
Methods: 30 patients with newly diagnosed metastatic RCC, from January 2010 to
May 2011, were evaluated prospectively at Hospital 12 de Octubre (Madrid, Spain).
Pts received SU in repeated 6-wk cycles of 50 mg/day (4 wks on followed by 2 wks
off treatment). A total of 92 of single nucleotide polymorphisms (SNPs) in 34 genes
in the pharmacokinetic and pharmacodynamic pathways of drugs were analyzed
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds399 | ix281