1
|
Jonasch E, Slack RS, Geynisman DM, Hasanov E, Milowsky MI, Rathmell WK, Stovall S, Juarez D, Gilchrist TR, Pruitt L, Ornstein MC, Plimack ER, Tannir NM, Rini BI. Phase II Study of Two Weeks on, One Week off Sunitinib Scheduling in Patients With Metastatic Renal Cell Carcinoma. J Clin Oncol 2018; 36:1588-1593. [PMID: 29641297 DOI: 10.1200/jco.2017.77.1485] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Standard frontline treatment of patients with metastatic renal cell carcinoma currently includes sunitinib. A barrier to long-term treatment with sunitinib includes the development of significant adverse effects, including diarrhea, hand-foot syndrome (HFS), and fatigue. This trial assessed the effect of an alternate 2 weeks on, 1 week off (2/1) schedule of sunitinib on toxicity and efficacy in previously untreated patients with metastatic renal cell carcinoma. Methods Patients started with oral administration of 50 mg sunitinib on a 2/1 schedule and underwent schedule and dose alterations if toxicity developed. The primary end point was < 15% grade ≥ 3 fatigue, diarrhea, or HFS. With 60 patients, the upper bound of the CI would fall below the published 4/2 schedule grade ≥ 3 toxicity rate of 25% to 30%. Results Fifty-nine patients were treated between August 2014 and March 2016. Seventy-seven percent were intermediate or poor risk per Memorial Sloan Kettering Cancer Center criteria. With a median follow-up of 17 months, 25% of patients experienced grade 3 fatigue, HFS, or diarrhea; 37% required a dose reduction, and 10% discontinued because of toxicity. The overall response rate was 57%, median progression-free survival was 13.7 months, and median overall survival was not reached. At 12 weeks, Functional Assessment of Cancer Therapy-General scores dropped between 0% and 10% from baseline, with less reduction in patients who continued treatment longer. Conclusion The primary end point of decreased grade 3 toxicity was not met; however, treatment with a 2/1 sunitinib schedule is associated with a lack of grade 4 toxicity, a low patient discontinuation rate, and high efficacy.
Collapse
Affiliation(s)
- Eric Jonasch
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Rebecca S Slack
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Daniel M Geynisman
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Elshad Hasanov
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Matthew I Milowsky
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - W Kimryn Rathmell
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Summer Stovall
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Donna Juarez
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Troy R Gilchrist
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Lisa Pruitt
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Moshe C Ornstein
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Elizabeth R Plimack
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Nizar M Tannir
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Brian I Rini
- Eric Jonasch, Rebecca S. Slack, Summer Stovall, Donna Juarez, Troy R. Gilchrist, Lisa Pruitt, and Nizar M. Tannir, The University of Texas MD Anderson Cancer Center; Elshad Hasanov, The University of Texas Health Science Center, Houston, TX; Daniel M. Geynisman and Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Matthew I. Milowsky, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; W. Kimryn Rathmell, Vanderbilt Ingram Cancer Center, Nashville, TN; and Moshe C. Ornstein and Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| |
Collapse
|