First-line tyrosine kinase inhibitors in metastatic renal cell carcinoma: A regional cancer center experience.
BACKGROUND
Renal cell carcinoma (RCC) is highly resistant to systemic chemotherapy, and historically a poor prognosis for metastatic disease has been reported, with a 5-year survival rate of <10%. Significant advances have been made in the last decade since the introduction of different tyrosine kinase inhibitors (TKIs) such as sunitinib, pazopanib, and sorafenib. Unfortunately, even though the TKIs have been used for a long time, there are very few published data regarding the experience of TKI therapy in metastatic RCC (mRCC) from India.


MATERIALS AND METHODS
This is a single institutional review of mRCC patients treated between January 2012 and July 2017. Patients who received at least 1 month of first-line TKIs were included for analysis of response rates, toxicity, survival outcomes, and prognostic factors.


RESULTS
Of the 40 mRCC patients, 31 (77.5%) were males. Median age at diagnosis was 58 years (range: 38-80 years). The most common site of metastasis was lungs (n = 24) followed by bone (n = 19) and liver (n = 7). Three patients had favorable risk disease, whereas 25 had intermediate risk and 12 had poor risk disease according to the MSKCC risk criteria. First-line TKI therapy used was sunitinib in 24, pazopanib in 11, and sorafenib in 5 patients. Toxicities of TKIs were Grade 1 or 2 in 13 patients and Grade 3 or 4 in 9 patients; the most common being fatigue, followed by hand-foot syndrome, skin rash, mucositis, and hypertension. Overall, 29 patients (72.5%) had disease control (complete responses in 1, partial responses in 10, and stable disease in 18 patients), whereas 11 had progression of disease at initial evaluation. At a median follow-up of 16 months (range: 2-38 months), median progression-free survival (PFS) was 10.8 months and median overall survival was 19.1 months.


CONCLUSIONS
Sunitinib and pazopanib are viable first-line options for mRCC and showed a comparable PFS in Indian patients. Careful patient selection, tailoring of TKI doses, and careful toxicity management are essential for optimum therapy.
['Rudresha|A H|AH|', 'Chaudhuri|Tamojit|T|', 'Lakshmaiah|K C|KC|', 'Babu|Govind K|GK|', 'Lokanatha|D|D|', 'Jacob|Linu Abraham|LA|', 'Suresh Babu|M C|MC|', 'Lokesh|K N|KN|', 'Rajeev|L K|LK|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002292:Carcinoma, Renal Cell D018572:Disease-Free Survival D064420:Drug-Related Side Effects and Adverse Reactions D005260:Female D006801:Humans D007191:Indazoles D007194:India D007211:Indoles D008297:Male D008875:Middle Aged D016609:Neoplasms, Second Primary D009536:Niacinamide D010671:Phenylurea Compounds D047428:Protein Kinase Inhibitors D011743:Pyrimidines D011758:Pyrroles D000077157:Sorafenib D013449:Sulfonamides D000077210:Sunitinib
Metastatic renal cell carcinoma sunitinib pazopanib sorafenib