Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, 22030, Edirne, Turkey.
Department of Radiology, Trakya University School of Medicine, Edirne, Turkey.
Cancer Chemother Pharmacol. 2019 Apr;83(4):735-742. doi: 10.1007/s00280-019-03779-5. Epub 2019 Jan 24.
To evaluate whether sunitinib and pazopanib treatments are associated with change in skeletal muscle area (SMA) and total lean body mass (LBM) as well as to compare their efficacies and safety profiles in patients with metastatic renal cell cancer (mRCC).
Thirty-six patients treated with a tyrosine kinase inhibitor were included. Eighteen of them received sunitinib and the rest/remaining received pazopanib in the first line of mRCC treatment. Baseline and follow-up computed tomography studies of the patients were performed to measure cross-sectional areas (cm) of muscle tissues.
About 69% of patients were male and median age was 60 (49-68) years. Median time interval between two CT imagings was 6.1 (3.1-7.7) months and it was similar between the two groups (for sunitinib, 4.9 (2.5-6.9) months vs for pazopanib, 7.3 (3.2-9.5) months, p = 0.16, respectively). Disease control rate was 77.7% in all patients. Of these, 66.6% in sunitinib group was consisted of four partial responses and eight stable diseases. In addition, 88.8% in pazopanib group was consisted of three partial responses and 13 stable diseases. A significant decrease in SMA and LBM was observed after sunitinib therapy, whereas SMA and LBM values of pazopanib group did not change significantly (p = 0.02 and p = 0.70, respectively). No significant differences were observed between patients with sunitinib, and pazopanib group median PFS [11.9 (95% CI 6.1-17.6) vs 8.1 months (95% CI 7.2-9.1), respectively; p = 0.28] and median OS [28.6 (95% CI 24.3-32.9) vs 25.5 months (95% CI 18.9-52.7), respectively; p = 0.42]. Dose-limiting toxicities were significantly more frequent in sunitinib group than in pazopanib group (66.7% vs 22.2%, p = 0.02, respectively).
Loss of SMA and LBM with sunitinib was more substantial than with pazopanib. Treatment efficacies of both drugs were similar, but dose-limiting toxicity was more frequent in sunitinib group. Loss of SMA had no significant association with prognosis. Further studies are needed to clarify the possible association between SMA and prognosis in mRCC patients who receive sunitinib or pazopanib.
评估舒尼替尼和帕唑帕尼治疗是否与转移性肾细胞癌（mRCC）患者的骨骼肌面积（SMA）和总瘦体重（LBM）变化相关，并比较它们的疗效和安全性。
纳入了 36 名接受酪氨酸激酶抑制剂治疗的患者。其中 18 名接受舒尼替尼治疗，其余/剩余的患者接受帕唑帕尼作为 mRCC 一线治疗。对患者进行基线和随访的计算机断层扫描研究，以测量肌肉组织的横截面积（cm）。
约 69%的患者为男性，中位年龄为 60（49-68）岁。两次 CT 成像之间的中位时间间隔为 6.1（3.1-7.7）个月，两组之间相似（舒尼替尼组为 4.9（2.5-6.9）个月，帕唑帕尼组为 7.3（3.2-9.5）个月，p=0.16）。所有患者的疾病控制率为 77.7%。其中，舒尼替尼组中有 66.6%的患者包括 4 个部分缓解和 8 个稳定疾病。此外，帕唑帕尼组中有 88.8%的患者包括 3 个部分缓解和 13 个稳定疾病。舒尼替尼治疗后 SMA 和 LBM 明显下降，而帕唑帕尼组的 SMA 和 LBM 值无明显变化（p=0.02 和 p=0.70）。舒尼替尼组和帕唑帕尼组的中位无进展生存期[11.9（95% CI 6.1-17.6）与 8.1 个月（95% CI 7.2-9.1）；p=0.28]和中位总生存期[28.6（95% CI 24.3-32.9）与 25.5 个月（95% CI 18.9-52.7）；p=0.42]无显著差异。舒尼替尼组的剂量限制毒性明显多于帕唑帕尼组（66.7%比 22.2%，p=0.02）。
舒尼替尼治疗导致 SMA 和 LBM 的损失比帕唑帕尼更为显著。两种药物的治疗效果相似，但舒尼替尼组的剂量限制毒性更为频繁。SMA 的损失与预后无显著相关性。需要进一步研究以阐明接受舒尼替尼或帕唑帕尼治疗的 mRCC 患者中 SMA 与预后之间的可能关联。
