Badran Ahmed, Elshenawy Mahmoud A, Shahin Amgad, Aljubran Ali, Alzahrani Ahmed, Eldali Abdelmoneim, Bazarbashi Shouki
Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
JCO Glob Oncol. 2020 Feb;6:19-26. doi: 10.1200/JGO.19.00111.
Antiangiogenic tyrosine kinase inhibitors have been the mainstay first-line therapy for metastatic renal cell carcinoma (mRCC). We reviewed the efficacy of first-line therapy with sunitinib in patients with mRCC in an Arab population.
Medical records of patients with mRCC treated at a tertiary care center in Saudi Arabia, during the period from 2007 to 2016, were reviewed. Demographic data, treatment received, response, and prognostic factors were analyzed.
Fifty-five patients who received sunitinib were identified. The median age was 60 years (range, 18 to 78 years), and 42 of the 55 patients were men (76.3%). International Metastatic RCC Diagnostic Consortium prognostic scores for favorable/intermediate/poor were 14.5%/43.6%/38.2%, respectively. The median performance status was 1, and the median Charlson comorbidity index score was 9. Thirty-seven patients (67.2%) had cytoreductive nephrectomy. Thirty-seven patients (67.2%) had clear cell histology. Twenty-two patients (40%) underwent dose reduction. Twenty-seven patients (49%) received second-line therapy, and seven patients (12.7%) received third-line therapy. Response rates were complete response in one patient (1.8%), partial response in 17 (30.9%), stable disease in 10 (18.1), and disease progression in 20 (36.3%). Progression-free survival (PFS) and overall survival (OS) were 6.0 and 24.7 months, respectively. Univariate analysis showed statistically improved PFS for dose reduction ( = .015) and the development of hypothyroidism ( = .03). It also showed statistically improved OS for dose reduction ( = .035), hypothyroidism ( = .0002), and cytoreductive nephrectomy ( = .0052). Multivariate analysis showed statistically improved PFS for dose reduction ( = .01) and OS for development of hypothyroidism ( = .007).
Our data for sunitinib in mRCC show significantly lower PFS than expected. The absence of prognostic value of the International Metastatic RCC Diagnostic Consortium scoring system and pathologic subtype warrant further investigation and possible inclusion of genetic scoring in this ethnic group of patients.
抗血管生成酪氨酸激酶抑制剂一直是转移性肾细胞癌（mRCC）的一线主要治疗方法。我们回顾了舒尼替尼一线治疗阿拉伯人群mRCC患者的疗效。
回顾了2007年至2016年期间在沙特阿拉伯一家三级医疗中心接受治疗的mRCC患者的病历。分析了人口统计学数据、接受的治疗、反应和预后因素。
确定了55例接受舒尼替尼治疗的患者。中位年龄为60岁（范围18至78岁），55例患者中有42例为男性（76.3%）。国际转移性RCC诊断联盟有利/中等/不良预后评分分别为14.5%/43.6%/38.2%。中位体能状态为1，中位查尔森合并症指数评分为9。37例患者（67.2%）接受了减瘤性肾切除术。37例患者（67.2%）为透明细胞组织学。22例患者（40%）接受了剂量减少。27例患者（49%）接受了二线治疗，7例患者（12.7%）接受了三线治疗。反应率为1例患者完全缓解（1.8%），17例部分缓解（30.9%），10例病情稳定（18.1%），20例病情进展（36.3%）。无进展生存期（PFS）和总生存期（OS）分别为6.0个月和24.7个月。单因素分析显示，剂量减少（P = 0.015）和甲状腺功能减退的发生（P = 0.03）使PFS有统计学意义的改善。还显示剂量减少（P = 0.035）、甲状腺功能减退（P = 0.0002）和减瘤性肾切除术（P = 0.0052）使OS有统计学意义的改善。多因素分析显示，剂量减少使PFS有统计学意义的改善（P = 0.01），甲状腺功能减退的发生使OS有统计学意义的改善（P = 0.007）。
我们关于舒尼替尼治疗mRCC的数据显示，PFS明显低于预期。国际转移性RCC诊断联盟评分系统和病理亚型缺乏预后价值，需要进一步研究，并可能在该种族患者中纳入基因评分。
