How clinical practice is changing the rules: the sunitinib 2/1 schedule in metastatic renal cell carcinoma. Issue 3 (4th March 2017)

• Record Type: Journal Article
• Authors: Bracarda, Sergio; Negrier, Sylvie; Casper, Jochen; Porta, Camillo; Schmidinger, Manuela; Larkin, James; Gross Goupil, Marine; Escudier, Bernard
• Is Part Of: Expert review of anticancer therapy. Volume 17:Issue 3(2017)
• Page Start: 227
• Page End: 233
• Publication Date: 2017-03-04
• Subjects: Angiogenesis inhibitors -- renal cell carcinoma -- standard of care -- sunitinib -- dose schedule; Cancer -- Treatment -- Periodicals; 616.99406
• DOI: 10.1080/14737140.2017.1276830
• Languages: English
• ISSNs: 1473-7140

Abstract

ABSTRACT: Introduction : Currently, sunitinib is a standard of care in first-line treatment for metastatic renal cell carcinoma (mRCC). However, with the standard 4/2 schedule (sunitinib 50 mg/day; 4 consecutive weeks on treatment; 2 weeks' rest), 50% of patients require dose reductions to mitigate toxicity, highlighting the need to investigate alternative dosing schedules that improve tolerability without compromising efficacy. Areas covered : We present a concise critical review of published studies comparing the efficacy and safety of the 4/2 and 2/1 schedule (2 weeks on treatment; 1 week rest) for sunitinib. While all studies evaluating the 2/1 schedule have a low level of evidence, the results indicate that the 2/1 schedule improves tolerability compared with the 4/2 schedule, including significant reductions in the incidence of specific adverse events. It was not possible to make any definitive conclusions regarding efficacy due to methodologic limitations of these studies. Expert commentary : In the absence of strong evidence supporting the safety and efficacy of the 2/1 schedule, we recommend that patients should be initiated on sunitinib therapy with the standard 4/2 schedule and only be switched to the 2/1 schedule after the development of dose-limiting toxicities from weeks 3–4 (cycle 1) of the 4/2 schedule cycle.