Sunitinib for Treatment of Advanced Renal Cell Cancer: Primary Tumor Response

• Published in: Clinical cancer research Vol. 14; no. 8; pp. 2431 - 2436
• Main Authors: VAN DER VELDT, Astrid A. M, MEIJERINK, Martijn R, VAN DEN EERTWEGH, Alfons J. M, BEX, Axel, DE GAST, Gijsbert, HAANEN, John B. A. G, BOVEN, Epie
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 15-04-2008
• Subjects: Aged; Antineoplastic agents; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - drug therapy; Female; Humans; Indoles - therapeutic use; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - drug therapy; Kidneys; Male; Medical sciences; Middle Aged; Nephrectomy; Nephrology. Urinary tract diseases; Pharmacology. Drug treatments; primary tumor; Pyrroles - therapeutic use; renal cell cancer; sunitinib; Tomography, X-Ray Computed; Tumors of the urinary system; Kidney disease; Urinary system disease; Carcinoma; Enzyme; Tyrosine kinase inhibitor; Transferases; Enzyme inhibitor; Malignant tumor; Sunitinib; Treatment; Kidney cancer; Primary; Grawitz tumor; Advanced stage; Multikinase inhibitor; Protein-tyrosine kinase; Cancer
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-07-4089

Purpose: Nephrectomy before immunotherapy in patients with metastatic renal cell cancer (RCC) will improve patient outcome. In addition,
the primary tumor is known to be refractory to cytokines. Sunitinib is now approved for treatment of advanced RCC, but its
effect on the primary tumor has yet to be reported.
Experimental Design: All patients treated with sunitinib for advanced RCC without prior nephrectomy were reviewed and sequential computed tomography
scans were evaluated for response in the primary tumor as well as metastases according to Response Evaluation Criteria in
Solid Tumors. Volumes of primary tumors and central necrotic areas were measured with the perimeter method.
Results: Computed tomography scans were available for evaluation of response in 17 of 22 patients with a primary tumor in situ (1 patient with two primaries). According to Response Evaluation Criteria in Solid Tumors, 4 patients had a partial response,
12 had stable disease, and 1 had progressive disease. The one-dimensional longest diameter of the primary tumor correlated
with the volumetric measurements both at baseline and at the time of evaluation of response. Excluding the patient with progressive
disease, the median volume reduction was 31% associated with a median increase in the volume of necrosis of 39%. Three patients
underwent nephrectomy and tumors showed extensive necrotic areas next to small fields of vital tumor cells.
Conclusions: Sunitinib can induce a significant reduction in volume of primary renal cell tumors. Further trials need to address the role
of nephrectomy in advanced RCC patients on sunitinib treatment.