Sunitinib in patients with favorable and intermediate risk metastatic renal cell carcinoma – Lithuanian National Cancer Institute experience

Abstract Introduction and Objectives Sunitinib, according to the European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network (NCCN) recommendations, is one of the recommended regimens for favorable and intermediate risk metastatic renal cell carcinoma (mRCC) patients. Our objective was to evaluate sunitinib efficacy as a first-line treatment for mRCC patients with favorable / intermediate prognostic risk in a real-world setting. Materials and Methods Patients with diagnosed mRCC and confirmed as appropriate candidates for the first-line systemic treatment were included in the retrospective study. The prognostic risk was evaluated according to the model of International Metastatic RCC Database Consortium (IMDC). Patients received sunitinib as a first-line treatment. Results A total of 94 patients were enrolled from 2019 to the 2020 year. 67 patients were included for the detailed analysis. The median age at diagnosis was 62 years. Majority of patients had clear cell renal carcinoma with prior nephrectomy. Half of patients had more than 3 metastatic sites. Metastasectomy was performed for one third of the patients. Median progression-free survival (PFS) was 23.4 (95% CI: 17.3-29.5), and median overall survival (OS) was 66 months (95% CI: 44.9-87.1). The age over 60 years was significant negative predictor for PFS and OS. Regarding IMDC model for disease risk prediction, the number of two risk factors in the intermediate risk group was a significant predictor for a shorter response to the first-line therapy. Conclusion In everyday clinical practice, sunitinib is an effective systemic therapy for favorable/intermediate risk groups mRCC patients. This tyrosine kinase inhibitor (TKI) can be used as a first-line treatment in this group of patients, especially in countries where novel systemic treatment modalities are not available yet.