Efficacy and Safety of Individualized Schedule of Sunitinib by Drug Monitoring in Patients with Metastatic Renal Cell Carcinoma

Xudong Zhu; Xingming Zhang; Guangxi Sun; Zhenhua Liu; Haoran Zhang; Yaojing Yang; Yuchao Ni; Jindong Dai; Sha Zhu; Junru Chen; Jinge Zhao; Zhipeng Wang; Hao Zeng; Pengfei Shen

doi:10.2147/CMAR.S327029

Efficacy and Safety of Individualized Schedule of Sunitinib by Drug Monitoring in Patients with Metastatic Renal Cell Carcinoma

Cancer Manag Res. 2021 Aug 31:13:6833-6845. doi: 10.2147/CMAR.S327029. eCollection 2021.

Authors

Xudong Zhu^#^{1

2}, Xingming Zhang^#^{1

2}, Guangxi Sun^#^{1

2}, Zhenhua Liu^#^{1

2}, Haoran Zhang^{1

2}, Yaojing Yang^{1

2}, Yuchao Ni^{1

2}, Jindong Dai^{1

2}, Sha Zhu^{1

2}, Junru Chen^{1

2}, Jinge Zhao^{1

2}, Zhipeng Wang^{1

2}, Hao Zeng^{1

2}, Pengfei Shen^{1

2}

Affiliations

¹ Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
² Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: To investigate the survival benefit and safety of individualized schedules for sunitinib in patients with metastatic renal cell carcinoma (mRCC) through plasma concentration monitoring.

Methods: A total of 105 patients with mRCC were enrolled. The schedule was adjusted in two ways: therapeutic drug monitoring (TDM) and toxicity-adjusted schedule (TAS). One group of patients were without any schedule adjustment (maintained schedule, MAS). Progression-free survival (PFS), overall survival (OS), tumor response, and adverse events (AEs) were compared. The relationship between AEs and steady-state concentration or consecutive monitoring curves was explored. Further monitoring of individualized schedules was also conducted.

Results: Based on the plasma concentration, the schedules of 18 patients were adjusted in the TDM group. The schedules were adjusted in 37 patients due to severe AEs in the TAS group, while 50 patients were without any schedule adjustment. The median PFS and OS were better in the TDM group than the other two groups (p = 0.001 and p = 0.004, respectively). Univariate and multivariate analyses indicated that TDM could decrease the risk of death independently (p = 0.026). Moreover, the incidence of grades 3/4 AEs decreased from 88.9% to 33.3% in the TDM group (p = 0.001). Sunitinib concentration in 150-200ng/mL was regarded as a "transitional zone" due to severe AEs mainly happened when concentration elevated over it. After TDM, further plasma concentration monitoring indicated that individualized schedules enabled sunitinib concentration to fluctuate in a much safer range.

Conclusion: Treatment-related toxicities could be minimized through plasma concentration monitoring. Patients with adjusted schedules by therapeutic drug monitoring could achieve better survival benefits.

Keywords: clinical outcomes; individualized schedule adjustment; metastatic renal cell carcinoma; plasma concentration; sunitinib.

Grants and funding

This work was supported by the Science and Technology Support Program of Sichuan Province (2021YFS0119), National Natural Science Foundation of China (NSFC 81974398, 81872107, and 81902577) and 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No.0040205301E21).