How clinical practice is changing the rules

the sunitinib 2/1 schedule in metastatic renal cell carcinoma

Sergio Bracarda, Sylvie Negrier, Jochen Casper, Camillo Porta, Manuela Schmidinger, James Larkin, Marine Gross Goupil, Bernard Escudier

Research output: Contribution to journalReview article

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalExpert Review of Anticancer Therapy
Volume17
Issue number3
DOIs
Publication statusPublished - Mar 4 2017

Fingerprint

Renal Cell Carcinoma
Appointments and Schedules
sunitinib
Safety
Therapeutics
Standard of Care
Incidence

Keywords

  • Angiogenesis inhibitors
  • dose schedule
  • renal cell carcinoma
  • standard of care
  • sunitinib

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

Cite this

Bracarda, S., Negrier, S., Casper, J., Porta, C., Schmidinger, M., Larkin, J., ... Escudier, B. (2017). How clinical practice is changing the rules: the sunitinib 2/1 schedule in metastatic renal cell carcinoma. Expert Review of Anticancer Therapy, 17(3), 227-233. https://doi.org/10.1080/14737140.2017.1276830

How clinical practice is changing the rules : the sunitinib 2/1 schedule in metastatic renal cell carcinoma. / Bracarda, Sergio; Negrier, Sylvie; Casper, Jochen; Porta, Camillo; Schmidinger, Manuela; Larkin, James; Gross Goupil, Marine; Escudier, Bernard.

In: Expert Review of Anticancer Therapy, Vol. 17, No. 3, 04.03.2017, p. 227-233.

Research output: Contribution to journalReview article

Bracarda, S, Negrier, S, Casper, J, Porta, C, Schmidinger, M, Larkin, J, Gross Goupil, M & Escudier, B 2017, 'How clinical practice is changing the rules: the sunitinib 2/1 schedule in metastatic renal cell carcinoma', Expert Review of Anticancer Therapy, vol. 17, no. 3, pp. 227-233. https://doi.org/10.1080/14737140.2017.1276830
Bracarda, Sergio ; Negrier, Sylvie ; Casper, Jochen ; Porta, Camillo ; Schmidinger, Manuela ; Larkin, James ; Gross Goupil, Marine ; Escudier, Bernard. / How clinical practice is changing the rules : the sunitinib 2/1 schedule in metastatic renal cell carcinoma. In: Expert Review of Anticancer Therapy. 2017 ; Vol. 17, No. 3. pp. 227-233.
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