Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer

Ugo De Giorgi, Karim Rihawi, Michele Aieta, Giovanni Lo Re, Teodoro Sava, Cristina Masini, Valentina Baldazzi, Fabio De Vincenzo, Andrea Camerini, Giuseppe Fornarini, Luciano Burattini, Giovanni Rosti, Luca Moscetti, Vincenzo E. Chiuri, Stefano Luzi Fedeli, Vittorio Ferrari, Emanuela Scarpi, Dino Amadori, Umberto Basso

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Abstract

Objective: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. Patients and Methods: We reviewed the clinical records of 181 patients with mRCC aged ≥ 70. years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. Results: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥ 1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P. <0.0001 and P = 0.023, respectively). Conclusions: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.

Original languageEnglish
Pages (from-to)156-163
Number of pages8
JournalJournal of Geriatric Oncology
Volume5
Issue number2
DOIs
Publication statusPublished - 2014

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Lymphopenia
Renal Cell Carcinoma
Lymphocyte Count
sunitinib
Survival
Neutropenia
Disease-Free Survival
Diarrhea
Multivariate Analysis
Incidence

Keywords

  • Elderly
  • Lymphopenia
  • Metastatic renal cell cancer
  • Prognosis
  • Sunitinib

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Oncology
  • Medicine(all)

Cite this

Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer. / De Giorgi, Ugo; Rihawi, Karim; Aieta, Michele; Lo Re, Giovanni; Sava, Teodoro; Masini, Cristina; Baldazzi, Valentina; De Vincenzo, Fabio; Camerini, Andrea; Fornarini, Giuseppe; Burattini, Luciano; Rosti, Giovanni; Moscetti, Luca; Chiuri, Vincenzo E.; Luzi Fedeli, Stefano; Ferrari, Vittorio; Scarpi, Emanuela; Amadori, Dino; Basso, Umberto.

In: Journal of Geriatric Oncology, Vol. 5, No. 2, 2014, p. 156-163.

Research output: Contribution to journalArticle

De Giorgi, U, Rihawi, K, Aieta, M, Lo Re, G, Sava, T, Masini, C, Baldazzi, V, De Vincenzo, F, Camerini, A, Fornarini, G, Burattini, L, Rosti, G, Moscetti, L, Chiuri, VE, Luzi Fedeli, S, Ferrari, V, Scarpi, E, Amadori, D & Basso, U 2014, 'Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer', Journal of Geriatric Oncology, vol. 5, no. 2, pp. 156-163. https://doi.org/10.1016/j.jgo.2014.01.001
De Giorgi, Ugo ; Rihawi, Karim ; Aieta, Michele ; Lo Re, Giovanni ; Sava, Teodoro ; Masini, Cristina ; Baldazzi, Valentina ; De Vincenzo, Fabio ; Camerini, Andrea ; Fornarini, Giuseppe ; Burattini, Luciano ; Rosti, Giovanni ; Moscetti, Luca ; Chiuri, Vincenzo E. ; Luzi Fedeli, Stefano ; Ferrari, Vittorio ; Scarpi, Emanuela ; Amadori, Dino ; Basso, Umberto. / Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer. In: Journal of Geriatric Oncology. 2014 ; Vol. 5, No. 2. pp. 156-163.
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title = "Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer",
abstract = "Objective: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. Patients and Methods: We reviewed the clinical records of 181 patients with mRCC aged ≥ 70. years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. Results: Twenty-nine (16{\%}) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84{\%}) patients had a lymphocyte count ≥ 1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P. <0.0001 and P = 0.023, respectively). Conclusions: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.",
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T1 - Lymphopenia and clinical outcome of elderly patients treated with sunitinib for metastatic renal cell cancer

AU - De Giorgi, Ugo

AU - Rihawi, Karim

AU - Aieta, Michele

AU - Lo Re, Giovanni

AU - Sava, Teodoro

AU - Masini, Cristina

AU - Baldazzi, Valentina

AU - De Vincenzo, Fabio

AU - Camerini, Andrea

AU - Fornarini, Giuseppe

AU - Burattini, Luciano

AU - Rosti, Giovanni

AU - Moscetti, Luca

AU - Chiuri, Vincenzo E.

AU - Luzi Fedeli, Stefano

AU - Ferrari, Vittorio

AU - Scarpi, Emanuela

AU - Amadori, Dino

AU - Basso, Umberto

PY - 2014

Y1 - 2014

N2 - Objective: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. Patients and Methods: We reviewed the clinical records of 181 patients with mRCC aged ≥ 70. years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. Results: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥ 1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P. <0.0001 and P = 0.023, respectively). Conclusions: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.

AB - Objective: Lymphopenia is associated with toxicity and outcomes in several cancer types. We assessed the association between pre-treatment lymphopenia, toxicity, and clinical outcomes in elderly patients with metastatic renal cell cancer (mRCC) treated with first-line sunitinib. Prognostic factors in these patients were also evaluated. Patients and Methods: We reviewed the clinical records of 181 patients with mRCC aged ≥ 70. years treated with first-line sunitinib in 17 Italian Oncology Units from February 2006 to September 2011. Baseline lymphopenia was defined as lymphocyte counts <1000/μL. Results: Twenty-nine (16%) patients had a baseline lymphocyte count <1000/μL (group A) and 152 (84%) patients had a lymphocyte count ≥ 1000/μL (group B). Although no differences between the two groups were reported in terms of overall response rate (P = 0.207), dose reductions (P = 0.740), discontinuation due to adverse events (P = 0.175) or overall incidence of grade 3-4 toxicities (P = 0.112), more patients in the lymphopenia group had grade 3-4 neutropenia (P = 0.017), grade 3-4 thrombocytopenia (P = 0.017) and grade 3-4 diarrhea (P = 0.006). In multivariate analysis, performance status and Heng score were predictors of progression-free survival (P = 0.015 and P = 0.0006, respectively), while performance status, Heng score, and lymphopenia were found to be significantly associated with overall survival (P = 0.007, P. <0.0001 and P = 0.023, respectively). Conclusions: Sunitinib appears to be safe and active in elderly patients with lymphopenia. Lymphocyte count is an independent prognostic factor for overall survival in elderly patients with mRCC treated with first-line sunitinib.

KW - Elderly

KW - Lymphopenia

KW - Metastatic renal cell cancer

KW - Prognosis

KW - Sunitinib

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