PD39-09: Does an alternative sunitinib dosing schedule really improve survival outcomes over a conventional dosing schedule in patients with metastatic renal cell carcinoma? An updated systematic review and meta-analysis

Doo Yong Chung, Beom-Yong Rho, Dong Hyuk Kang, Young Deuk Choi, Kang Soo Cho

Introduction: Treatment-related adverse events (AEs) can obfuscate the maintenance of a conventional schedule of sunitinib in patients with metastatic renal cell carcinoma(mRCCa). Accordingly, alternative schedules seeking to improve the safety profile of sunitinib have been tested. Recently, two meta-analyses similarly described improved safety profiles favoring a 2-weeks-on and 1-week-off (2/1) schedule, but conflicting results for survival outcomes. Therefore, we conducted an updated systematic review and meta-analysis including all recently published studies and using complementary statistical methods.

Methods: Systematic literature searches were conducted in PubMed/Medline and Embase for all studies that examined alternative treatment of sunitinib for mRCCa. We performed this study according to the Preferred Reported Items for Systematic Reviews and Meta-analysis guidelines. Endpoints included progression-free survival, overall survival, and AEs of 15 types. Eleven articles were included in this meta-analysis.

Results: Using adjusted findings, we noted statistically better results in progression-free survival (hazard ratio, 0.58; 95% confidence interval, 0.39-0.84; P=0.005), but no difference in overall survival (hazard ratio, 0.66; 95% confidence interval, 0.42-1.04; P=0.08). Moreover, 2/1 schedule was beneficial for reducing the incidence of several AEs. Conclusively, our meta-analysis suggests that /1 schedule holds promise as an alternative means of reducing AEs and maintaining patient quality of life.

Conclusions: Our meta-analysis suggests that alternative 2/1 sunitinib dosing schedule may have better PFS than conventional 4/2 sunitinib schedule. However, its level of evidence was very low, the interpretation of this result should be cautious. Moreover, the 2/1 schedule was beneficial for reducing the incidence of AEs. Accordingly, the 2/1 sunitinib dosing schedule holds promise as an alternative means of reducing AEs, maintaining patient QOL and prolonging treatment. Source of

Funding: There was no funding provided in the current research.