NCCS pioneers new drug regimen which reduces toxicities for renal cancer patients

A study led by the Genitourinary (GU) oncology team at National Cancer Centre Singapore (NCCS) has revealed conclusive results in reducing toxicities for Asian patients with metastatic renal cell carcinoma (mRCC) or cancer that has spread beyond the kidney.

The seven-year study began in 2007 and the findings revolutionised the standard protocol for patient management in NCCS with an attenuated-dose regimen of sunitinib for patients with mRCC.

The new treatment regimen for sunitinib has been accepted by oncologists in Singapore. For the patients, this would mean an estimated 30 per cent reduction in fees because of the lower dosage. The median overall survival rate (OStotal) was 27.4 as compared to 21.8 months among patients receiving the attenuated dosage.

Sunitinib was introduced as a treatment for mRCC in Singapore since early 2005. The U.S. Food and Drug Administration (FDA) approved dosing of sunitinib is 50mg once daily for four weeks, followed by a two-week break in a six-week treatment cycle (conventional-doseregimen). Subsequent findings from 2005 to 2006 show that high toxicities were observed with the conventional dosing, especially in Asians.

"Many of the patients were experiencing severe side effects of grade 3 or higher with the conventional dosing. Our immediate response was to refine the treatment protocol to improve patients' quality of life", explained Dr Tan Min Han, Visiting Consultant, Division of Medical Oncology and member of the GU team, NCCS.

NCCS initiated a prospective clinical registry with 127 mRCC patients receiving attenuated sunitinib dosing of 37.5mg/d/4/2 (37.5mg of sunitinib once daily for four weeks, followed by a two-2 week break) as treatment protocol in 2007. Clinical data of patients receiving sunitinib at NCCS from 2005 to 2012 and three other tertiary centres in Singapore (Johns Hopkins-International Medical Centre, National University Hospital Singapore, and Onco-Care of Gleneagles Medical Centre) from 2005 to 2009 were used for comparison, representing at least 90 percent of all patients with mRCC treated over the period.

Kidney Cancer Facts

The American Cancer Society estimates that more than 58,240 people were diagnosed with kidney cancer in 2010. In the 1980s, up to 80% of kidney cancers were in advanced stages when they were diagnosed. Today, thanks to more advanced detection methods, only about 40% of cases are advanced at diagnosis.

You have two kidneys, one on each side of the back above the waist. Kidneys filter blood, and the waste is carried in the urine, which is produced by microscopic tubules. Urine flows into the ureter tubes and down into the bladder. Cancer arises from the microscopic tubules inside the kidney. Although kidney cancer usually grows as a single mass within the kidney, a kidney may contain more than one tumor, or tumors may be found in both kidneys.