A Phase II Trial of Sunitinib in Patients With Renal Cell Cancer and Untreated Brain Metastases

Chevreau, Christine; Ravaud, Alain; Escudier, Bernard; Amela, Eric Yaovi; Delva, R.; Rolland, Frédéric; Tosi, Diego; Oudard, Stéphane; Blanc, Ellen; Ferlay, Céline; Négrier, Sylvie

doi:10.1016/j.clgc.2013.09.008

Cited by 74 publications

(43 citation statements)

References 9 publications

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“…114 Conversely, in a small phase II study of 16 patients with untreated brain metastases receiving sunitinib, 5 patients had SD only. 115 A synergism between targeted therapies and SRS has been suggested. 116 Supportive care: This section can be found in the Supplementary material.…”

Section: Renal Cell Carcinomamentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

422

338

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The management of patients with brain metastases has become a major issue due to the increasing frequency and complexity of the diagnostic and therapeutic approaches. In 2014, the European Association of NeuroOncology (EANO) created a multidisciplinary Task Force to draw evidence-based guidelines for patients with brain metastases from solid tumors. Here, we present these guidelines, which provide a consensus review of evidence and recommendations for diagnosis by neuroimaging and neuropathology, staging, prognostic factors, and different treatment options. Specifically, we addressed options such as surgery, stereotactic radiosurgery/stereotactic fractionated radiotherapy, whole-brain radiotherapy, chemotherapy and targeted therapy (with particular attention to brain metastases from non-small cell lung cancer, melanoma and breast and renal cancer), and supportive care. Key wordsbrain metastases | chemotherapy | neuroimaging | neuropathology | stereotactic radiosurgery/stereotactic fractionated radiotherapy | supportive care | surgery | targeted therapy | whole-brain radiation therapy

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Section: Renal Cell Carcinomamentioning

confidence: 99%

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Soffietti

Abacıoğlu²,

Baumert³

et al. 2017

Neuro-Oncology

422

338

View full text Add to dashboard Cite

show abstract

“…The usual total whole brain radiation dose used to treat brain metastases in this fractionation is 35–37.5 Gy. The addition of sunitinib to 25 Gy in 2.5-Gy fractions may have stabilized intracranial disease that may have been undertreated by radiation, since sunitinib use has been reported to stabilize[11] progression of or delay in appearance[12] of brain metastases by some, but not others[13]. …”

Section: Discussionmentioning

confidence: 99%

Positive Interaction between Prophylactic Cranial Irradiation and Maintenance Sunitinib for Untreated Extensive-Stage Small Cell Lung Cancer Patients After Standard Chemotherapy: A Secondary Analysis of CALGB 30504 (ALLIANCE)

Salama

Wang

et al. 2016

Journal of Thoracic Oncology

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Background Prophylactic cranial irradiation (PCI) has become a standard option for extensive stage small cell lung cancer (ES-SCLC) patients. CALGB 30504 was a randomized phase II study of sunitinib vs placebo in ES-SCLC patients responding to platinum-based therapy requiring pre-enrollment brain imaging. PCI was at the discretion of treating physicians. We performed a secondary analysis of CALGB 30504 to determine the impact of PCI on ES-SCLC patients. Methods Fisher’s exact and Wilcoxon rank-sum tests were conducted to test the differences between PCI and non-PCI patients. Kaplan-Meier analyses described PFS and OS for PCI and non-PCI patients. Results 85 patients received maintenance (41 placebo, 44 sunitinib). 41 received PCI, 44 did not. Characteristics were balanced between PCI and no-PCI patients. PCI patients receiving sunitinib had non-significant 2.7-month PFS improvement (5.0 months vs. 2.3 months, p=0.14, HR=0.62 (95% CI: 0.33–1.18)), trending toward improved OS (8.9 months vs. 5.4 months, p=0.053, HR: 0.47 (0.22–1.03)). PCI was associated with a trend toward improved median PFS (2.9 months vs. 2.2 months, p=0.096, HR=0.69 (95% CI 0.45–1.07)), but not median OS (PCI 8.3 months vs. no PCI 8.7 months, p=0.76, HR=1.07 (95% CI 0.67–1.71)). Placebo patients had no PFS or OS difference. Conclusions Trends for improved PFS and OS were seen in patients receiving PCI and sunitinib supporting the need for further prospective research evaluating the integration of maintenance systemic therapy and PCI in ES-SCLC. Improved outcomes for ES-SCLC patients after induction chemotherapy may require PCI and systemic therapy to achieve control of both intracranial and extracranial disease.

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“…A small, single arm Phase II study investigated the impact of sunitinib in patients with newly diagnosed BM. However, no intracranial responses were observed, indicating that targeted therapies alone might only have minor impact in newly diagnosed BM of renal cell carcinoma [78]. Some small case series further postulate efficacy of the VEFG antibody bevacizumab in patients with BM from renal cell carcinoma [79,80].…”

Section: • • Targeted Therapy Approaches In Melanoma Brain Metastasesmentioning

confidence: 95%

The Future of Targeted Therapies for Brain Metastases

Berghoff

2015

Future Oncol.

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Brain metastases (BM) are an increasing challenge in the management of patients with advanced cancer. Treatment options for BM are limited and mainly focus on the application of local therapies. Systemic therapies including targeted therapies are only poorly investigated, as patients with BM were frequently excluded from clinical trials. Several targeted therapies have shown promising activity in patients with BM. In the present review we discuss existing and emerging targeted therapies for the most frequent BM primary tumor types. We focus on challenges in the conduction of clinical trials on targeted therapies in BM patients such as patient selection, combination with radiotherapy, the obstacles of the blood-brain barrier and the definition of study end points.

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A Phase II Trial of Sunitinib in Patients With Renal Cell Cancer and Untreated Brain Metastases

Abstract: Although tolerability was acceptable in RCC patients with previously untreated BM, sunitinib has limited efficacy in this setting.

Cited by 74 publications

References 9 publications

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO)

Positive Interaction between Prophylactic Cranial Irradiation and Maintenance Sunitinib for Untreated Extensive-Stage Small Cell Lung Cancer Patients After Standard Chemotherapy: A Secondary Analysis of CALGB 30504 (ALLIANCE)

The Future of Targeted Therapies for Brain Metastases

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