Prognostic and Predictive Value of Hematologic Parameters inPatients with Metastatic Renal Cell Carcinoma: Second LineSunitinib Treatment Following IFN-alpha

Background: Long-term survival is a problem with locally advanced and metastatic renal cell carcinomas.Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor, but data on sunitinib use as a second linetreatment in metastatic renal cell carcinoma (mRCC) are limited. Prognostic and predictive value of peripheralblood markers has been shown for many cancers. Materials and
Methods: Efficacy and safety profiles ofsunitinib after interferon alpha (IFN-α) were evaluated based on retrospective data for 23 patients with mRCC.Hematological parameters (neutrophils, lymphocytes, platelets, mean platelet volume, neutrophil/lymphocyteratio, platelet/lymphocyte ratio) were recorded at the time of metastasis. It was evaluated whether hematologicalparameters were prognostic and predictive factors.
Results: Median progression-free survival (PFS) time was16.5 months (95%CI: 0-34.5). Median overall survival (OS) time was 25.7 months (95%CI: 10.8-40.0). Mostcommon side effects were neutropenia (52.2%), stomatitis (26.1%) and hand-food syndrome (26.1%). PFS wasfound 3.13 vs 17.1 months in patients with neutrophil / lymphocyte ratio (NLR)>3 vs NLR≤3 (p:0.012). MedianOS was 6.96 vs 27.1 months in patients with NLR>3 vs NLR≤3 (p:0.001).While 75% of patients who respondedto sunitinib had NLR≤3, in 72% of patients with no response to sunitinib NLR>3 was detected (p:0.036). Theassociation between the Memorial Sloan-Kettering Cancer Center (MSKCC) criteria and NLR was statisticallysignificant (p:0.022).
Conclusions: Data on second line sunitinib treatment following cytokine in mRCC arelimited. In our study, we observed second line sunitinib treatment following IFN-α to be effective and tolerable.NLRappeared to have prognostic and predictive value.