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Bisphosphonates combined with sunitinib may improve the response rate, progression free survival and overall survival of patients with bone metastases from renal cell carcinoma
European Journal of Cancer,  Clinical Article

Keizman D et al. – Bisphosphonates may improve the RR, PFS and OS of sunitinib treatment in RCC with bone metastases.

Methods

  • A multicentre retrospective study of patients with bone metastases from RCC treated with sunitinib was conducted.
  • The effect of bisphosphonates on RR, PFS and OS was tested with adjustment for known prognostic factors.

Results
  • Between 2004 and 2011, 209 patients with metastatic RCC were treated with sunitinib, 76 had bone metastases, 35 bisphosphonates users and 41 non-users.
  • Objective response was partial response/stable disease 86% (n=30) versus 71% (n=29), and progressive disease 14% (n=5) versus 29% (n=12) (p=0.125, OR 2.48) in users versus non-users, respectively.
  • Median PFS was 15 versus 5 months (HR=0.55, p<0.0001), and median OS was not reached (with a median follow-up time of 45months) versus 14months (HR=0.4, p=0.029), in favour of users.
  • In multivariate analysis of the entire patient cohort (n=76), factors associated with PFS were bisphosphonates use (HR=0.58, p=0.035), and pre-treatment neutrophil to lymphocyte ratio >3 (HR=3.5, p=0.009).
  • Factors associated with OS were bisphosphonates use (HR=0.5, p=0.008), elevated pre-treatment alkaline phosphatase (HR=2.9, p=0.003) and sunitinib induced HTN (HR=0.63, p<0.0001).

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