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, 03/19/2012

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


  • 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.


  • 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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