New therapeutic schedules of Sunitinib: Current evidence regarding the 2:1 scheme.Authors:
Ignacio Puche-Sanz, José Francisco Flores-Martín, Fernando Vázquez-Alonso, Juan Moreno-Jiménez y José Manuel Cózar-Olmo.
Arch. Esp. Urol. 2017; 70 (3): 336-341
Vol. 70, Number. 3, April 2017
INTRODUCTION: In 2006, sunitinib
approval by the FDA was a real revolution for the
treatment of metastatic renal cell carcinoma (mRCC).
However, considerable rates of dose reductions and
therapeutic suppressions with the standard regimen
(4:2) have forced the search for new schedule proposals
in order to optimize the balance between side effects
and oncologic efficacy. Among these new proposals,
the 2:1 scheme is the one that has generated more
OBJECTIVE: The objective of this paper is to make a
review and critical discussion of current evidence about
the new schedules of treatment with sunitinib.
METHODS: Unstructured review of the literature on the
various therapeutic regimens with sunitinib, making a
comparison in terms of progression-free survival (PFS),
overall survival (OS) and toxicity.
RESULTS: We summarize the data from all relevant
studies published to date comparing the standard 4:2
schedule versus the new 2:1. Most patients treated
with 2:1 scheme are grouped in three retrospective
observational studies and mostly correspond to patients
who were initially treated with a 4:2 scheme and then
moved to 2:1. A phase II randomized clinical trial
comparing 4:2 and 2:1 schemes from the beginning
has also been conducted. None of these studies found
significant differences between the two regimens in
terms of PFS or OS. Regarding the toxicity profile, the
2:1 scheme has proved to be more advantageous than
CONCLUSIONS: Despite the still limited amount of data,
current evidence supports the use of a 2:1 schedule, as
it provides patients substantial advantages because of
its better tolerability profile, without a loss in oncological
efficacy. Currently, the 2:1 scheme is an appropriate
alternative therapeutic strategy, especially in patients
with poor tolerance to the standard 4:2 regimen.
ONLY IN SPANISH.