Dose escalation of second-line sunitinib results in rapid partial remission of multiple hepatic metastases

Abstract

A 58-year-old man with metastatic clear cell renal cell carcinoma on sunitinib therapy, who previously failed on sorafenib, was found to have progression of multiple hepatic metastases; he was on a standard sunitinib dose of 50 mg/day (4 weeks on, 2 weeks off). Due to the unavailability of alternative therapies, a sunitinib dose escalation of 50 mg/day was attempted. After one 6-week cycle of continuously dosed sunitinib 50 mg, the hepatic lesions regressed. After the second cycle, virtual disappearance of the lesions was recorded. There was no added toxicity. These findings suggest that sunitinib dose escalation to 50 mg/day using continuous daily administration dosing might represent a valid, effective and well-tolerated therapeutic option in patients who progress on standard sunitinib therapy.

Fig. 1.

Axial computed tomography (CT) scans of the patient before sunitinib induction therapy, demonstrating the primary renal tumour(*), pleural carcinomitosis of the lung (A) and liver (C) compared to the scans after 18 months of a standard sunitinib dose of 50 mg/day (4 weeks on, 2 weeks off) demonstrating virtual resolution of the lung (B) and liver (D) metastases. A: Axial CT-Scan before sunitinib induction therapy demonstrating pleural carcinomitosis of the lung; B: Axial CT-Scan after 18 months of standard sunitinib demonstrating virtual resolution of the pleural carcinomitosis of the lung; C: Axial CT-Scan before sunitinib induction demonstrating liver and retroperitoneal metastases; D: Axial CT-Scan after 18 months of standard sunitinib and a cytoreductive nephrectomy demonstrating virtual resolution of the liver metastases and removal of the primary tumour.

Fig. 2.

Axial and coronal computed tomography (CT) scans of the patient after 24 months of a standard sunitinib dose of 50 mg/day (4 weeks on, 2 weeks off) demonstrating hepatic metastases (A and C) and after one 6-week cycle of sunitinib dose escalation, 50 mg/day delivered in continuous form, demonstrating virtual resolution of hepatic metastases (B and D). A: Axial CT-Scan before sunitinib dose-escalation demonstrating the presence of hepatic metastases; B: Axial CT-Scan after 6-week cycle of sunitinib dose escalation demonstrating virtual resolution of hepatic metastases; C: Coronal CT-Scan before sunitinib dose escalation demonstrating the presence of hepatic metastases ; D: Coronal CT-Scan after 6-week cycle of sunitinib dose escalation demonstrating virtual resolution of hepatic metastases.