Only physicians working as part of a multi-disciplinary team should prescribe Pfizer's Sutent (sunitinib malate) for renal cell cancer, say experts
speaking at the recent European Association of Urology congress held in
Prof Joaquim Bellmunt of the University Hospital del Mar, Barcelona, said:
“Targeted therapies need specialised treatment, and should be prescribed by medical oncologists working as part of a specialised multi-disciplinary team that meets regularly to discuss patients’ overall treatment.
“In the UK there’s not a great deal of experience with the newer, targeted
therapies in the urological cancers but there’s a need for all professionals
to work more closely together.”
Prof Bellmunt explained that the side effects seen with Sutent and other
tyrosine kinase inhibitors were milder than those associated with cytokine
therapy but they could be distressing to patients. As the newer therapies
are oral, and so self administered, it was crucial that patients were told
of potential side effects and actively managed.
“Early identification of adverse events and intervention is important so
that dose interruption or reduction can be avoided, as well as easing
patient’s discomfort,” said Prof Bellmunt. Side effects include fatigue, hypertension, hand and foot syndrome, GI, haematological and dermatological changes, and very rarely changes in left ventricular ejection fraction.
The EAU has just issued new guidelines that recommend Sutent as first line treatment in all patients with advanced and/or metastatic renal cell
carcinoma (mRCC). The advice is based on data that shows patients taking
Sutent had more than doubled prolonged progression-free survival (PFS)
compared to patients on interferon, which is known to work in only a small
proportion of patients with RCC.
Experts at the Congress hailed targeted therapies as a major advance in
mRCC. While they agreed that nephrectomy would remain gold standard for most patients with RCC Prof Jean-Jaques Patard from Rennes University
Hospital, France said: “Not all patients will benefit from nephrectomy and
we should go straight to systemic treatment.” He added that despite a lack
of evidence regarding adjuvant treatment for RCC the positive data for
tyrosine kinase inhibitors made them a logical choice for adjuvant
treatment. By Maya Anaokar