PMID- 34512023 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220426 IS - 1179-1322 (Print) IS - 1179-1322 (Electronic) IS - 1179-1322 (Linking) VI - 13 DP - 2021 TI - Efficacy and Safety of Individualized Schedule of Sunitinib by Drug Monitoring in Patients with Metastatic Renal Cell Carcinoma. PG - 6833-6845 LID - 10.2147/CMAR.S327029 [doi] AB - PURPOSE: To investigate the survival benefit and safety of individualized schedules for sunitinib in patients with metastatic renal cell carcinoma (mRCC) through plasma concentration monitoring. METHODS: A total of 105 patients with mRCC were enrolled. The schedule was adjusted in two ways: therapeutic drug monitoring (TDM) and toxicity-adjusted schedule (TAS). One group of patients were without any schedule adjustment (maintained schedule, MAS). Progression-free survival (PFS), overall survival (OS), tumor response, and adverse events (AEs) were compared. The relationship between AEs and steady-state concentration or consecutive monitoring curves was explored. Further monitoring of individualized schedules was also conducted. RESULTS: Based on the plasma concentration, the schedules of 18 patients were adjusted in the TDM group. The schedules were adjusted in 37 patients due to severe AEs in the TAS group, while 50 patients were without any schedule adjustment. The median PFS and OS were better in the TDM group than the other two groups (p = 0.001 and p = 0.004, respectively). Univariate and multivariate analyses indicated that TDM could decrease the risk of death independently (p = 0.026). Moreover, the incidence of grades 3/4 AEs decreased from 88.9% to 33.3% in the TDM group (p = 0.001). Sunitinib concentration in 150-200ng/mL was regarded as a "transitional zone" due to severe AEs mainly happened when concentration elevated over it. After TDM, further plasma concentration monitoring indicated that individualized schedules enabled sunitinib concentration to fluctuate in a much safer range. CONCLUSION: Treatment-related toxicities could be minimized through plasma concentration monitoring. Patients with adjusted schedules by therapeutic drug monitoring could achieve better survival benefits. CI - (c) 2021 Zhu et al. FAU - Zhu, Xudong AU - Zhu X AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Zhang, Xingming AU - Zhang X AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Sun, Guangxi AU - Sun G AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Liu, Zhenhua AU - Liu Z AUID- ORCID: 0000-0003-1926-6020 AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Zhang, Haoran AU - Zhang H AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Yang, Yaojing AU - Yang Y AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Ni, Yuchao AU - Ni Y AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Dai, Jindong AU - Dai J AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Zhu, Sha AU - Zhu S AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Chen, Junru AU - Chen J AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Zhao, Jinge AU - Zhao J AUID- ORCID: 0000-0002-2790-462X AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Wang, Zhipeng AU - Wang Z AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Zeng, Hao AU - Zeng H AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. FAU - Shen, Pengfei AU - Shen P AUID- ORCID: 0000-0002-0370-0411 AD - Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. AD - Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China. LA - eng PT - Journal Article DEP - 20210831 PL - New Zealand TA - Cancer Manag Res JT - Cancer management and research JID - 101512700 PMC - PMC8418361 OTO - NOTNLM OT - clinical outcomes OT - individualized schedule adjustment OT - metastatic renal cell carcinoma OT - plasma concentration OT - sunitinib COIS- All authors declared that there were no potential conflicts of interest. EDAT- 2021/09/14 06:00 MHDA- 2021/09/14 06:01 PMCR- 2021/08/31 CRDT- 2021/09/13 06:38 PHST- 2021/07/03 00:00 [received] PHST- 2021/08/17 00:00 [accepted] PHST- 2021/09/13 06:38 [entrez] PHST- 2021/09/14 06:00 [pubmed] PHST- 2021/09/14 06:01 [medline] PHST- 2021/08/31 00:00 [pmc-release] AID - 327029 [pii] AID - 10.2147/CMAR.S327029 [doi] PST - epublish SO - Cancer Manag Res. 2021 Aug 31;13:6833-6845. doi: 10.2147/CMAR.S327029. eCollection 2021.