Active smokingmay negatively affect response rate, progression-free survival, and overall survival of patients with metastatic renal cell carcinoma treatedwith sunitinib

Daniel Keizman, Maya Gottfried, Maya Ish-Shalom, Natalie Maimon, Avivit Peer, Avivit Neumann, Hans Hammers, Mario A. Eisenberger, Victoria Sinibaldi, Roberto Pili, Henry Hayat, Svetlana Kovel, Avishay Sella, Ben Boursi, Rony Weitzen, Wilmosh Mermershtain, Keren Rouvinov, Raanan Berger, Michael A. Carducci

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Obesity, smoking, hypertension, and diabetes are risk factors forrenal cell carcinomadevelopment.Theirpresence has been associated with a worse outcome in various cancers. We sought to determine their association with outcome of sunitinib treatment in metastatic renal cell carcinoma (mRCC). Methods. An international multicenter retrospective study of sunitinib-treated mRCC patients was performed. Multivariate analyses were performed to determine the association between outcome and the pretreatment status of smoking, body mass index, hypertension, diabetes, and other known prognostic factors. Results. Between 2004 and 2013, 278 mRCC patients were treated with sunitinib: 59 were active smokers, 67 were obese, 73 were diabetic, and 165 had pretreatment hypertension. Median progression-free survival (PFS) was 9 months, and overall survival (OS) was 22 months. Factors associated with PFS were smoking status (past and active smokers: hazard ratio [HR]: 1.17, p=.39; never smokers: HR: 2.94, p<.0001), non-clear cell histology (HR: 1.62, p =.011), pretreatment neutrophil-to-lymphocyte ratio.3 (HR: 3.51, p<.0001), use of angiotensin system inhibitors (HR: 0.63, p =.01), sunitinib dose reduction or treatment interruption (HR: 0.72, p=.045), and Heng risk (good and intermediate risk: HR: 1.07, p =.77; poor risk: HR: 1.87, p=.046). Factors associated with OS were smoking status (past and active smokers: HR: 1.25, p 5.29; never smokers: HR: 2.7, p<.0001), pretreatment neutrophilto- lymphocyte ratio.3 (HR: 2.95, p<.0001), and sunitinibinduced hypertension (HR: 0.57, p =.002). Conclusion. Active smoking may negatively affect the PFS and OS of sunitinib-treated mRCC. Clinicians should consider advising patients to quit smoking at initiation of sunitinib treatment for mRCC.

Original languageEnglish (US)
Pages (from-to)51-60
Number of pages10
JournalOncologist
Volume19
Issue number1
DOIs
StatePublished - Jan 22 2014

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Keywords

  • Active smoking
  • Metastatic renal cell carcinoma
  • Outcome
  • Sunitinib treatment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Keizman, D., Gottfried, M., Ish-Shalom, M., Maimon, N., Peer, A., Neumann, A., Hammers, H., Eisenberger, M. A., Sinibaldi, V., Pili, R., Hayat, H., Kovel, S., Sella, A., Boursi, B., Weitzen, R., Mermershtain, W., Rouvinov, K., Berger, R., & Carducci, M. A. (2014). Active smokingmay negatively affect response rate, progression-free survival, and overall survival of patients with metastatic renal cell carcinoma treatedwith sunitinib. Oncologist, 19(1), 51-60. https://doi.org/10.1634/theoncologist.2012-0335