Phase I Study of Dalteparin in Combination With Sunitinib in Patients With Metastatic Clear Cell Renal Carcinoma

Madelon Q. Wentink, Henk M.W. Verheul, Sumanta K. Pal, Saby George, Johannes Voortman, Pongwut Danchaivijitr, Remi Adelaiye, Diane Poslinski, Adrienne Groman, Alan Hutson, Roberto Pili

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Abstract

The processes of angiogenesis and coagulation are highly interconnected. This phase I trial investigated the TKI sunitinib in combination with the LMWH dalteparin in patients with metastatic renal cell carcinoma. In 3 dose cohorts and a separate expansion cohort, 17 patients were included. Combination treatment was safe and without increased incidence of bleeding events. Background: Based on the tumor-driven concomitant activation of angiogenesis and coagulation we conducted a phase I combination study of sunitinib with the low molecular weight heparin dalteparin in patients with metastatic clear cell renal cell carcinoma (ccRCC). Materials and Methods: Patients received standard treatment with sunitinib (50 mg daily, 4 weeks on, 2 weeks off). During the second week of no sunitinib in the first cycle (week 6) patients received dalteparin monotherapy (in escalating doses). Combination therapy of the 2 agents was administered from the second cycle onward. Seventeen patients were enrolled at 3 dose levels of dalteparin. Results: Diarrhea and fatigue were the most frequent reported drug-related toxicities (41%). One dose-limiting toxicity (grade 3 anemia) was observed at the highest dose level of dalteparin. There were 4 partial responses (24%) and the median progression-free survival in this study was 14 months (95% confidence interval, 8.0-23.4). Anti-factor Xa levels were increased during combination therapy compared with dalteparin monotherapy. Conclusions: Combination therapy of sunitinib with therapeutic doses of dalteparin is safe and well tolerated. The increased anti-factor Xa levels during combination treatment suggest that sunitinib might increase the anticoagulation activity of dalteparin. The positive safety profile warrants prospective evaluation of the clinical benefit of this combination strategy in patients with ccRCC.

Original languageEnglish (US)
Pages (from-to)e1-e9
JournalClinical Genitourinary Cancer
Volume16
Issue number1
DOIs
StatePublished - Feb 2018

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Keywords

  • Dalteparin
  • LMWH
  • Renal cell carcinoma
  • Sunitinib
  • VEGF

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Wentink, M. Q., Verheul, H. M. W., Pal, S. K., George, S., Voortman, J., Danchaivijitr, P., Adelaiye, R., Poslinski, D., Groman, A., Hutson, A., & Pili, R. (2018). Phase I Study of Dalteparin in Combination With Sunitinib in Patients With Metastatic Clear Cell Renal Carcinoma. Clinical Genitourinary Cancer, 16(1), e1-e9. https://doi.org/10.1016/j.clgc.2017.07.004