Safety and Effectiveness of Classical and Alternative Sunitinib Dosing Schedules For Metastatic Renal Cell Carcinoma: A Meta-Analysis

The optimal dosing schedule to maintain the effectiveness of sunitinib for metastatic renal cell carcinoma – while reducing toxicity – remains an important clinical question. A meta-analysis of randomized trials and observational studies assessed the relative treatment effects of 4/2, 2/1 and transitional-2/1 schedules on outcomes and adverse events using Bayesian network meta-analysis methods. Treatment with 2/1 reduced the risk of disease progression or death by 25% and had lower odds of hand-and-foot syndrome compared with the 4/2. A numerical but not ‘statistical’ benefit in progression-free survival was observed with the transitional-2/1 compared with 4/2. Alternative schedules with the 2/1 and transitional-2/1 may be more clinically beneficial in metastatic renal cell carcinoma than the 4/2 schedule.