Sunitinib: Ten Years of Successful Clinical Use and Study in Advanced Renal Cell Carcinoma.

The oral multikinase inhibitor sunitinib malate was approved by the U.S. Food and Drug Administration in January 2006 for use in patients with advanced renal cell carcinoma (RCC). Since then, it has been approved globally for this indication and for patients with imatinib-resistant or -intolerant gastrointestinal stromal tumors and advanced pancreatic neuroendocrine tumors. As we mark the 10-year anniversary of the beginning of the era of targeted therapy, and specifically the approval of sunitinib, it is worthwhile to highlight the progress that has been made in advanced RCC as it relates to the study of sunitinib. We present the key trials and data for sunitinib that established it as a reference standard of care for first-line advanced RCC therapy and, along with other targeted agents, significantly altered the treatment landscape in RCC. Moreover, we discuss the research with sunitinib that has sought to refine its role via patient selection and prognostic markers, improve dosing and adverse event management, and identify predictive efficacy biomarkers, plus the extent to which this research has contributed to the overall understanding and management of RCC. We also explore the key learnings regarding study design and data interpretation from the sunitinib studies and how these findings and the sunitinib development program, in general, can be a model for successful development of other agents. Finally, ongoing research into the continued and future role of sunitinib in RCC management is discussed. THE ONCOLOGIST: 2017;22:41-52 IMPLICATIONS FOR PRACTICE: Approved globally, sunitinib is established as a standard of care for first-line advanced renal cell carcinoma (RCC) therapy and, along with other targeted agents, has significantly altered the treatment landscape in RCC. Research with sunitinib that has sought to refine its role via patient selection and prognostic markers, improve dosing and adverse event management, and identify predictive efficacy biomarkers has contributed to the overall understanding and management of RCC. Key learnings regarding study design and data interpretation from the sunitinib studies and the sunitinib development program, in general, can be a model for the successful development of other agents.

The 46-kDa mannose 6-phosphate receptor does not depend on endosomal acidification for delivery of hydrolases to lysosomes.

In mammalian cells, the mannose 6-phosphate receptor pathway accounts for the transport of most soluble acid hydrolases to lysosomes. It is believed that dissociation of mannose 6-phosphate receptors and their ligands is entirely driven by the acidic environment in endosomal compartments. Indeed, pH-perturbing substances such as ammonium chloride and monensin have been shown to inhibit lysosomal enzyme targeting in cells that express both known mannose 6-phosphate receptors. We now demonstrate that ammonium chloride and monensin exert modest effects on the intracellular retention of lysosomal hydrolases in murine cells that synthesize only the 46-kDa mannose 6-phosphate receptor. Neither ammonium chloride nor monensin induces changes to the subcellular localization of lysosomal hydrolases and the 46-kDa mannose 6-phosphate receptor in these cells. This suggests that endosomal dissociation of the receptor and its ligands still occurs in the presence of these agents. We conclude that the murine 46-kDa mannose 6-phosphate receptor has the capacity to deliver its cargo proteins to lysosomes even in the absence of endosomal acidification.

Oxygen and carbon dioxide sensitivity of ventilation in amphibious crabs, Cardisoma guanhumi, breathing air and water.

Amphibious crabs, Cardisoma guanhumi, were acclimated to breathing either air or water and exposed to altered levels of oxygen and/or carbon dioxide in the medium. Hypercapnia (22, 36 and 73 torr CO(2)) stimulated a significant hypercapnic ventilatory response (HCVR) in both groups of crabs, with a much greater effect on scaphognathite frequency (Deltaf(SC)=+700%) in air-breathing crabs than water-breathing crabs (Deltaf(SC)=+100%). In contrast, hyperoxia induced significant hypoventilation in both sets of crabs. However, simultaneous hyperoxia and hypercapnia triggered a greater than 10-fold increase in f(SC) in air-breathing crabs but no change in water-breathing crabs. For water-breathing crabs hypoxia simultaneous with hypercapnia triggered the same response as hypoxia alone-bradycardia (-50%), and a significant increase in f(SC) at moderate exposures but not at the more extreme levels. The response of air-breathing crabs to hypoxia concurrent with hypercapnia was proportionally closer to the response to hypercapnia alone than to hypoxia. Thus, C. guanhumi were more sensitive to ambient CO(2) than O(2) when breathing air, characteristic of fully terrestrial species, and more sensitive to ambient O(2) when breathing water, characteristic of fully aquatic species. C. guanhumi possesses both an O(2)- and a CO(2)-based ventilatory drive whether breathing air or water, but the relative importance switches when the respiratory medium is altered.