Sunitinib in metastatic renal cell carcimoma: a single-center experience.

INTRODUCTION: Historically, metastatic renal cell carcinoma (RCC) has had poor prognosis; the outcomes have improved with the introduction of tyrosine-kinase inhibitors, such as sunitinib. There is no reported literature from India on the use of sunitinib in metastatic RCC. We present an analysis of sunitinib at our institute over 4 years. MATERIALS AND METHODS: An unselected population of patients with metastatic or relapsed metastatic RCC receiving sunitinib was analyzed with respect to patient characteristics, response, toxicity, and outcomes. RESULTS: Fifty-nine patients (51 males, 8 females) with a median age of 55 years were included in the study. Lungs and bones were the most common site of metastases. The patients received a median number of 4 cycles, with 23 patients requiring dose-modification and 12 discontinuing therapy due to toxicity. Overall, 38 patients (65%) had CR, PR, or standard deviation while 14 had progression or death at initial evaluation. The median progression-free survival (PFS) was 11.4 months and overall survival was 22.6 months. Hand-foot syndrome, fatigue, mucositis, skin rash, and vomiting were seen more often among our patients, whereas hypertension was not as common compared with previously published reports. CONCLUSION: Sunitinib is a viable option for the treatment of metastatic RCC and shows a comparable PFS in Indian patients. Although toxicity remains a concern, most of the adverse effects can be managed conservatively. Careful patient selection, tailoring the dose of therapy, adequate counseling, and careful follow-up is essential for optimum therapy.

Rare metastatic prostatic malignancy: A case report and approach to management.

We present a patient with metastatic leiomyosarcoma of the prostate who achieved complete response with chemotherapy. A 70 years old male patient presented with urinary tract symptoms and a prostatic mass. After having been treated as carcinoma prostate, he presented with progressive pelvic mass, lung and bone metastases to our hospital. Repeat biopsy was suggestive of prostatic leiomyosarcoma. He was treated with chemotherapy with the ifosfamide-epirubicin regimen and achieved complete remission on positron emission tomography/computerized tomography after three cycles. He was given a total of six cycles of chemotherapy and continues to be disease-free after 8 months. Although adenocarcinomas are the commonest prostatic malignancies in the elderly, a careful evaluation is essential to rule out alternative diagnoses. Our case report illustrates the potential role of combination chemotherapy in the management of advanced leiomyosarcoma of the prostate. The literature on this entity is reviewed.