Singapore, 11 March 2015 - A study led by the Genitourinary (GU) oncology team at National Cancer Centre Singapore (NCCS) has revealed conclusive results in reducing toxicities for Asian patients with metastatic renal cell carcinoma (mRCC) or cancer that has spread beyond the kidney.
The seven-year study began in 2007 and the findings revolutionised the standard protocol for patient management in NCCS with an attenuated-dose regimen of sunitinib for patients with mRCC.
The new treatment regimen for sunitinib has been accepted by oncologists in Singapore. For the patients, this would mean an estimated 30 per cent reduction in fees because of the lower dosage. The median overall survival rate (OStotal) was 27.4 as compared to 21.8 months among patients receiving the attenuated dosage.
Sunitinib was introduced as a treatment for mRCC in Singapore since early 2005. The U.S. Food and Drug Administration (FDA) approved dosing of sunitinib is 50mg once daily for four weeks, followed by a two-week break in a six-week treatment cycle (conventional-doseregimen). Subsequent findings from 2005 to 2006 show that high toxicities were observed with the conventional dosing, especially in Asians.
"Many of the patients were experiencing severe side effects of grade 3 or higher with the conventional dosing. Our immediate response was to refine the treatment protocol to improve patients' quality of life", explained Dr Tan Min Han, Visiting Consultant, Division of Medical Oncology and member of the GU team, NCCS.
NCCS initiated a prospective clinical registry with 127 mRCC patients receiving attenuated sunitinib dosing of 37.5mg/d/4/2 (37.5mg of sunitinib once daily for four weeks, followed by a two-2 week break) as treatment protocol in 2007. Clinical data of patients receiving sunitinib at NCCS from 2005 to 2012 and three other tertiary centres in Singapore (Johns Hopkins-International Medical Centre, National University Hospital Singapore, and Onco-Care of Gleneagles Medical Centre) from 2005 to 2009 were used for comparison, representing at least 90 percent of all patients with mRCC treated over the period.
The data revealed favourable results between the attenuated dosing regimen compared to the conventional dosing. 59 percent of the participants experienced severe side effects as compared to the previous 85 percent; 24 percent than 58 percent required reduction in dose delays; and 35 percent rather than 70 percent of patients requiring dose reduction during their course of treatment. Both dose delays and reduction are only required when high level of toxicities are observed.
Dr Tan reiterated the importance of the findings, "This is an affirmation to our efforts and we believed that the continuous understanding of real world outcomes will reap greater benefits for our patients. The findings would not be possible without the collaborative nature of our tertiary healthcare counterparts."
This research was published in Clinical Genitourinary Cancer journal in November 2014 and supported by a grant of $50,000 from the NCC Research Fund.
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National Cancer Centre Singapore (NCCS) provides a holistic and multidisciplinary approach to cancer treatment and patient care. We treat almost 70 per cent of the public sector oncology cases, and they are benefiting from the sub-specialization of our clinical oncologists. NCCS is accredited by the US-based Joint Commission International for its quality patient care and safety. To deliver among the best in cancer treatment and care, our clinicians work closely with our scientists who conduct robust cutting-edge clinical and translational research programmes which have been internationally recognised. NCCS strives to be a global leading cancer centre, and shares its expertise and knowledge by offering training to local and overseas medical professionals. http://www.
About NCC Research Fund
The faster we learn more about cancer, the closer we are to a cancer-free future. Hence, the NCCS set up the NCC Research Fund in 2005 to serve as its flagship fundraising and grant-making channel to provide for an array of translational and clinical research programmes. Some of these improve the early diagnosis of cancer, develop and evaluate new treatments to ensure that they can be used safely and effectively on patients, and establish ways to prevent recurrences. Medical breakthroughs as well as remarkable diagnosis, care and treatment advancements that lead to more lives saved, better outcomes and quality of life for patients today are results from years of research.
The Fund is registered under the Charities Act as an Institution of Public Character (IPC) with an independent Board of Trustees. The fund provides (1) seeding funds to help kick-start worthy and emerging research projects; (2) bridging funds between grant cycles when the need arises, and enabling our scientists to work with productive momentum; as well as (3) advancement funds to enhance research related infrastructural capabilities, hardware, tools and processes.