Practical first-line management of renal cell carcinoma in a community practice

Sunitinib is an oral receptor tyrosine kinase inhibitor (TKI) that targets signalling by vascular endothelial growth factor receptors (VEGFRs). The standard sunitinib dosing schedule for metastatic renal cell carcinoma (mRCC) is 50 mg for four weeks (28 days) of treatment, followed by a two-week (14-day) break from treatment (four/two schedule). However, this schedule is associated with toxicities that can limit the patient's health-related quality of life (HRQOL) and impede treatment compliance. Given the generally incurable nature of mRCC and the toxicity associated with therapy, treatment strategies should focus on achieving long-term response, preserving HRQOL, and minimizing treatment-related toxicity. The William Osler Cancer Clinic in Brampton, ON, has instituted an alternative schedule of sunitinib treatment as our standard dosing strategy, involving two weeks of treatment, followed by a one-week break (two/one schedule), to minimize toxicity and improve HRQOL among their patients with mRCC.