Patients starting sunitinib (Sutent) treatment for metastatic renal cell carcinoma (mRCC) should be advised to quit smoking, as active smoking appears to negatively affect progression-free and overall survival in such patients, according to study findings published online ahead of print in The Oncologist.
The study, by Michael A. Carducii, MD, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltirmore, and colleagues, focused on 278 patients (median age 63 years) with mRCC who underwent sunitinib therapy from 2004 to 2013. Among the participants, 67 were obese, 73 had diabetes, and 165 had pretreatment hypertension. Approximately half the patients were never-smokers, more than 20% were active smokers, and the remaining subjects had some history of smoking. Obesity, smoking, diabetes, and hypertension are all risk factors for the development of RCC.
After a median follow-up period of 55 months, a complete response was noted in 3% of patients, a partial response in 36%, stable disease in 39%, and progression in 22%. Median progression-free survival was nine months and median overall survival was 22 months. Ultimately, nearly 90% of patients had progressed and 73% had died.
Active smokers had significantly worse progression-free survival than did never-smokers (4 vs. 12 months) and significantly worse overall survival (11 vs. 25 months). The association between smoking and survival remained strong in additional analyses, one of which indicated that never-smokers and past smokers had a dramatically lower risk of showing progression on follow-up and had more than double the rate of progression-free and overall survival when compared with active smokers matched on age, gender, and a number of clinical characteristics.