From the Guidelines
Discontinuing sunitinib in a patient with a new primary lung cancer should be considered on a case-by-case basis, but generally, it is recommended to continue TKI therapy life-long for palliation of symptoms as part of best supportive care, as suggested by clinical experience that discontinuing tyrosine kinase inhibitor (TKI) therapy may accelerate the pace of disease progression and worsen symptoms 1. When managing a patient with a new primary lung cancer who is currently on sunitinib, several key factors must be considered to determine the optimal timing for discontinuation. These factors include:
- The patient's current response to sunitinib
- The stage and aggressiveness of the new lung cancer
- Potential drug interactions with planned lung cancer treatments
- The patient's overall performance status It is crucial to consult with both oncology specialists managing the original cancer for which sunitinib was prescribed and the lung cancer team to make an informed decision. The presence of a new primary lung cancer may necessitate adjusting or discontinuing sunitinib, as it could complicate the treatment plan for the lung malignancy. Sunitinib, as a multi-targeted tyrosine kinase inhibitor, may have complex interactions with chemotherapy or immunotherapy regimens that might be planned for the lung cancer. During this transition period, closely monitor for any worsening symptoms from either cancer and be prepared to manage potential withdrawal effects if sunitinib is discontinued. Ultimately, the decision to discontinue sunitinib should prioritize the patient's quality of life, morbidity, and mortality, considering the potential benefits and risks of continuing or stopping the therapy, as continuation of TKI therapy life-long for palliation of symptoms as part of best supportive care is recommended 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sunitinib Treatment Duration
The optimal duration of sunitinib treatment in patients with non-small cell lung cancer (NSCLC) is not clearly established. However, several studies provide insights into the treatment outcomes and safety of sunitinib in this patient population.
Treatment Outcomes
- A phase II study of sunitinib as maintenance therapy in patients with locally advanced or metastatic NSCLC reported a median overall survival of 10.4 months 2.
- Another study evaluated the role of sunitinib monotherapy following irinotecan and carboplatin as first-line treatment for patients with extensive-stage small-cell lung cancer, and reported a 1-year overall survival of 54% 3.
- The objective response rate with sunitinib maintenance therapy was 27.4% in one study 2, and an additional 20% of patients had stable disease in another study 3.
Safety and Toxicity
- The most frequently reported adverse events during sunitinib maintenance therapy were fatigue, diarrhea, and nausea 2.
- Grade 3/4 toxicity was rare during sunitinib monotherapy in one study 3.
- The principal toxicities associated with sunitinib treatment included fatigue, pain, myalgias, nausea/vomiting, and hypertension 4.
Discontinuation Criteria
- The decision to discontinue sunitinib treatment should be based on individual patient factors, including disease progression, unacceptable toxicity, or withdrawal of consent 2.
- Patients with stable disease or responding disease may continue to receive sunitinib monotherapy until disease progression or unacceptable toxicity 3.