Give me a break.

More than one in five patients with renal cell carcinoma (RCC) have to discontinue sunitinib due to side effects, and that’s on trial. Sunitinib is standardly dosed daily for 4 weeks followed by a 2 week break (4/2 schedule), with side effects culminating in week 4. So it makes sense that 2 weeks on 1 week off (2/1 schedule) might increase tolerability. Well, it didn’t. A phase 2 trial assessed the 2/1 schedule in 59 patients with hopes of achieving a rate of ≥ grade 3 toxicity of < 15%. That rate was 25% and over one-third required dose reductions and another 10% discontinued treatment altogether. The authors maintain this is still better than what’s achieved with the 4/2 schedule, but we’ll take this opportunity to remind you nivo + ipi is now the preferred first-line treatment for intermediate/high risk advanced RCC. TBL: 2/1 scheduling of sunitinib is a reasonable option for RCC, but don’t forget about ipi + nivo. | Jonasch, J Clin Oncol 2018