Addition of gemcitabine at the time of sunitinib resistance in metastatic renal cell cancer

OBJECTIVE To investigate the role of adding gemcitabine at the time of sunitinib failure in patients with metastatic renal cell cancer (mRCC). PATIENTS AND METHODS A retrospective chart review of 13 patients with mRCC who experienced disease progression on sunitinib and received gemcitabine 750 mg/m(2) i.v. on days 1 and 8 and sunitinib 37.5 mg/day on days 2-15 every 21 days from September 2006-2009 was carried out. Responses were assessed using the Response Evaluation Criteria in Solid Tumors. The median age was 59, male to female ratio 10: 3, Eastern Cooperative Oncology Group performance status 1-3; the number of prior regimens ranged from one to five, and duration on sunitinib alone ranged from 3 months to >1 year. RESULTS Twelve out of 13 patients received more than two cycles with one documented partial response, five stable disease and seven progressive disease. The median time to progression was 21 weeks. We documented grade 4 pulmonary emboli (n = 1), grade 3 neutropenia (n = 2), anaemia (n = 2) and thrombocytopenia (n = 1). CONCLUSION The combination of sunitinib and gemcitabine in patients with mRCC may delay disease progression in some patients exhibiting resistance to sunitinib. This regimen merits further prospective investigation in this patient population.