Efficacy and toxicity of sunitinib for non clear cell renal cell carcinoma (RCC): a systematic review of the literature

Crit Rev Oncol Hematol. 2015 May;94(2):238-50. doi: 10.1016/j.critrevonc.2015.01.006. Epub 2015 Jan 19.


Background: The randomized phase III trial of sunitinib versus interferon Alfa provided level-A evidence for the use of sunitinib in advanced clear cell renal cell carcinoma (RCC). This systematic literature review aims at the evaluation of the level of evidence for the use of sunitinib monotherapy for advanced non clear cell RCC in terms of efficacy and toxicity parameters.

Methods: Eligible studies were identified using MEDLINE, Google scholar, ASCO, ESMO and the Cochrane databases. Searches were last updated on 1 June 2014. Eligible studies reported survival and/or response data for patients with non clear cell RCC receiving sunitinib monotherapy.

Results: four hundred and five results were obtained from the searches in MEDLINE (n=319 studies) and other databases (n=86). Twelve studies (involving 980 patients) were considered eligible and were included in the final analysis: six phase II clinical trials, one expanded access prospective trial and five retrospective analyses. Median PFS was reported in 11 studies ranging from 1.6 to 8.9 months. Median OS was reported in 9 studies ranging from 12 months to 22 months. The disease control rate (DCR) was reported in 10 studies, and it ranged from 35% to 91%. The overall response rate (ORR) was reported in 10 studies and it ranged from 0% to 36%. Frequently reported Grade 3/4 toxicities were gastrointestinal toxicities, mucocutaneous toxicities and hematologic toxicities.

Conclusion: There is insufficient evidence (level C) to recommend sunitinib monotherapy in advanced non clear cell RCC and the available data suggests it appears less efficacious than that in advanced clear cell RCC. Further prospective and randomized studies are needed to explore alternative therapies in this setting.

Keywords: Chromophobe RCC; Papillary RCC; Sunitinib, Non clear RCC.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Renal Cell / diagnosis
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / mortality
  • Combined Modality Therapy
  • Humans
  • Indoles / adverse effects
  • Indoles / therapeutic use*
  • Kidney Neoplasms / diagnosis
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / mortality
  • Neoplasm Staging
  • Pyrroles / adverse effects
  • Pyrroles / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Sunitinib
  • Survival Analysis
  • Treatment Outcome


  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Indoles
  • Pyrroles
  • Sunitinib