Evaluation of Targeted Therapy for Locally Advanced or Metastatic Renal Cell Carcinoma in Tunisia

Introduction: Renal cell carcinoma (RCC) is known to be chemo resistant but with the introduction of targeted therapies;there has been a “revolution” in its treatment strategies. The only targeted therapy available in Tunisia for the treatment of metastatic and/or locally advanced RCC is sunitinib. Objective of the Study: To evaluate therapeutic results and tolerance of sunitinib in metastatic and/or locally advanced RCC. Subjects and Methods: This was a retrospective study covering a period of six years (from January 2008 to January 2014) conducted in 5 medical oncology departments in Tunisia. The population of the study consisted of 29 patients treated with sunitinib for metastatic and/or locally advanced RCC. Results: The mean age of patients was 51 years. Three patients had tumor recurrence and 26 patients had a metastatic RCC. The prognosis was good for 5 patients, intermediate for 19 patients and poor for 5 patients. The median duration of treatment was 5 months. Because of side effects, treatment was discontinued in 12.5% of cases and the dose was reduced in 10.3% of cases. Side effects consisted of asthenia (95.8%), stomatitis (70.8%), anemia (50%), hand-foot syndrome (55.8%) in addition to nausea and vomiting (54.2%). Objective response was observed in 37.5% of patients after 3 months of treatment and in 50% after 6 months. The median progression-free survival was 14 months (95% CI, 7.9 to 20.6). The median overall survival was 22 months (95% CI, 15.6 to 28.7). Conclusion: The prognosis of RCC in Tunisian patients has clearly improved with the introduction of sunitinib, but other therapies with a proven efficacy as a first and second line therapy should be considered.

Metastatic Colorectal Cancer: Evolution of the Response Rate and Survival with Therapeutic Progress

Introduction: The therapeutic strategy for metastatic colorectal cancer (mCRC) has evolved greatly in the last two decades. This study aimed to compare patients with mCRC treated at the University Hospital of Sousse (Tunisia) through three periods, in terms of treatment strategy;objective response rate (ORR) to chemotherapy;median overall survival (OS) and prognostic factors conditioning OS. Methods: This was a retrospective study covering the period from January 1994 to December 2011. It involved 401 patients with mCRC divided into three groups: group 1 (G1) including patients treated in the period 1994-1998, group 2 (G2) including patients treated in the period 1999-2005 and group 3 (G3) including patients treated in the period 2006-2011. Results: The ORR after 3 cycles of first line chemotherapy was 33%, 50% and 57.8% for G1, G2 and G3 respectively. The median OS was 13.8 months for G1, 19 months for G2 and 23 months for G3. The prognostic factors associated with a better OS for G3 were absence of initial tumor complication, normal initial level of carcinoembryonic antigen, normal liver function tests, surgery of the primary tumor, surgery of liver metastases and the ORR after three cycles of first line chemotherapy. Conclusion: The development of the therapeutic strategy, whatever of medical or surgical nature, has led to improved response rates and survival of patients treated for mCRC.