Changes in skeletal muscle area and lean body mass during pazopanib vs sunitinib therapy for metastatic renal cancer

  • Osman KöstekEmail author
  • Erdem Yılmaz
  • Muhammet Bekir Hacıoğlu
  • Nazım Can Demircan
  • Ali Gökyer
  • Sernaz Uzunoğlu
  • Nermin Tunçbilek
  • İrfan Çiçin
  • Bülent Erdoğan
Original Article



To evaluate whether sunitinib and pazopanib treatments are associated with change in skeletal muscle area (SMA) and total lean body mass (LBM) as well as to compare their efficacies and safety profiles in patients with metastatic renal cell cancer (mRCC).


Thirty-six patients treated with a tyrosine kinase inhibitor were included. Eighteen of them received sunitinib and the rest/remaining received pazopanib in the first line of mRCC treatment. Baseline and follow-up computed tomography studies of the patients were performed to measure cross-sectional areas (cm2) of muscle tissues.


About 69% of patients were male and median age was 60 (49–68) years. Median time interval between two CT imagings was 6.1 (3.1–7.7) months and it was similar between the two groups (for sunitinib, 4.9 (2.5–6.9) months vs for pazopanib, 7.3 (3.2–9.5) months, p = 0.16, respectively). Disease control rate was 77.7% in all patients. Of these, 66.6% in sunitinib group was consisted of four partial responses and eight stable diseases. In addition, 88.8% in pazopanib group was consisted of three partial responses and 13 stable diseases. A significant decrease in SMA and LBM was observed after sunitinib therapy, whereas SMA and LBM values of pazopanib group did not change significantly (p = 0.02 and p = 0.70, respectively). No significant differences were observed between patients with sunitinib, and pazopanib group median PFS [11.9 (95% CI 6.1–17.6) vs 8.1 months (95% CI 7.2–9.1), respectively; p = 0.28] and median OS [28.6 (95% CI 24.3–32.9) vs 25.5 months (95% CI 18.9–52.7), respectively; p = 0.42]. Dose-limiting toxicities were significantly more frequent in sunitinib group than in pazopanib group (66.7% vs 22.2%, p = 0.02, respectively).


Loss of SMA and LBM with sunitinib was more substantial than with pazopanib. Treatment efficacies of both drugs were similar, but dose-limiting toxicity was more frequent in sunitinib group. Loss of SMA had no significant association with prognosis. Further studies are needed to clarify the possible association between SMA and prognosis in mRCC patients who receive sunitinib or pazopanib.


Skeletal muscle area Lean body mass Sunitinib Pazopanib Renal cell cancer 



There is no financial support in this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Osman Köstek
    • 1
    Email author
  • Erdem Yılmaz
    • 2
  • Muhammet Bekir Hacıoğlu
    • 1
  • Nazım Can Demircan
    • 1
  • Ali Gökyer
    • 1
  • Sernaz Uzunoğlu
    • 1
  • Nermin Tunçbilek
    • 2
  • İrfan Çiçin
    • 1
  • Bülent Erdoğan
    • 1
  1. 1.Division of Medical Oncology, Department of Internal MedicineTrakya University School of MedicineEdirneTurkey
  2. 2.Department of RadiologyTrakya University School of MedicineEdirneTurkey

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