Sunitinib in Metastatic Renal Cell Carcinoma: Recommendations for Management of Noncardiovascular Toxicities

Author:

Kollmannsberger Christian1,Bjarnason Georg2,Burnett Patrick3,Creel Patricia4,Davis Mellar5,Dawson Nancy6,Feldman Darren7,George Suzanne8,Hershman Jerome9,Lechner Thomas10,Potter Amy8,Raymond Eric11,Treister Nathaniel12,Wood Laura5,Wu Shenhong13,Bukowski Ronald5

Affiliation:

1. a British Columbia Cancer Agency Vancouver Cancer Centre, Vancouver, British Columbis, Canada;

2. b Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada;

3. c Vanderbilt University Medical Center, Nashville, Tennessee, USA;

4. d Duke University Medical Center, Durham, North Carolina, USA;

5. e Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA;

6. f Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C., USA;

7. g Memorial Sloan-Kettering Cancer Center, New York, New York, USA;

8. h Dana Farber Cancer Institute, Boston, Massachusetts, USA;

9. i David Geffen School of Medicine, Los Angeles, California, USA;

10. j Pfizer Oncology, New York, New York, USA;

11. k Service Inter-Hospitalier de Cancérologie Beaujon-Bichat, Clichy, France;

12. l Brigham and Women's Hospital, Boston, Massachusetts, USA;

13. m Stony Brook University Medical Center, Stony Brook, New York, USA

Abstract

Abstract The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.

Funder

Pfizer Inc.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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