title: Onset of male gynaecomastia in a patient treated with sunitinib for metastatic renal cell carcinoma.
abstract: Sunitinib is an orally administered multitargeted tyrosine kinase inhibitor that has demonstrated substantial antitumour activity in patients with metastatic renal cell carcinoma. The more common grade 3 or 4 adverse effects of sunitinib include hypertension, fatigue, hand-foot syndrome, elevated lipase and lymphopenia. We report the case of a 69-year-old patient with metastatic renal clear-cell carcinoma, treated with nephrectomy and three lines of therapy (interleukin-2 plus interferon-alpha2a, vinorelbine plus gemcitabine, and capecitabine), who started a fourth-line therapy with oral sunitinib because of disease progression. At the end of his fifth cycle of sunitinib therapy, the patient complained of the development of abnormally large mammary glands associated with pain and peri-areolar erythema. After 2 weeks' off therapy, a partial reduction in mammary gland enlargement, local pain and erythema was observed. However, re-initiation of sunitinib treatment was followed by bilateral breast enlargement again. The mechanism by which sunitinib induces gynaecomastia is thought to be associated with an unknown direct action on breast hormonal receptors. To the best of our knowledge, this is the first report of an association between sunitinib and gynaecomastia.
authors.affiliation: Department of Internal Medicine, Hospital of the Delta, Via Valle Oppio 2, 44023, Lagosanto (FE), Azienda USL di Ferrara, Italy. p.ballardini@ausl.fe.it.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Ballardini
authors.affiliation: Department of Internal Medicine, Hospital of the Delta, Via Valle Oppio 2, 44023, Lagosanto (FE), Azienda USL di Ferrara, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Margutti
authors.affiliation: Department of Radiology, Hospital of the Delta, Lagosanto (FE), Azienda USL di Ferrara, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Aliberti
authors.affiliation: Department of Internal Medicine, Hospital of the Delta, Via Valle Oppio 2, 44023, Lagosanto (FE), Azienda USL di Ferrara, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D006177:Gynecomastia / Q000139:chemically induced*; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib