Management of sorafenib, sunitinib, and temsirolimus toxicity in metastatic renal cell carcinoma.
OBJECTIVE
To review the common and serious toxicities associated with the use of tyrosine kinase inhibitors such as sorafenib and sunitinib and mTOR inhibitor temsirolimus, and to outline the most recent toxicity management guidelines.


RESULTS
Common grade 3 or 4 side effects with sorafenib include lymphopenia (13%), hypophosphatemia (13%), elevated lipase (12%), hand-foot syndrome (6%), and mucositis/stomatitis (6%). Common grade 3 or 4 side effects with suntinib elevated lipase (16%), neutropenia (12%), lymphopenia (12%), hypertension (8%), and fatigue/asthenia (7%). As for temsirolimus, common grade 3 or 4 side effects consist of anemia (20%), hyperglycemia (11%), fatigue/asthenia (11%), dyspnea (9%), and hypophosphatemia (5%). Intracranial hemorrhage (ICH) is rare but occurred in sorafenib-exposed and sunitinb-exposed patients. Cardiovascular morbidity may also be observed in sorafenib-exposed and sunitinib-exposed patients.


CONCLUSIONS
Through preventive and therapeutic measures, these side effects can be effectively managed, without reducing the dose and, therefore, affecting the efficacy of the treatment.
Guevremont
Catherine
C
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Canada.
Alasker
Ahmed
A
Karakiewicz
Pierre I
PI
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001557:Benzenesulfonates / Q000009:adverse effects / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary; D002986:Clinical Trials as Topic; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D017410:Practice Guidelines as Topic; D011505:Protein-Tyrosine Kinases / Q000009:adverse effects* / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077157:Sorafenib; D000077210:Sunitinib
D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D007211:Indoles; D010671:Phenylurea Compounds; D011725:Pyridines; D011758:Pyrroles; D009536:Niacinamide; C401859:temsirolimus; D000077157:Sorafenib; D011505:Protein-Tyrosine Kinases; D000077210:Sunitinib; D020123:Sirolimus