title: Spontaneous bilateral pneumothorax in metastatic renal cell carcinoma on sunitinib therapy.
abstract: Bilateral spontaneous pneumothorax is a rare occurrence in patients with both primary and metastatic lung cancer. Pneumothorax occurring as a complication of vascular endothelial growth factor receptor (VEGFR) inhibitor therapy has not been previously described in the medical literature. Sunitinib malate is a VEGFR inhibitor approved for the treatment of advanced renal cell carcinoma. We present a patient with metastatic renal cell carcinoma manifested as bilateral pulmonary nodules who developed a bilateral spontaneous pneumothorax 3 weeks after initiation of sunitinib therapy. We believe that sunitinib therapy resulted in necrosis of multiple pleural-based pulmonary nodules with central cavernization and ultimately rupture with bronchopleural fistula formation. Based on this experience, we advise that practitioners exercise caution when prescribing anti-VEGFR therapy in patients with pleural-based pulmonary metastases and recognize that the efficacy and toxicity of these agents may be closely linked.
authors.affiliation: Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO 63110, USA.
authors.forename: Anilkumar
authors.initials: A
authors.lastname: Katta
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Fesler
authors.forename: Alan
authors.initials: A
authors.lastname: Tan
authors.forename: Giao
authors.initials: G
authors.lastname: Vuong
authors.forename: John M
authors.initials: JM
authors.lastname: Richart
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D009336:Necrosis / Q000473:pathology; D009362:Neoplasm Metastasis; D011030:Pneumothorax / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000187:drug effects; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D007376:Interleukin-2; D011758:Pyrroles; D040262:Receptors, Vascular Endothelial Growth Factor; D000077210:Sunitinib