title: Management of sunitinib-related adverse events: an evidence- and expert-based consensus approach.
abstract: BACKGROUND
  The advance of medical treatment in renal cell carcinoma (RCC) has fostered the development of diverse continuous oral therapies with tyrosine kinase inhibitors (TKI), among these sunitinib remains the mainstay of therapy for most of the patients. Based on its clinical activity, disease control over a period of 11 months can be expected with sunitinib treatment. Given this prolonged period of exposure to sunitinib, adverse events tend to reoccur and can possibly decrease the quality of life in our patients. Hence, development of modalities to detect, treat and cope with such adverse events has become a major focus for physicians and patients. Today, numerous publications address these questions and offer advice from experienced centers. However, these reviews summarize single or oligo-center experiences.
  
  
  RESULTS
  Our approach is based (1) on an extensive review and analysis of available evidence from literature and (2) a structured consensus survey among 12 German experts in the field who treated at least 30 patients each with a TKI.
  
  
  CONCLUSIONS
  Derived from this process, this paper gives an overview on Sunitinib therapy management recommendations deducted from published evidence and consensus agreement among experts.
authors.affiliation: Clinic for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
authors.forename: Viktor
authors.initials: V
authors.lastname: Grünwald
authors.forename: Daniel
authors.initials: D
authors.lastname: Kalanovic
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000188:drug therapy*; D032921:Consensus; D003967:Diarrhea / Q000139:chemically induced / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D055088:Early Detection of Cancer; D019317:Evidence-Based Medicine; D005221:Fatigue / Q000139:chemically induced / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D009059:Mouth Diseases / Q000139:chemically induced / Q000628:therapy; D017410:Practice Guidelines as Topic; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*; D018570:Risk Assessment; D012871:Skin Diseases / Q000139:chemically induced / Q000188:drug therapy; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib
references.citation: Eur Urol. 2008 May;53(5):917-30
references.pmid: 18054825
references.citation: N Engl J Med. 2008 Jan 3;358(1):95-7
references.pmid: 18172185
references.citation: J Clin Oncol. 2008 Nov 10;26(32):5204-12
references.pmid: 18838713
references.citation: Am J Physiol Regul Integr Comp Physiol. 2009 Jul;297(1):R1-5
references.pmid: 19439616
references.citation: Ann Oncol. 2009 May;20(5):807-15
references.pmid: 19150949
references.citation: Onkologie. 2009 Mar;32(3):129-38
references.pmid: 19295254
references.citation: Onkologie. 2007 Oct;30(10):519-24
references.pmid: 17890892
references.citation: N Engl J Med. 2007 May 31;356(22):2271-81
references.pmid: 17538086
references.citation: J Clin Oncol. 2009 Aug 1;27(22):3584-90
references.pmid: 19487381
references.citation: Eur J Cancer. 2006 Dec;42(18):3127-39
references.pmid: 17098419
references.citation: Can Urol Assoc J. 2007 Jun;1(2 Suppl):S41-54
references.pmid: 18542784
references.citation: Dtsch Arztebl Int. 2008 Mar;105(13):232-7
references.pmid: 19629201
references.citation: N Engl J Med. 2007 Jan 11;356(2):115-24
references.pmid: 17215529
references.citation: Eur J Oncol Nurs. 2007 Jul;11(3):238-46
references.pmid: 17350337
references.citation: Hautarzt. 2008 Oct;59(10):814-20
references.pmid: 18766322
references.citation: Clin J Oncol Nurs. 2007 Oct;11(5):659-66
references.pmid: 17962174
references.citation: Support Care Cancer. 2008 Jun;16(6):557-66
references.pmid: 18274784
references.citation: Clin Genitourin Cancer. 2006 Dec;5 Suppl 1:S24-30
references.pmid: 17239281
references.citation: Lancet. 2007 Dec 15;370(9604):2011-9
references.pmid: 18083403
references.citation: Ann Oncol. 2009 Sep;20(9):1535-1542
references.pmid: 19474115
references.citation: Urologe A. 2006 Oct;45(10):1333-42; quiz 1343
references.pmid: 17021905
references.citation: Clin Exp Med. 2007 Dec;7(4):127-34
references.pmid: 18188524
references.citation: FASEB J. 2001 Mar;15(3):645-58
references.pmid: 11259383
references.citation: Oncologist. 2008 Sep;13(9):1001-11
references.pmid: 18779536