title: Hypertension as predictor of sunitinib treatment outcome in metastatic renal cell carcinoma.
abstract: Hypertension and hypothyreoidism are frequent side effects of VEGFR-inhibitors. We investigated whether hypertension or hypothyreoidism diagnosed during sunitinib treatment is associated with treatment efficacy.
  
  
  METHODS
  Sixty-four consecutive patients with metastatic renal cell cancer (RCC) were treated with sunitinib in a single center. Hypertension was defined as persistent blood pressure >150/100 mmHg or blood pressure requiring intensification of pre-existing anti-hypertensive medication. Hypothyreoidism was defined as elevation of TSH levels and clinical symptoms requiring hormone replacement therapy (≥Gr. II hypothyreoidim).
  
  
  RESULTS
  Twenty-four (38%) patients developed hypertension and 12 (19%) hypothyreoidism. The dose of sunitinib administered was not significantly associated with hypertension or hypothyreoidism. There was no correlation between hypertension and hypothyreoidism. Hypertension was associated with frequent tumor response to sunitinib, a long time to disease progression and long overall survival (p= 0.001, 0.0003 and 0.001, respectively). In a multivariate analysis, hypertension was an independent predictor of progression-free survival (hazard ratio, 0.21; 95% CI 0.076 to 0.59, p=0.0030). There were no statistically significant differences in the frequency of ≥ grade 3 adverse events between patients with or without hypertension.
  
  
  CONCLUSIONS
  Sunitinib-associated hypertension may be a strong predictive marker for treatment efficacy in metastatic RCC.
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland. petri.bono@hus.fi
authors.forename: Petri
authors.initials: P
authors.lastname: Bono
authors.forename: Juhana
authors.initials: J
authors.lastname: Rautiola
authors.forename: Tapio
authors.initials: T
authors.lastname: Utriainen
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011758:Pyrroles / Q000009:adverse effects*; D012307:Risk Factors; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib