title: Sunitinib-induced microangiopathic hemolytic anemia with fatal outcome.
abstract: Sunitinib, a new vascular endothelial growth factor receptor inhibitor, has demonstrated activity in renal cell carcinoma and is now widely used in the palliative treatment of patients with metastatic renal cell carcinoma. It is generally well tolerated but has been associated with a low incidence of grade 3 and 4 toxicities including fatigue, diarrhea, anorexia, mucositis, skin toxicity, immune thrombocytopenic purpura, hypertension, hypothyroidism, cytopenias, and decreased cardiac ejection fraction. Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) is a rare condition that is severe and may be fatal. Several medications have been implicated in causing TTP-HUS including clopidogrel, mitomycin C, cisplatin. In this report, we describe a case of atypical HUS-microangiopathic hemolytic anemia during treatment with sunitinib in a patient with metastatic renal cell carcinoma. To our knowledge, this is the fourth case of microangiopathic hemolytic anemia associated with sunitinib described in the literature and the first case with fatal outcome despite treatment with plasmapheresis, dialysis, and withdrawal of sunitinib.
authors.affiliation: Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA. tony0272@gmail.com
authors.forename: Tony N
authors.initials: TN
authors.lastname: Talebi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Stefanovic
authors.forename: Jaime
authors.initials: J
authors.lastname: Merchan
authors.forename: Eric
authors.initials: E
authors.lastname: Lian
authors.forename: Orlando
authors.initials: O
authors.lastname: Silva
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D017809:Fatal Outcome; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D010956:Plasmapheresis / Q000379:methods; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib