title: Sunitinib in metastatic renal cell carcinoma: recommendations for management of noncardiovascular toxicities.
abstract: The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.
authors.affiliation: Division of Medical Oncology, BCCA Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada. ckollmannsberger@bccancer.bc.ca
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Georg
authors.initials: G
authors.lastname: Bjarnason
authors.forename: Patrick
authors.initials: P
authors.lastname: Burnett
authors.forename: Patricia
authors.initials: P
authors.lastname: Creel
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
authors.forename: Nancy
authors.initials: N
authors.lastname: Dawson
authors.forename: Darren
authors.initials: D
authors.lastname: Feldman
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.forename: Jerome
authors.initials: J
authors.lastname: Hershman
authors.forename: Thomas
authors.initials: T
authors.lastname: Lechner
authors.forename: Amy
authors.initials: A
authors.lastname: Potter
authors.forename: Eric
authors.initials: E
authors.lastname: Raymond
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Treister
authors.forename: Laura
authors.initials: L
authors.lastname: Wood
authors.forename: Shenhong
authors.initials: S
authors.lastname: Wu
authors.forename: Ronald
authors.initials: R
authors.lastname: Bukowski
mesh_terms: D001247:Asthenia / Q000139:chemically induced / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary; D003967:Diarrhea / Q000139:chemically induced / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004890:Erythema / Q000139:chemically induced / Q000628:therapy; D005076:Exanthema / Q000139:chemically induced / Q000628:therapy; D005221:Fatigue / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced / Q000628:therapy; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017410:Practice Guidelines as Topic; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D059039:Standard of Care; D000077210:Sunitinib
chemical_list: D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D000077210:Sunitinib