title: Early onset recall pneumonitis during targeted therapy with sunitinib.
abstract: BACKGROUND
  Sunitinib interacts with radiation therapy, leading to synergism of the toxicities of these treatments. Radiation recall pneumonitis is a rare but serious complication of targeted therapy with tyrosine kinase inhibitors.
  
  
  METHODS
  The case of a patient with metastatic renal cell cancer (RCC) who developed recall pneumonitis on the first cycle of systemic sunitinib treatment is reported here. A 65-year-old man with RCC and bone metastasis underwent radiation therapy on his thoracic vertebrae (Th5-8) with a total dose of 24 Gy. Sunitinib (37.5 mg) was started 14 days after completing the radiation therapy. On the 14th day of sunitinib treatment, the patient developed progressive fever with worsening of dyspnea and general weakness. Treatment with pulse administration of prednisolone 1,000 mg for 3 days was initiated. Thereafter, the symptoms and the radiological findings regarding the interstitial filtration gradually improved over 7 days.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of early onset recall pneumonitis during sunitinib therapy. At present, how sunitinib interacts with radiation therapy remains unclear. The possibility that tyrosine kinase inhibitor therapy, including with sunitinib, after radiation therapy may lead to adverse effects should be kept in mind.
authors.affiliation: Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, 135-8550, Japan. takeshi.yuasa@jfcr.or.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kitsukawa
authors.forename: Gen
authors.initials: G
authors.lastname: Sukegawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Keita
authors.initials: K
authors.lastname: Kudo
authors.forename: Kazunari
authors.initials: K
authors.lastname: Miyazawa
authors.forename: Takuyo
authors.initials: T
authors.lastname: Kozuka
authors.forename: Sohei
authors.initials: S
authors.lastname: Harada
authors.forename: Junji
authors.initials: J
authors.lastname: Yonese
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D058990:Molecular Targeted Therapy; D011239:Prednisolone / Q000008:administration & dosage; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D020551:Pulse Therapy, Drug; D011758:Pyrroles / Q000009:adverse effects*; D011829:Radiation Dosage; D017564:Radiation Pneumonitis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D000077210:Sunitinib; D013904:Thoracic Vertebrae / Q000187:drug effects / Q000528:radiation effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011758:Pyrroles; D011239:Prednisolone; D000077210:Sunitinib