title: Risk of hematologic toxicities in cancer patients treated with sunitinib: a systematic review and meta-analysis.
abstract: BACKGROUND
  The incidence and risk of unique toxicities associated with a multi-targeted tyrosine kinase inhibitor sunitinib, such as hypertension and thromboembolic events, have been previously reported. However, the incidence and risk of hematologic toxicities have been less well characterized. We performed an up-to-date meta-analysis of trials to evaluate the risk of sunitinib-related hematologic toxicities.
  
  
  METHODS
  We searched Medline and the American Society of Clinical Oncology online database of meeting abstracts up to July 2012 for relevant clinical trials. Eligible studies included phase II and III trials and expanded access programs of sunitinib that reported adequate safety data profile reporting neutropenia, thrombocytopenia or anemia. The summary incidence, relative risk (RR) and 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  A total of 8,526 patients from 60 trials of sunitinib as a single agent revealed that the incidence of sunitinib-associated all-grade and high-grade (Grades 3 and 4) hematologic toxicities were, respectively: neutropenia: 42.1% and 12.8%; thrombocytopenia: 44.7% and 10.7% and anemia: 50.4% and 6.2%. Sunitinib-treated patients (2667 subjects from 10 randomized trials) had a significantly increased risk of all-grade (RR=3.58; 95% CI, 1.71-7.49) and high-grade (RR=3.32; 95% CI, 1.60-6.90) neutropenia, all-grade (RR=4.59; 95% CI, 2.76-7.63) and high-grade (RR=5.84; 95% CI, 2.22-15.41) thrombocytopenia and all-grade anemia (RR=1.15; 95% CI, 1.00-1.31).
  
  
  CONCLUSIONS
  Sunitinib is associated with a significant increase in the risk of developing all-grade and high-grade neutropenia and thrombocytopenia and all-grade anemia compared with control.
authors: Department of Medicine, Beth Israel Medical Center, University Hospital, New York, USA. tfunakoshi@chpnet.org
authors: Tomohiro
authors: T
authors: Funakoshi
authors: Asma
authors: A
authors: Latif
authors: Matthew D
authors: MD
authors: Galsky
mesh_terms: D000740:Anemia / Q000139:chemically induced / Q000453:epidemiology; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006402:Hematologic Diseases / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D009503:Neutropenia / Q000139:chemically induced / Q000453:epidemiology; D017594:Publication Bias; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D012306:Risk; D000077210:Sunitinib; D013921:Thrombocytopenia / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: Anemia; Hematologic toxicities; Meta-analysis; Neutropenia; Sunitinib; Thrombocytopenia