Management of adverse events in patients with metastatic renal cell carcinoma treated with sunitinib and clinical outcomes.
Patients with progressive renal cell carcinoma who undergo sunitinib treatment, experience many adverse events (AEs), including thrombopenia and hypertension. Dose reduction or treatment discontinuation due to AEs makes it difficult to control the clinical condition. Therefore, patients' understanding regarding the basics of blood pressure (BP) measurement and how to deal with each AE are particularly important. Here we report whether or not pharmacist instructions help in order to increase patients' awareness of early AE management results in an improvement of treatment outcomes. The present study included 15 patients who were administered sunitinib. From the start of sunitinib treatment, pharmacists continuously provided drug administration guidance to the patients and confirmed their awareness and knowledge regarding AEs, symptom management, and drug adherence. The relative dose intensity (RDI) of 15 patients from week 1 to 24 after sunitinib treatment was calculated. Pharmaceutical interventions significantly improved patients' understanding of BP measurements and reference values, etc. Although the RDI was 67.3%-78.7%, there were no cases of discontinuation of administration or reduction of the dose caused by e.g. hypertension, hand and foot syndrome (HFS) and stomatitis. Pharmaceutical interventions improved patients' awareness of the management of AEs and adherence to sunitinib therapy. As a result, a high RDI was maintained, which may lead to prolonged survival. Therefore, our results suggest that early AE management provided by pharmacists is particularly important to assure the safety and efficacy of sunitinib therapy.
Department of Hospital Pharmacy, Aichi Medical University School of Medicine, Karimata, Yazako, Nagakute, Aichi 480-1195, Japan. arakawa3@aichi-med-u.ac.jp.
Maki
M
Arakawa-Todo
Takahiko
T
Yoshizawa
Kenji
K
Zennami
Genya
G
Nishikawa
Yoshiharu
Y
Kato
Ikuo
I
Kobayashi
Keishi
K
Kajikawa
Yoshiaki
Y
Yamada
Katsuhiko
K
Matsuura
Ikuto
I
Tsukiyama
Hiroko
H
Saito
Takaaki
T
Hasegawa
Kogenta
K
Nakamura
Makoto
M
Sumitomo
D000368:Aged; D001795:Blood Pressure Determination; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010349:Patient Compliance; D011379:Prognosis; D011758:Pyrroles / Q000009:adverse effects*; D000077210:Sunitinib
D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
Sunitinib; adherence; adverse events; blood pressure; early management; pharmacist