title: Treatment-related fatigue with sorafenib, sunitinib and pazopanib in patients with advanced solid tumors: an up-to-date review and meta-analysis of clinical trials.
abstract: Fatigue is the most common symptom associated with cancer and cancer treatment. We performed an up-to-date meta-analysis to determine the incidence and relative risk (RR) of fatigue in patients (pts) with cancer treated with sorafenib (SO), sunitinib (SU) and pazopanib (PZ). PubMed databases were searched for articles published till August 2013. Eligible studies were selected according to PRISMA statement. Summary incidence, RR and 95% confidence intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies. Fifteen studies were included in our analysis. A total of 6,996 pts was enrolled: 2,260 had renal cell carcinomas (RCC), 1,691 non-small cell lung cancers, 1,290 breast cancers, 823 hepatocellular carcinomas, 362 soft tissue sarcomas, 304 gastrointestinal solid tumors, 165 neuroendocrine tumors and 101 melanomas. When stratified by drug, SO registered lower incidence and RR of all and high-grade fatigue when compared to SU, whereas the difference between SO and PZ was significant only for all-grade fatigue (p < 0.001). The difference between SU and PZ was significant for high-grade (p < 0.001) but not for all-grade fatigue (p = 0.52). In RCC pts, PZ showed the lower incidence and RR of all and high-grade fatigue. The differences were significant for SU vs. SO (p < 0.001), SU vs. PZ (p < 0.001) and SO vs. PZ (p < 0.001). Treatment with SO, SU and PZ is associated with an increased incidence of fatigue in pts with cancer. Early and appropriate management is required to avoid unnecessary dose reductions and transitory or definitive treatment discontinuations.
authors.affiliation: Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Santoni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Conti
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arnaldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Iacovelli
authors.forename: Mimma
authors.initials: M
authors.lastname: Rizzo
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.forename: Laura
authors.initials: L
authors.lastname: Trementino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tortora
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D005221:Fatigue / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007191:Indazoles; D007211:Indoles / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000009:adverse effects* / Q000627:therapeutic use; D012306:Risk; D000077157:Sorafenib; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D020533:Angiogenesis Inhibitors; D007191:Indazoles; D007211:Indoles; D010671:Phenylurea Compounds; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D009536:Niacinamide; C516667:pazopanib; D000077157:Sorafenib; D000077210:Sunitinib
keywords: cancer; fatigue; meta-analysis; pazopanib; renal cell carcinoma; sorafenib; sunitinib; tyrosine kinase inhibitors