title: Uncommon gastrointestinal bleeding during targeted therapy for advanced renal cell carcinoma: A report of four cases.
abstract: Clinically available targeted agents to treat advanced renal cell carcinoma (RCC) include sunitinib, sorafenib and temsirolimus. Sorafenib and sunitinib have been associated with bleeding in selected trials, but clinical and endoscopic characteristics of gastrointestinal bleeding are not well described. Herein, we report four cases of advanced RCC in which endoscopic hemostasis effectively resolved high-grade, life-threatening gastrointestinal bleeding that occurred during targeted therapy. Although stomatitis and mucositis have occurred during targeted therapies, life-threatening gastrointestinal bleeding is less common. In these four patients, the origins of gastrointestinal bleeding were identified, and complete endoscopic hemostasis was achieved. Endoscopies revealed variable characteristics including angiodysplasia, multiple gastric ulcers and oozing bleeding of the normal mucosa. Although the most effective diagnostic and treatment strategies are disputed, endoscopic examinations are best performed before starting targeted therapies. Additionally, these patients should be monitored even for rare life-threatening events.
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Department of Urology, Tottori Red Cross Hospital, Tottori 680-8517, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Ohata
authors.affiliation: Department of Urology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Ueda
authors.affiliation: Department of Urology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Urology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kakehi
authors.affiliation: Department of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
keywords: argon plasma coagulation; gastrointestinal bleeding; sorafenib; sunitinib; targeted therapy; temsirolimus