title: Metastatic renal cell carcinoma: the first report of unilateral fundus hemorrhage induced by sorafenib.
abstract: BACKGROUND
  Renal cell carcinoma (RCC) is the most common type of kidney tumor with increasing incidence. Tyrosine Kinase Inhibitors (TKIs) are considered important treatment in the management of metastatic RCC. Some previous studies demonstrated that sorafenib treatment is associated with a significantly increased risk of potentially life-threatening adverse events, like bleeding. But bleeding at the fundus site is the rarest type of hemorrhage. As for TKIs' risk of bleeding, how we distinguish the degree of bleeding and what optimal strategies should we take to manage bleeding, needs to be studied systematically.
  
  
  RESULTS
  With a long-term exposure (17 months) to sorafenib, he experienced blurred vision in his right eye and was hospitalized. The patient's diagnosis was central retinal vein occlusion (CRVO) of the right eye. Unfortunately sorafenib was terminated.
  
  
  METHODS
  The authors describe the first case of unilateral fundus hemorrhage induced by sorafenib. A 42-year-old man was diagnosed metastatic left RCC, with clinical stage and prognostic risk being assessed as T4N1M1 and intermediate. He received a radical left nephrectomy and retroperitoneal lymph node dissection, with taking the oral multi-targeted TKI, sorafenib (800 mg daily) from 7 months to 7 days before the surgery and 7 days after the surgery restarting again until the occurrence of fundus hemorrhage.
  
  
  CONCLUSIONS
  In this patient, long-term exposure to sorafenib possibly has increased the risk of fundus hemorrhage. This article provides us a previously undescribed morbidity associated with sorafenib, which reminds us of understanding the risk of bleeding and how this complication might be managed systematically.
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Zhi Yong
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Urology, Sun Yat-Sen Memorial Hospital, Guangzhou, China.
authors.forename: Xin Xiang
authors.initials: XX
authors.lastname: Fan
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Yan Jun
authors.initials: YJ
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Yao
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Zhuo Wei
authors.initials: ZW
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Wen Tao
authors.initials: WT
authors.lastname: Pan
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Yun Lin
authors.initials: YL
authors.lastname: Ye
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Yang
authors.affiliation: Department of Urology, Sun Yat-Sen Memorial Hospital, Guangzhou, China.
authors.forename: Yi Chuan
authors.initials: YC
authors.lastname: Huang
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Zhi Ming
authors.initials: ZM
authors.lastname: Wu
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, China.|Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Fang Jian
authors.initials: FJ
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology; D005130:Eye Hemorrhage / Q000139:chemically induced*; D005654:Fundus Oculi; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000009:adverse effects*; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: CRVO; RCC; TKIs; sorafenib; unilateral