A Case of Cobalamin Deficiency and Macrocytic Anemia Secondary to Sunitinib

Reed, Jarred P; Chung, Joanie; Banerjee, Natasha

doi:10.7759/cureus.4310

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…These events may be present coincidentally. Initial observations published by Gillessen and Billemont [ 19 , 27 ] and supported by another case report by Reed et al [ 20 ] suggested a connection between absolute or relative vitamin B12 deficiency and sunitinib-related macrocytosis. However, these observations were performed on a limited number of patients.…”

Section: Discussionmentioning

confidence: 73%

“…It has been reported that sunitinib and several other tyrosine kinase inhibitors influence the erythrocyte mean corpuscular volume parameter (MCV) [ 17 , 18 ]. Initial considerations about this phenomenon included possible relative folate and cobalamin deficiency [ 19 , 20 ]. However, more recent studies provided data that this effect is related to the inhibitory activity of tyrosine kinase inhibitors towards c-KIT, which is extensively expressed by progenitor cells in the bone marrow [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Sunitinib-Induced Elevation of Mean Corpuscular Volume (MCV)—Exploring Its Possible Clinical Relevance in Cancer Patients

et al. 2022

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Sunitinib is a broad-spectrum multitargeted tyrosine kinase inhibitor mainly used as second-line therapy for non-resectable gastrointestinal stromal or first-line treatment option of metastatic renal cell carcinoma (mRCC), and as an “off-label” option in pediatric oncology. It has been previously reported that sunitinib elevates the mean corpuscular volume of erythrocytes (MCV) in treated subjects. The aim of this study was to assess time-dependent changes of this effect and evaluate its possible clinical relevance. In this study, 179 adult and 21 pediatric patients with solid tumors treated with sunitinib were retrospectively analyzed. The laboratory and treatment-related data were collected for each treatment period. The regression model with a broken-line relationship was used to fit time dependence of the MCV. In the adult group, the MCV was increasing during the first 21.6 weeks (median) of treatment in a median level of 99.8 fL, where it stabilized. MCV increase was faster in the patients who suffered from treatment-related adverse events (21.3 vs. 24.6 weeks, p = 0.010). In the pediatric cohort, the MCV dynamics were similar to adults. In conclusion, MCV changes during sunitinib treatment in pediatric and adult patients may be of clinical utility in monitoring sunitinib treatment course.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Sunitinib-Induced Elevation of Mean Corpuscular Volume (MCV)—Exploring Its Possible Clinical Relevance in Cancer Patients

et al. 2022

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“…Among these mechanisms, the most prevalent is the occurrence of point mutations at the tyrosine kinase's binding site, resulting in a diminished affinity for TKIs. Given that TKIs necessitate prolonged administration, non-compliance with the prescribed treatment regimen is one of the foremost reasons for diminished efficacy [12].…”

Section: Discussionmentioning

confidence: 99%

Effect of macrocytosis on erlotinib response in metastatic non-small cell lung cancer

Kazaz,

Duygulu

2023

J Surg Med

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Background/Aim: Numerous studies have assessed the relationship between macrocytosis and responses to chemotherapeutic agents and TKIs such as sunitinib and imatinib. However, there is limited data in the literature regarding the prognostic or predictive value of macrocytosis in using erlotinib. If a relationship is detected, early response/resistance assessment can be performed before imaging time in the follow-up of treatments, and a more cost-effective, non-invasive method can be employed for response monitoring. This study aimed to elucidate the effect of macrocytosis on response rates in patients treated with erlotinib for non-small cell lung cancer. Methods: Seventy-five individuals diagnosed with non-small cell lung cancer (NSCLC) and admitted to our institution were enrolled in this retrospective cohort study. Baseline demographics, time of diagnosis, previous treatment, and the initiation or cessation of erlotinib were recorded. Data of patients with and without macrocytosis were analyzed. Stable disease, partial and complete response rates, and progressive disease response were evaluated separately as response rates. Progression-free survival between drug initiation and discontinuation due to progression was interpreted using Kaplan-Meier curves. Results: The distribution of the overall survival (OS) and progression-free survival (PFS) evaluations revealed that 84% (n=63) of the patients were deceased, and the progression rate was 94.7% (n=71). The median OS of the patients was 18 months, and the median PFS was 11 months. There was a statistically significant difference in overall survival in females, with a median OS of 25 months (95% CI 17–32 months) and a median OS of 13 months in males (95% CI 9–20 months) (P=0.008). PFS was 14.5 months (95% CI 11–21 months) in women and six months (95% CI 4–17 months) in men, and there was a statistically significant difference (P=0.02). A statistically significant difference was achieved between MCV values measured during diagnosis and the third month between age groups (P=0.044). Conclusion: The outcomes of this research suggest a statistically significant difference between the MCV values measured at the time of diagnosis and the third month regarding age groups. Both OS and PFS in women were statistically significantly higher than in men.

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A Case of Cobalamin Deficiency and Macrocytic Anemia Secondary to Sunitinib

Cited by 2 publications

References 8 publications

Sunitinib-Induced Elevation of Mean Corpuscular Volume (MCV)—Exploring Its Possible Clinical Relevance in Cancer Patients

Sunitinib-Induced Elevation of Mean Corpuscular Volume (MCV)—Exploring Its Possible Clinical Relevance in Cancer Patients

Effect of macrocytosis on erlotinib response in metastatic non-small cell lung cancer

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