Management of sunitinib-related adverse events: an evidence- and expert-based consensus approach

Abstract

Derived from this process, this paper gives an overview on Sunitinib therapy management recommendations deducted from published evidence and consensus agreement among experts.

The use of targeted therapies in pancreatic neuroendocrine tumours: patient assessment, treatment administration, and management of adverse events

“…hypothyroidism, anaemia, depression, malnutrition, distress, sleep disorders, pain) and provide medical treatment as necessary Provide counselling on how to cope with fatigue and provide motivation to succeed during therapy Deliver strategies to support the adaptation of daily activities to conserve energy In patients with reduced QoL, consider reducing the sunitinib dose Neutropenia Treatment can continue if severity is less than grade 3 For severe neutropenia, treatment should be interrupted until toxicity decreases and should be permanently discontinued if symptoms recur [Novartis Pharmaceuticals Corporation, 2012;Pfizer Inc., 2011;Moldawer and Wood, 2010;Balagula et al 2012;Ferte et al 2011;de Oliveira et al 2011;Boers-Doets et al 2011;White et al 2010;Rodriguez-Pascual et al 2010;Nathan et al 2009;Grunwald et al 2010;Cohen and Oudard, 2012;Ravaud, 2011;Di Lorenzo et al 2011;Eisen et al 2012;Bhojani et al 2008;Aparicio-Gallego et al 2011]. ACE, angiotensin-converting enzyme; QoL, quality of life.…”

“…Patients should be treated with antihypertensive therapy, and the sunitinib dose should be reduced if the condition is persistent [Grunwald et al 2010;Cohen and Oudard, 2012;Eisen et al 2012]. Cardiovascular AEs have been reported in 11-27% of patients treated with sunitinib [Pfizer Inc., 2011].…”

Learning Experiences with Sunitinib Continuous Daily Dosing in Patients with Pancreatic Neuroendocrine Tumours

“…Experience of managing adverse events in patients receiving sunitinib was initially gained predominantly with the use of schedule 4/2 in metastatic rcc, because sunitinib has become the mainstay of treatment for most patients with that disease 33 ; however, the recommendations for dealing with adverse events in patients receiving sunitinib are similar whether dosing is by cdd or schedule 4/2. …”

“…A review of patients with rcc in medline and in the database of the American Society of Clinical Oncology 34 , together with a literature review and results of a structured consensus survey of German specialists 33 , suggests an incidence of up to 59%, although most cases are of mild-to-moderate severity. Grade 3 or 4 diarrhea (determined according to the Common Toxicity Criteria) was reported in 5% of patients with rcc receiving sunitinib 34 .…”

“…Grade 3 or 4 diarrhea (determined according to the Common Toxicity Criteria) was reported in 5% of patients with rcc receiving sunitinib 34 . Those proportions are matched in experiences of the cdd schedule in patients with pancreatic nets (Table ii) 33 . Because many patients with pancreatic net have previously undergone pancreatectomy 35 , that procedure could be the basis of pancreatic insufficiency and related diarrhea in some patients.…”