Department of Medical Oncology, Oita University, Hasama-machi, Yufu-shi, Japan.
BMC Gastroenterol. 2010 Nov 1;10:128. doi: 10.1186/1471-230X-10-128.
The oral multi-kinase inhibitor sunitinib malate improves the survival of patients with gastrointestinal stromal tumors (GIST) after the disease progresses or intolerance to imatinib mesylate develops. Urinary fistulae arising during treatment with sunitinib for GIST have not been described.
We describe a 62-year-old female patient diagnosed with unresectable GIST that involved the abdominal wall, urinary bladder wall, bowel, mesentery and peritoneum in the pelvic cavity. Intestinocutaneous fistulae developed on a surgical lesion after orally administered imatinib was supplemented by an arterial infusion of 5-flurouracil. Sunitinib was started after the patient developed resistance to imatinib. On day 4 of the fourth course of sunitinib, a widely dilated cutaneous fistula discharged large amounts of fluid accompanied by severe abdominal pain. Urinary communication was indicated based on the results of an intravenous injection of indigo carmine. Computed tomography findings suggested a small opening on the anterior urinary bladder wall and fistulous communication between the bladder and abdominal walls bridged by a subcutaneous cavity. The fistula closed and the amount of discharge decreased when sunitinib was discontinued. Therefore, sunitinib might have been associated with the development of the vesicocutaneous fistula in our patient.
This is the first description of a vesicocutaneous fistula forming while under sunitinib treatment. Clinicians should be aware of the possible complication of vesicocutaneous fistula formation during treatment with molecular targeting agents in patients with extravesical invasion and peritoneal dissemination of GIST.
苹果酸舒尼替尼是一种口服多激酶抑制剂，可改善胃肠道间质瘤（GIST）患者在疾病进展或对甲磺酸伊马替尼不耐受时的生存情况。目前尚未有关于舒尼替尼治疗 GIST 时发生尿瘘的报道。
我们报告了 1 例 62 岁女性患者，诊断为不可切除的 GIST，肿瘤累及腹壁、膀胱壁、肠、肠系膜和盆腔腹膜。患者接受伊马替尼口服治疗后，手术部位出现肠皮肤瘘，后加用 5-氟尿嘧啶动脉输注。患者对伊马替尼产生耐药后开始使用舒尼替尼。在第四个疗程的第 4 天，广泛扩张的皮肤瘘大量排出液体，同时伴有严重腹痛。根据靛胭脂静脉注射的结果，提示存在尿路相通。计算机断层扫描结果提示前膀胱壁有一个小开口，膀胱和腹壁之间存在瘘管相通，由皮下腔桥连接。停止使用舒尼替尼后，瘘管闭合，排出量减少。因此，舒尼替尼可能与我们患者的膀胱皮肤瘘的发生有关。
这是首例描述舒尼替尼治疗时发生膀胱皮肤瘘的病例。对于存在膀胱外侵袭和 GIST 腹膜播散的患者，在使用分子靶向药物治疗时，临床医生应注意可能发生膀胱皮肤瘘的并发症。
