Division of Medical Oncology, BCCA Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
Oncologist. 2011;16(5):543-53. doi: 10.1634/theoncologist.2010-0263. Epub 2011 Apr 13.
The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.
多靶点酪氨酸激酶抑制剂舒尼替尼已成为治疗中高危转移性肾细胞癌的标准治疗方法之一。尽管舒尼替尼通常具有可接受的毒性，但它表现出一种新颖而独特的毒性特征，需要进行监测和管理。疲劳、腹泻、厌食、口腔变化、手足综合征和其他皮肤毒性、甲状腺功能障碍、骨髓毒性和高血压似乎是舒尼替尼最常见和最具临床相关性的毒性。药物剂量和治疗持续时间与治疗反应和生存相关。已经发布了高血压治疗建议，但目前尚无管理非心血管副作用的标准指南。为了讨论非心血管副作用的最佳管理，一个国际跨学科专家小组于 2009 年 11 月聚集在一起。对副作用的发生率、严重程度和潜在机制以及潜在治疗选择的现有文献进行了仔细审查和讨论。在此基础上，根据这些进展和对现有文献的全面审查，提出了监测、预防和治疗最常见非心血管副作用的建议，并在本综述中进行了总结。积极评估和持续及时管理舒尼替尼相关副作用对于确保最佳治疗效果至关重要，这可以允许适当的药物剂量和延长治疗时间。
