Ansari Zia, George Mathew K
Department of Medical Oncology, Tamworth Rural Referral Hospital, Locked Mail Bag 9783, 2348, Tamworth, NEMSC NSW, Australia.
J Med Case Rep. 2013 Feb 26;7:54. doi: 10.1186/1752-1947-7-54.
Sunitinib is an oral multi-targeted tyrosine kinase inhibitor approved for first line treatment for metastatic renal cell carcinoma and imatinib-resistant metastatic gastrointestinal stromal tumors. Sunitinib administration can cause myelosuppression resulting in neutropenia and thrombocytopenia. Here we present the case of a patient with metastatic renal cell carcinoma who developed sunitinib-induced immune-mediated thrombocytopenia and who was treated with withdrawal of sunitinib and administration of intravenous immunoglobulin and steroids.
This case report describes a 70-year-old Aboriginal Australian with a diagnosis of metastatic renal cell carcinoma. Three weeks after the initiation of sunitinib he developed epistaxis and was admitted with thrombocytopenia (platelets 7 × 109/L) which was found to be refractory to platelet transfusion. Sunitinib was stopped and he was treated with intravenous immunoglobulin and steroids. His platelet count rapidly improved and returned to baseline in three weeks. Only two cases of sunitinib-induced immune-mediated thrombocytopenia have been described in the literature.
Clinicians should have a high index of suspicion for the potential of immune-mediated thrombocytopenia after the initiation of multi-targeted tyrosine kinase inhibitors such as sunitinib. This is a diagnosis of exclusion and can be safely treated by drug withdrawal.
舒尼替尼是一种口服多靶点酪氨酸激酶抑制剂，被批准用于转移性肾细胞癌的一线治疗以及对伊马替尼耐药的转移性胃肠道间质瘤的治疗。使用舒尼替尼可导致骨髓抑制，引起中性粒细胞减少和血小板减少。在此，我们报告一例转移性肾细胞癌患者，该患者发生了舒尼替尼诱导的免疫介导性血小板减少症，并通过停用舒尼替尼以及给予静脉注射免疫球蛋白和类固醇进行治疗。
本病例报告描述了一名70岁的澳大利亚原住民，被诊断为转移性肾细胞癌。开始使用舒尼替尼三周后，他出现鼻出血，并因血小板减少症（血小板计数为7×10⁹/L）入院，发现对血小板输注无效。停用舒尼替尼后，他接受了静脉注射免疫球蛋白和类固醇治疗。他的血小板计数迅速改善，并在三周内恢复到基线水平。文献中仅描述了两例舒尼替尼诱导的免疫介导性血小板减少症病例。
临床医生在开始使用舒尼替尼等多靶点酪氨酸激酶抑制剂后，应高度怀疑免疫介导性血小板减少症的可能性。这是一种排除性诊断，通过停药可安全治疗。
