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Metastatic paraganglioma and treatment with sunitinib: a case report
1Department of General Surgery General Surgery Unit, Rare Hormonal Tumors Group, Surgery of Rare Hormonal Tumors, Istituti Ospitalieri, Cremona, Italy. f.cirillo@neuroendocrini.it
Abstract:
Sunitinib malate is a small kinase inhibitor with activity against a number of tyrosine kinase receptors. We treated a young man suffering from a metastatic paraganglioma with sunitinib. In this report we discuss a number of related questions including the correct dosage, schedules and timing of administration of the molecule, the main side effects and their treatment, and evaluation of the treatment response by CT scan. Treatment with sunitinib started at a dose of 50 mg daily for 4 weeks followed by 2 weeks off (4/2). Because of the side effects, the dose was reduced to 25 mg daily (4/2) and then to 25 mg daily (2/1). This resulted in a significant decrease in the plasma chromogranin A value and the radiological size of the metastases, as well as important clinical improvement. After 6 cycles the treatment was stopped because of a rise in plasma NSE values and disease progression. Sunitinib malate can induce marked toxicity, in which case the daily dose should be reduced and a different schedule of administration adopted. Response evaluation by CT scan should take into account tumor necrosis caused by sunitinib. Sunitinib malate is an interesting molecule for targeted therapy also for advanced neuroendocrine tumors. There has been evidence of significant clinical improvement, as in the case reported here.
Insights
Sunitinib malate, a kinase inhibitor, showed clinical improvement in a metastatic paraganglioma patient. Dosage adjustments managed toxicity, leading to decreased tumor size and improved patient outcomes.
Area of Science:
- Oncology
- Pharmacology
Background:
- Metastatic paraganglioma is a rare neuroendocrine tumor.
- Sunitinib malate is a multi-targeted receptor tyrosine kinase inhibitor.
Observation:
- A young male patient with metastatic paraganglioma was treated with sunitinib malate.
- Initial dosage of 50 mg daily (4/2 schedule) led to side effects.
- Dosage was reduced to 25 mg daily (4/2, then 2/1 schedules) to manage toxicity.
Findings:
- Sunitinib treatment resulted in decreased plasma chromogranin A and tumor size.
- Significant clinical improvement was observed.
- Treatment was halted after 6 cycles due to disease progression and increased plasma NSE.
Implications:
- Sunitinib malate can be effective for advanced neuroendocrine tumors, including paraganglioma.
- Dosage and administration schedules require careful adjustment to manage toxicity.
- CT scan evaluation should consider sunitinib-induced tumor necrosis.
