[Management of sunitinib-associated adverse events]

Patients diagnosed with metastatic renal cell carcinoma (mRCC) are currently treated with oral tyrosine kinase inhibitors (TKIs). Sunitinib malate (Sutent R Pfizer INC) is an oral multitargeted TKI and is the mainstay of therapy for mRCC patients in Japan. Although it shows a high therapeutic response and prolonged survival rates, sunitinib exhibits a novel and distinct toxicity profile that requires appropriate monitoring and management. Therefore, the physician needs to understand the modalities to detect and cope with such adverse events to effectively treat the patient. We summarized the management of the most frequent and clinically significant adverse events of sunitinib treatment. Myelotoxicity, especially thrombocytopenia seemed to be the most common and severe toxicity (73% all grade, 36.8%, ≧grade 3). The incidences of thyroid dysfunction, fatigue, hypertension, hand-foot syndrome, nausea, diarrhea and oral changes were reviewed. The incidences of ≧grade 3 adverse events and dose reduction were higher than those in western reports. In our institution, fever was frequently observed (up to 63.1%). When the patient is at high risk of sunitinib assosicated adverse events, dose reduction from the beginning of sunitinib therapy may be useful. To maintain the patient's quality of life and for long-term administration of the sunitinib, it is worth while to modulate the sunitinib administration schedule for each patient.