Related Experiment Video
Updated: May 14, 2026
Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
Published on: January 25, 2015
Tolvaptan for paraneoplastic SIADH in small cell lung cancer: a scoping review
Victoria L Cammann1, Menzi Sheryl1, Thomas Fürst2
1Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
Background:
Hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) occurs in approximately 25 % of patients with small cell lung cancer (SCLC). Tolvaptan has emerged as a promising option to treat SIADH in such patients. Here, we analyse the current literature on tolvaptan for managing paraneoplastic SIADH in SCLC.
Methods:
PubMed, EMBASE, Cochrane, and Web of Science were searched for studies that enrolled patients with paraneoplastic SIADH in SCLC and were treated with tolvaptan until December 2024.
Results:
Out of 155 studies identified by database searches, 29 studies comprising 86 patients were included in this scoping review. The mean age was 64 years, 38.4 % were female, and 32.6 % patients had extensive disease. The median sodium concentration before initiation of tolvaptan was 117 mmol/L (IQR, 113 -121 mmol/L). Starting doses of tolvaptan ranged from 1.875 mg/day to 15 mg/day, with most patients receiving 7.5 mg/day or 15 mg/day. An initial response to tolvaptan was reported in all included cases. The median treatment duration with tolvaptan was 8 days (IQR 5 - 150 days). Side effects of tolvaptan were reported in 8.1 % of cases (N = 7) and included plasma sodium overcorrection (N = 5), extreme thirst and polyuria (N = 1), and dry mouth with episodic dizziness (N = 1). Among the included studies, five patients with secondary failure to tolvaptan were identified. Three of these cases were accompanied by very high arginine vasopressin (AVP) or copeptin concentrations and a progression in tumor burden.
Conclusion:
In SCLC patients with paraneoplastic SIADH, tolvaptan is a welcome addition to the treatment armamentarium for hyponatremia. The use of tolvaptan demands considerable expertise to avoid plasma sodium overcorrection. Secondary failure to tolvaptan can occur and should prompt further investigations to detect tumor progression.
Insights
Tolvaptan effectively treats hyponatremia in small cell lung cancer (SCLC) patients with SIADH, showing initial response in all cases. Careful management is needed to prevent overcorrection and monitor for tumor progression.
Area of Science:
- Oncology
- Nephrology
- Endocrinology
Background:
- Syndrome of inappropriate antidiuretic hormone (SIADH) is a common complication in small cell lung cancer (SCLC), affecting approximately 25% of patients.
- Hyponatremia associated with SIADH in SCLC requires effective management strategies.
- Tolvaptan has emerged as a potential therapeutic option for SIADH in this patient population.
Purpose of the Study:
- To analyze the current literature on the efficacy and safety of tolvaptan for managing paraneoplastic SIADH in SCLC patients.
- To review treatment responses, side effects, and potential failure patterns associated with tolvaptan use.
Main Methods:
- A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane, and Web of Science databases.
- Studies included patients with paraneoplastic SIADH in SCLC treated with tolvaptan, with data analyzed up to December 2024.
- A scoping review methodology was employed to synthesize findings from eligible studies.
Main Results:
- Twenty-nine studies comprising 86 patients were included, with a mean age of 64 years and 32.6% having extensive disease.
- The median baseline sodium concentration was 117 mmol/L. Tolvaptan showed an initial response in all cases, with doses typically ranging from 7.5 mg/day to 15 mg/day.
- Side effects were reported in 8.1% of cases, primarily plasma sodium overcorrection. Secondary failure occurred in five patients, linked to high AVP levels and tumor progression.
Conclusions:
- Tolvaptan is a valuable treatment option for hyponatremia in SCLC patients with paraneoplastic SIADH.
- Expertise is crucial for managing tolvaptan to avoid complications like sodium overcorrection.
- Secondary failure necessitates investigation for tumor progression, as it may be associated with elevated AVP and worsening cancer burden.
Related Concept Videos
02:57Targeted Cancer Therapies
There are several types of targeted therapies against specific...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...