Reactions 1430 - 1 Dec 2012

SAntineoplastics

Various toxicities: 2 case reportsTwo men developed various toxicities following

sequential antineoplastic therapy for metastatic renal cellcarcinoma (RCC).

A 53-year-old man received sunitinib 50 mg/day [routenot stated] for 4 weeks with a 2-week washout phasealongside vinorelbine, bevacizumab and zolendronic acid.He experienced mild hypertension due to sunitinib whichwas successfully treated with an angiotensin receptorantagonist [time to reaction onset and duration oftreatment before reaction not stated]. He achieved a partialresponse although his disease subsequently relapsed andsunitinib was switched to temsirolimus 25 mg/week [routenot stated]. His condition deteriorated further andsorafenib and bevacizumab were added. He subsequentlyexperienced grade III anaemia due to temsirolimus and wastreated with erythropoiesis-stimulating agents and bloodtransfusions [time to reaction onset, duration of treatmentbefore reaction and outcome not stated]. He subsequentlydied of an uncontrollable allergic shock during a bloodtransfusion possibly due to an indirect effect oftemsirolimus-induced anaemia.

A 54-year-old man received sunitinib 50 mg/day [routenot stated] for 4 weeks with a 2-week washout phase. Hedeveloped hypothyroidism 6 months after initiatingsunitinib which was treated with levothyroxine [outcomenot stated]. His disease continued to progress despitetreatment with temsirolimus and zolendronic acid sosorafenib 400 mg/day [route not stated] was initiated. Heexperienced mild asthenia, grade I myelosupression andhyperlipidemia due to sorafenib although no treatmentdelay or dose reduction was necessary [time to reactiononset, duration of treatment before reaction and outcomenot stated]. Further pulmonary metastases occurred andpazopanib 800 mg/day was initiated. Despite experiencinganorexia and grade II diarrhoea due to pazopanib heachieved stable disease [time to reaction onset, duration oftreatment before reaction and outcome not stated].

Author comment: "[W]e present two patients whose RCCwas treated with nephrectomy, metastasectomies, andsequential systemic therapy and who experienced a verysatisfactory quality of life and long-term survival".Syrios J, et al. Prolonged survival after sequential multimodal treatment inmetastatic renal cell carcinoma: Two case reports and a review of the literature.Journal of Medical Case Reports 6: [6 pages], No. 303, 14 Sep 2012. Availablefrom: URL: http://dx.doi.org/10.1186/1752-1947-6-303 - Greece 803080574

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