Abstract
Context: The therapeutic scenario for metastatic renal cell carcinoma (mRCC) has been evolving rapidly, with sunitinib, sorafenib, bevacizumab, everolimus, pazopanib, and temsirolimus being successfully tested and approved in a short period of time. Oncologists must be familiar with the management of toxicity that these biologic agents cause, as such toxicity is different from that of conventional chemotherapeutic agents. Objective: To describe toxic effects associated with targeted therapy of mRCC and their proper management on the basis of currently available evidence. Evidence acquisition: We conducted a systematic analysis of the literature on 15th October 2010 by performing a search of Medical Subject Headings (MeSH) on PubMed using the words sorafenib, sunitinib, bevacizumab, everolimus, pazopanib, or temsirolimus combined with the MeSH term kidney neoplasms. Consideration for inclusion was given to articles providing data concerning (1) incidence and grading and (2) management of targeted therapy-related toxic effects. A separate search was conducted on PubMed to retrieve meta-analyses using each drug name and the word meta-analysis. Evidence synthesis: Hypertension, fatigue, bone marrow toxicity, skin toxicity, and gastrointestinal side-effects are common with the six targeted agents. Everolimus and temsirolimus are associated with immunosuppression, metabolic alterations, and interstitial pneumonitis, while sunitinib is associated with hypothyroidism. Recommendations for treating these conditions usually follow those for the general population because of the lack of experimental data in this setting (eg, for management of sunitinib-induced hypertension). Conclusions: The treating oncologist should try to manage side-effects associated with targeted therapy using supportive and pharmacologic interventions. Severe toxicity requires external specialist consultation and treatment suspension and/or dose reduction. Experimental data about the management of targeted therapy-related toxicity in mRCC is lacking and required in this setting.
| Original language | English |
|---|---|
| Pages (from-to) | 526-540 |
| Number of pages | 15 |
| Journal | European Urology |
| Volume | 59 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2011 |
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Keywords
- Metastatic renal cell cancer
- Targeted agents
- Toxicity
ASJC Scopus subject areas
- Urology
Cite this
Toxicities of targeted therapy and their management in kidney cancer. / Di Lorenzo, Giuseppe; Porta, Camillo; Bellmunt, Joaquim; Sternberg, Cora; Kirkali, Ziya; Staehler, Michael; Joniau, Steven; Montorsi, Francesco; Buonerba, Carlo.
In: European Urology, Vol. 59, No. 4, 04.2011, p. 526-540.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Toxicities of targeted therapy and their management in kidney cancer
AU - Di Lorenzo, Giuseppe
AU - Porta, Camillo
AU - Bellmunt, Joaquim
AU - Sternberg, Cora
AU - Kirkali, Ziya
AU - Staehler, Michael
AU - Joniau, Steven
AU - Montorsi, Francesco
AU - Buonerba, Carlo
PY - 2011/4
Y1 - 2011/4
N2 - Context: The therapeutic scenario for metastatic renal cell carcinoma (mRCC) has been evolving rapidly, with sunitinib, sorafenib, bevacizumab, everolimus, pazopanib, and temsirolimus being successfully tested and approved in a short period of time. Oncologists must be familiar with the management of toxicity that these biologic agents cause, as such toxicity is different from that of conventional chemotherapeutic agents. Objective: To describe toxic effects associated with targeted therapy of mRCC and their proper management on the basis of currently available evidence. Evidence acquisition: We conducted a systematic analysis of the literature on 15th October 2010 by performing a search of Medical Subject Headings (MeSH) on PubMed using the words sorafenib, sunitinib, bevacizumab, everolimus, pazopanib, or temsirolimus combined with the MeSH term kidney neoplasms. Consideration for inclusion was given to articles providing data concerning (1) incidence and grading and (2) management of targeted therapy-related toxic effects. A separate search was conducted on PubMed to retrieve meta-analyses using each drug name and the word meta-analysis. Evidence synthesis: Hypertension, fatigue, bone marrow toxicity, skin toxicity, and gastrointestinal side-effects are common with the six targeted agents. Everolimus and temsirolimus are associated with immunosuppression, metabolic alterations, and interstitial pneumonitis, while sunitinib is associated with hypothyroidism. Recommendations for treating these conditions usually follow those for the general population because of the lack of experimental data in this setting (eg, for management of sunitinib-induced hypertension). Conclusions: The treating oncologist should try to manage side-effects associated with targeted therapy using supportive and pharmacologic interventions. Severe toxicity requires external specialist consultation and treatment suspension and/or dose reduction. Experimental data about the management of targeted therapy-related toxicity in mRCC is lacking and required in this setting.
AB - Context: The therapeutic scenario for metastatic renal cell carcinoma (mRCC) has been evolving rapidly, with sunitinib, sorafenib, bevacizumab, everolimus, pazopanib, and temsirolimus being successfully tested and approved in a short period of time. Oncologists must be familiar with the management of toxicity that these biologic agents cause, as such toxicity is different from that of conventional chemotherapeutic agents. Objective: To describe toxic effects associated with targeted therapy of mRCC and their proper management on the basis of currently available evidence. Evidence acquisition: We conducted a systematic analysis of the literature on 15th October 2010 by performing a search of Medical Subject Headings (MeSH) on PubMed using the words sorafenib, sunitinib, bevacizumab, everolimus, pazopanib, or temsirolimus combined with the MeSH term kidney neoplasms. Consideration for inclusion was given to articles providing data concerning (1) incidence and grading and (2) management of targeted therapy-related toxic effects. A separate search was conducted on PubMed to retrieve meta-analyses using each drug name and the word meta-analysis. Evidence synthesis: Hypertension, fatigue, bone marrow toxicity, skin toxicity, and gastrointestinal side-effects are common with the six targeted agents. Everolimus and temsirolimus are associated with immunosuppression, metabolic alterations, and interstitial pneumonitis, while sunitinib is associated with hypothyroidism. Recommendations for treating these conditions usually follow those for the general population because of the lack of experimental data in this setting (eg, for management of sunitinib-induced hypertension). Conclusions: The treating oncologist should try to manage side-effects associated with targeted therapy using supportive and pharmacologic interventions. Severe toxicity requires external specialist consultation and treatment suspension and/or dose reduction. Experimental data about the management of targeted therapy-related toxicity in mRCC is lacking and required in this setting.
KW - Metastatic renal cell cancer
KW - Targeted agents
KW - Toxicity
UR - http://www.scopus.com/inward/record.url?scp=79952282127&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952282127&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2011.01.002
DO - 10.1016/j.eururo.2011.01.002
M3 - Article
C2 - 21277078
AN - SCOPUS:79952282127
VL - 59
SP - 526
EP - 540
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 4
ER -