Sunitinib

Sunitinib has bene widely used in many different malignancies. We report here a case of a 67 year old woman with metastatic adenocarcinoma of the lungs who developed acute life threatening hyponatremia after received sunitinib 40mg a day for 20 days. Lab study is consistent with syndrome of Inappropriate antidiuretic hormone secretion(SIADH). She was admitted to medical intensive care unit and received hypertonic saline infusion, strict fluid restriction and vasopressin receptor antagonist tolvaptan. She recovered from this episode and was discharged home. Sunitinib was discontinued permanently. This is a first case report of sunitnib induced severe SIADH.

Purpose Sunitinib has shown antitumor activity with a manageable safety profile as metastatic renal cell carcinoma (RCC) treatment, when given by the standard intermittent schedule as well as a continuous daily dosing (CDD) schedule. A trial was conducted to compare the schedules. Patients and Methods Patients with treatment-naive, clear cell advanced RCC were randomly assigned 1:1 to receive sunitinib 50 mg/d for 4 weeks followed by 2 weeks off treatment (schedule 4/2; n = 146) or 37.5 mg/d on the CDD schedule (n = 146) for up to 2 years. The primary end point was time to tumor progression. Results Median time to tumor progression was 9.9 months for schedule 4/2 and 7.1 months for the CDD schedule (hazard ratio, 0.77; 95% CI, 0.57 to 1.04; P = .090). No significant difference was observed in overall survival (23.1 v 23.5 months; P = .615), commonly reported adverse events, or patient-reported kidney cancer symptoms. Schedule 4/2 was statistically superior to CDD in time to deterior...

Conclusion: High expression of HO-1 was associated with a lower tumor response rate and a shorter overall survival time when compared with low expression of HO-1.

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PurposeTo evaluate the potential benefit of continuous daily dosing sunitinib in patients with advanced nongastrointestinal stromal tumor (GIST) sarcomas.Patients and MethodsA total of 53 patients with advanced non-GIST soft tissue sarcomas received sunitinib 37.5 mg daily. Primary end point was Response Evaluation Criteria in Solid Tumors defined response. Secondary end points were stable disease at 16 and 24 weeks. [18F]-fluorodeoxyglucose positron emission tomography was performed on a subset of 24 patients at baseline and after 10 to 14 days of therapy.ResultsForty-eight patients were eligible for response. One patient (desmoplastic round cell tumor [DSRCT]) achieved a confirmed partial response (PR) and remained on study for 56 weeks. Ten patients (20%) achieved stable disease for at least 16 weeks. Metabolic PR was seen in 10 (47%) of 21 of patients. Metabolic stable disease was seen in 11 (52%) of 21. There were no unexpected toxicities observed.ConclusionSunitinib demonstrat...

Sunitinib malate (Sutent™) is an inhibitor of multiple protein tyrosine kinases that shows antitumor and antiangiogenic activities. In a randomized Phase III trial of treatment-naive patients with metastatic renal cell carcinoma (mRCC), patients treated with sunitinib showed a significant improvement in progression-free survival compared with those treated with IFN-α. Sunitinib also exhibited antitumor activity in unselected RCC patients, including those with who were refractory to treatment, had non-clear cell histology brain metastases, or an Eastern Cooperative Oncology Group performance status >1. Typical side effects of sunitinib malate are fatigue, asthenia, diarrhea, skin rash, stomatitis, hand-foot skin syndrome, hypothyroidism and hematological abnormalities. Hypertension, other toxicities may serve as biomarkers for improved clinical outcomes in sunitinib treatment. Currently, sunitinib remains the gold standard of care in the treatment of mRCC.