Novel Therapies in Advanced Renal Cell Carcinoma – Management of Adverse Events from Sorafenib and Sunitinib: Addition

by Dr. med. Philipp Ivanyi, Dr. med. Thomas Winkler, Prof. Dr. med. Arnold Ganser, Priv.-Doz. Dr. med. Christoph Reuter, Dr. med. Viktor Grünwald in volume 13/2008

The number of specific tyrosine kinase inhibitors that are already licensed or in development is about 25 or 30, and these substances are always presented as low in side effects. Thanks to the authors for having dispensed with this myth – at least for sunitinib and sorafenib.
However, an addition seems required. Four months after the review article was submitted, an article was published (1) that pointed out the cardiotoxic risk of sunitinib. OF 75 patients in a phase I/II study, eight had a cardiovascular event: one cardiac death, one myocardial infarction, and six patients with heart failure. 35 patients (47%) developed hypertension (>150/100 mm Hg).
The authors' recommendation to use antidepressants in therapy associated exhaustion also has to be questioned. If it is to be interpreted as „ut aliquid fiat“("for something to happen") it seems advisable to do without or prescribe St John's wort. If a patient does indeed have concomitant depression, the indication for treatment has to be considered individually. Even the newer antidepressants have shown an advantage only in severe depression (2). Antidepressants present a whole range of possible further adverse effects and interactions. DOI: 10.3238/arztebl.2008.0500a

Prof. Dr. med. Frank P. Meyer
Magdeburger Str. 29
39167 Groß Rodensleben, Germany
[e-mail]

References

1. Chu TF, Rupnick MA, Kerkela R et al.: Cardiotoxicity associated with tyrosine kinase inhibitor sunitinib. Lancet 2007; 370: 2011–9.

2. Kirsch I, Deacon BJ, Huedo-Medina TB et al.: Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PloS Med 2008; 5: 260–8.