Targeted therapies for metastatic renal cell carcinoma: An overview of toxicity and dosing strategies Journal Article
| Authors: | Hutson, T. E.; Figlin, R. A.; Kuhn, J. G.; Motzer, R. J. |
| Article Title: | Targeted therapies for metastatic renal cell carcinoma: An overview of toxicity and dosing strategies |
| Abstract: | The targeted therapies sunitinib, sorafenib, temsirolimus, and bevacizumab (when used in combination with interferon-α2a) have dramatically improved outcomes for patients with advanced renal cell carcinoma (RCC). Clinical application of these novel agents outside the trial setting, however, may present some challenges for treating individual patients with unique needs. In some patients, dose modifications may be considered for potential drug interactions and for management of severe cases of hematologic or nonhematologic toxicities. The more common grade 3 or 4 side effects with sunitinib and sorafenib include hypertension, fatigue, hand-foot syndrome, elevated lipase, lymphopenia, and neutropenia. Congestive heart failure is a less common but serious side effect that warrants treatment discontinuation. Temsirolimus exhibits a different side-effect profile, with the more common grade 3 or 4 side effects being metabolic in nature (i.e., elevated triglycerides, elevated glucose, hypophosphatemia) as a result of its inhibitory effects on the mammalian target of rapamycin-regulated lipid and glucose pathways. Asthenia, rash, and dyspnea also occur in patients receiving temsirolimus. Virtually all of the side effects associated with these agents can be managed effectively in the majority of patients with medical treatment or supportive interventions. Recognition and prompt management of side effects are important to avoid unnecessary dose reductions that may result in suboptimal efficacy. ©AlphaMed Press. |
| Keywords: | treatment outcome; treatment response; acute granulocytic leukemia; clinical trial; fatigue; neutropenia; review; fistula; sorafenib; bevacizumab; doxorubicin; fluorouracil; placebo; sunitinib; advanced cancer; area under the curve; cancer combination chemotherapy; diarrhea; drug dose reduction; drug withdrawal; heart left ventricle failure; hypertension; hypophosphatemia; monotherapy; nonhuman; recommended drug dose; side effect; skin toxicity; solid tumor; treatment duration; unspecified side effect; benzenesulfonates; pyridines; alpha interferon; paclitaxel; carboplatin; unindexed drug; metastasis; drug eruption; multiple cycle treatment; neutrophil count; anemia; bleeding; blood toxicity; leukopenia; mucosa inflammation; nausea; stomatitis; thrombocytopenia; vomiting; antineoplastic combined chemotherapy protocols; qt prolongation; combination chemotherapy; hemoglobin blood level; continuous infusion; renal cell carcinoma; kidney carcinoma; kidney neoplasms; docetaxel; temsirolimus; asthenia; dyspnea; febrile neutropenia; hyperglycemia; lymphocytopenia; pneumonia; antibodies, monoclonal; carcinoma, renal cell; stroke; thromboembolism; cardiotoxicity; warfarin; peripheral edema; thrombocyte count; single drug dose; insulin; glucose blood level; triacylglycerol blood level; interstitial lung disease; safety; food drug interaction; optimal drug dose; maximum plasma concentration; drug metabolism; intestine perforation; drug blood level; leukocyte count; ketoconazole; hypercholesterolemia; drug half life; hypothyroidism; alpha2a interferon; drug dose increase; indoles; pyrroles; oxaliplatin; drug dose regimen; hand foot syndrome; triacylglycerol lipase blood level; alopecia; digestive system perforation; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; sulfonylurea derivative; antiangiogenic activity; dose calculation; everolimus; wound complication; congestive heart failure; proteinuria; uric acid blood level; rapamycin; hyperlipidemia; sirolimus; diuretic agent; leukoencephalopathy; hypertriglyceridemia; lymphocyte count; angiotensin receptor antagonist; itraconazole; grapefruit juice; diphenhydramine; premedication; dosing; thyroid disease; ranitidine; phosphate blood level; famotidine; hexachlorophene; blood clot; interferon alfa-2a |
| Journal Title: | The Oncologist |
| Volume: | 13 |
| Issue: | 10 |
| ISSN: | 1083-7159 |
| Publisher: | Oxford University Press |
| Date Published: | 2008-10-01 |
| Start Page: | 1084 |
| End Page: | 1096 |
| Language: | English |
| DOI: | 10.1634/theoncologist.2008-0120 |
| PUBMED: | 18838439 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 71" - "Export Date: 17 November 2011" - "CODEN: OCOLF" - "Source: Scopus" |
