UROLOGICAL ONCOLOGY

Toxicities associated with the administration of sorafenib, sunitinib, and temsirolimus and their management in patients with metastatic renal cell carcinoma
Bhojani N, Jeldres C, Patard JJ, Perrotte P, Suardi N, Hutterer G, Patenaude F, Oudard S, Karakiewicz PI
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, QC, Canada
Eur Urol. 2008; 53: 917-30

• Objective: To provide a systematic review of the side effects associated with sorafenib, sunitinib, and temsirolimus and to provide an outline of possible preventive or therapeutic measures.
• Methods: We performed a PubMed-based systematic review of side effects associated with the three agents and relied on product monographs and prescribing information to provide an outline of treatments aimed at reducing these toxicities.
• Results: Side effects range from < 1% to 72%. Grade 3/4 side effects are less common and range from < 1% to 13% for sorafenib, < 1% to 16% for sunitinib, and 1% to 20% for temsirolimus. Overall, sunitinib causes the most grade 3/4 side effects and sorafenib causes the fewest grade 3/4 side effects, although head-to-head trials are required to compare safety profiles of all three kinase inhibitors. Virtually all side effects can be managed effectively.
• Conclusion: Prevention, recognition, and prompt management of side effects are of key importance and avoid unnecessary dose reductions, which may undermine treatment efficacy.
  
  
• Editorial Comment
  Three targeted medical therapies against metastatic renal cancer have recently been approved and are more and more widely used. Either as a therapist himself or in counseling his/her patients in further medical therapy the urologist faces a new generation of drugs with unfamiliar side-effects. The article focuses on the side effects of sunitib, sorafenib and temsirolimus as reported in the literature from all phase I, II and III studies. This article is worthwhile reading, profound and detailed and is recommended for every urologist dealing with this tumor entity.
  The authors not only describe the side-effects of treatment but also give detailed advice on the management of hematologic, systemic or endocrinologic, cardiac, gastrointestinal, cutaneous and laboratory adverse events. Moreover, dose-modifications are suggested. Finally, a helpful questionnaire to monitor the patents course and standardized prescriptions are given.
  Again, strongly advised reading for everyone dealing with medical therapy against renal cancer.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de