Annals of Oncology Advance Access originally published online on April 23, 2008
Annals of Oncology 2008 19(9):1613-1618; doi:10.1093/annonc/mdn168
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urogenital tumors |
Cardiotoxicity associated with the cancer therapeutic agent sunitinib malate
1 Division of Medical Oncology, Department of Medicine
2 Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, USA
* Correspondence to: Dr S. Srinivas, Department of Medicine, Division of Medical, Oncology, Stanford University 875 Blake Wilbur Drive, Stanford, CA 94305, USA. Tel: +1-650-725-2078; Fax: +1-650-736-1640; E-mail: sandysri{at}stanford.edu
Background: In the pivotal phase III metastatic renal cell carcinoma trial, updated data indicates that 21% of sunitinib-treated patients experienced a decline in left ventricular ejection fraction to below normal. This cardiotoxicity was reported to be reversible and without clinical sequelae. We conducted a retrospective analysis of our institutional experience of cardiotoxicity with sunitinib after observing a high incidence of symptomatic heart failure.
Patients and methods: Patients receiving sunitinib at Stanford University from 1 July 2004 to 1 July 2007 were identified. Medical records were reviewed and those patients experiencing symptomatic grade 3/4 left ventricular systolic dysfunction were identified. Potential cardiac risk factors were analyzed.
Results: Forty-eight patients treated with sunitinib were assessable. Seven patients experienced symptomatic grade 3/4 left ventricular dysfunction 22–435 days after initiation of sunitinib. Three patients had persistent cardiac dysfunction after discontinuation of sunitinib and initiation of heart failure therapy. A history of congestive heart failure, coronary artery disease and lower body mass index were factors associated with increased risk.
Conclusions: Among patients treated with sunitinib at our institution, 15% developed symptomatic grade 3/4 heart failure. Future studies of sunitinib-related cardiotoxicity are urgently needed, particularly as the oncologic indications for this drug continue to expand.
Key words: cardiotoxicity, congestive heart failure, sunitinib, tyrosine kinase inhibitor
Received for publication January 17, 2008. Revision received March 19, 2008. Accepted for publication March 20, 2008.
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