Toxicities associated with the administration of sorafenib, sunitinib, and temsirolimus and their management in patients with metastatic renal cell carcinoma

Eur Urol. 2008 May;53(5):917-30. doi: 10.1016/j.eururo.2007.11.037. Epub 2007 Nov 26.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Benzenesulfonates / administration & dosage
  • Benzenesulfonates / adverse effects*
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / secondary*
  • Dose-Response Relationship, Drug
  • Drug-Related Side Effects and Adverse Reactions* / diagnosis
  • Drug-Related Side Effects and Adverse Reactions* / epidemiology
  • Drug-Related Side Effects and Adverse Reactions* / prevention & control
  • Humans
  • Indoles / administration & dosage
  • Indoles / adverse effects*
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / pathology
  • Niacinamide / analogs & derivatives
  • Phenylurea Compounds
  • Prognosis
  • Pyridines / administration & dosage
  • Pyridines / adverse effects*
  • Pyrroles / administration & dosage
  • Pyrroles / adverse effects*
  • Receptors, Vascular Endothelial Growth Factor
  • Sirolimus / administration & dosage
  • Sirolimus / adverse effects
  • Sirolimus / analogs & derivatives*
  • Sorafenib
  • Sunitinib

Substances

  • Antineoplastic Agents
  • Benzenesulfonates
  • Indoles
  • Phenylurea Compounds
  • Pyridines
  • Pyrroles
  • Niacinamide
  • temsirolimus
  • Sorafenib
  • Receptors, Vascular Endothelial Growth Factor
  • Sunitinib
  • Sirolimus