Nephrotoxicities associated with the use of tyrosine kinase inhibitors: a single-center experience and review of the literature.

Overview

BACKGROUND: Sunitinib is an oral multitargeted tyrosine kinase receptor inhibitor (MTKI) used for the treatment of renal cell carcinoma. These small-molecule agents inhibit signaling through receptor tyrosine kinases such as vascular endothelial growth factor receptor, platelet-derived growth factor receptor and cytokine stem cell factor receptor, among others. Although the development of these novel molecular-targeted agents represents a substantial advance in the treatment of metastatic cancer, the spectrum of their adverse effects may be broader than initially predicted. METHOD: We performed a retrospective chart review of patients who had received sunitinib and developed renal insufficiency. RESULTS: We describe 4 patients with renal cell carcinoma and 1 patient with transitional cell carcinoma treated with sunitinib who experienced various degrees of nephrotoxicity including hypertension, proteinuria, thrombotic microangiopathy, and acute and chronic kidney injury which resolved upon cessation of MTKI. CONCLUSIONS: Nephrologists and oncologists should be aware of the potential for toxic renal effects, and we recommend guidelines for early recognition and treatment of these conditions in patients receiving MTKI.