Harvard-Led Team Finds Small but Significant Increased Risk of CHF with Sunitinib

Debra Wood, RN

June 2011, Vol 2, No 3 -

Orlando, FL—Acomprehensive report demonstrates a small, but significant, increased risk of left ventricular decline and congestive heart failure (CHF) in patients taking sunitinib to treat renal and other cancers, and the researchers are recommending screening to detect cardiac problems before patients become symptomatic.

“Sunitinib has not been used as long as Avastin [bevacizumab], but we are finding the risk similar, and that could impact how practices monitor patients during treatment,” said Christopher J. Richards, a medical student at Harvard Medical School and the Dana-Farber Cancer Institute Kidney Cancer Center in Boston, at the 2011 Genitourinary Cancers Symposium, sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Urologic Oncology.

Mr Richards and colleagues performed a meta-analysis of 12 published phase 2 and 3 clinical trials to determine the risk of developing serious CHF in 5497 patients with renal-cell carcinoma and other cancers who were treated with the multitargeted receptor tyrosine kinase inhibitor sunitinib (Sutent).

Compared with patients receiving placebo, the relative risk of developing all-grade CHF in sunitinib-treated patients was 1.81, and the risk of highgrade CHF was 3.17.

Underreporting of low-grade CHF probably has occurred in the clinical trials, Mr Richards said, because it is an asymptomatic condition detected on screening. He added that he hoped this study would raise investigators’ awareness of the cardiac risks associated with the drug and include screening as part of the protocol.

“Catch it early, because there is significant mortality associated with heart failure, even with low-grade CHF,” Mr Richards said. “If the patient with asymptomatic CHF has screening, adjusting the dose [of sunitinib] and changing other medications is something you can easily act upon.”