From the Guidelines
Yes, sunitinib can cause neutropenia, with an incidence of 12% for severe (grade 3-4) neutropenia, as reported in a large, multinational phase III trial 1. Neutropenia, a condition characterized by abnormally low levels of neutrophils (a type of white blood cell), is a common adverse effect of sunitinib therapy. This medication, which is primarily used to treat certain types of cancer including renal cell carcinoma and gastrointestinal stromal tumors, works by inhibiting multiple receptor tyrosine kinases involved in tumor growth and angiogenesis. However, this mechanism also affects rapidly dividing normal cells, particularly those in the bone marrow responsible for producing neutrophils. Some key points to consider when managing patients on sunitinib include:
- Regular complete blood count monitoring, typically before each treatment cycle and as clinically indicated, to detect neutropenia early 1.
- Dose modifications or temporary interruptions may be necessary if neutropenia develops, to minimize the risk of complications such as infection 1.
- Patients should be educated about the signs of infection (fever, chills, sore throat) that could indicate complications from neutropenia and instructed to seek immediate medical attention if these occur.
- The standard dosing regimen for sunitinib (50 mg daily for 4 weeks followed by 2 weeks off) may need adjustment based on individual tolerance and neutrophil counts, to balance the benefits of treatment with the risks of adverse effects like neutropenia 1.
From the FDA Drug Label
Grade 3 to 4 laboratory abnormalities that occurred in ≥ 2% of patients receiving sunitinib include neutropenia (13%) Neutrophils decreased 71 16 Neutrophils decreased 77 17 aGrade 4 laboratory abnormalities in patients on sunitinib included uric acid (14%), lipase (3%), neutrophils (2%)
Yes, sunitinib can cause neutropenia 2, 2.
From the Research
Sunitinib and Neutropenia
- Sunitinib has been associated with neutropenia in several studies 3, 4, 5, 6.
- The incidence of sunitinib-induced neutropenia varies across studies, with reported rates of 42.1% for all-grade neutropenia and 12.8% for high-grade neutropenia 5.
- A meta-analysis of 13 studies found that the overall incidence of all-grade neutropenia in patients with gastrointestinal stromal tumors (GIST) treated with sunitinib was 41.8% 6.
- Sunitinib has been shown to increase the risk of high-grade neutropenia, with a relative risk of 10.39 compared to placebo 6.
- Neutropenia has been identified as a potential biomarker of sunitinib efficacy in patients with metastatic renal cell carcinoma, with patients who develop neutropenia having better outcomes than those who do not 4.
Management of Sunitinib-Induced Neutropenia
- Neutropenia usually does not require intervention, and no episodes of neutropenic fever have been reported in some studies 3.
- However, appropriate prevention and management of hematologic toxicities, including neutropenia, seem to be necessary 6.
- Dose adjustments or interruptions may be made if necessary to manage neutropenia and other adverse effects 7.