Oral chemotherapy drugs have increased treatment options for patients with metastatic renal cell carcinoma (RCC); however, many of these drugs are associated with adverse effects. A recent study, published in Journal of Hematology Oncology Pharmacy, retrospectively assessed the reasons for dose reductions and treatment discontinuation in patients who received oral chemotherapy for metastatic RCC.

The retrospective study included a total of 124 patients with metastatic RCC who were prescribed oral chemotherapy at the Marshfield Clinic system. The drugs assessed were those approved by the FDA at the time of the study: sunitinib, sorafenib, pazopanib, axitinib, or everolimus.

There were 76 dose reductions in 36% of patients. Common reasons for dose reduction included mucositis (17%), fatigue (13%), diarrhea (11%), and palmar-plantar erythrodysesthesia (11%). Mucositis was more commonly associated with sunitinib, fatigue with axitinib, diarrhea with pazopanib, and palmar-plantar erythrodysesthesia with sorafenib. Among 116 patients, treatment was discontinued in 218 cases. The most common reasons for treatment discontinuation were fatigue (17%), palmar-plantar erythrodysesthesia (11%), diarrhea (7%), and nausea (7%). Two cases of hypothyroidism associated with sunitinib resulted in thyroid replacement therapy, and one case of hyperglycemia associated with everolimus also resulted in treatment discontinuation.

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“These findings highlight the potential for treatment of emergent adverse events with oral chemotherapy agents used for metastatic RCC that may require monitoring and/or a supportive care plan to help patients better tolerate these agents,” concluded the authors.


Griesbach S, Kawamura NM, Mercier R, Wilhelm S. Retrospective review of the use of oral chemotherapy drugs for patients with metastatic kidney cancer. J Hematol Oncol Pharm. 2018;8(3).