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@article{1670259,
author = {Demlová, Regina and Turjap, Miroslav and Peš, Ondřej and Kostolanská, Katarína and Juřica, Jan},
article_location = {PHILADELPHIA},
article_number = {1},
doi = {http://dx.doi.org/10.1097/FTD.0000000000000663},
keywords = {sunitinib; N-desethylsunitinib; mRCC; GIST; therapeutic drug monitoring; toxicity-adjusted dosing},
language = {eng},
issn = {0163-4356},
journal = {THERAPEUTIC DRUG MONITORING},
title = {Therapeutic Drug Monitoring of Sunitinib in Gastrointestinal Stromal Tumors and Metastatic Renal Cell Carcinoma in Adults-A Review},
url = {https://journals.lww.com/drug-monitoring/Abstract/2020/02000/Therapeutic_Drug_Monitoring_of_Sunitinib_in.3.aspx},
volume = {42},
year = {2020}
}
TY - JOUR
ID - 1670259
AU - Demlová, Regina - Turjap, Miroslav - Peš, Ondřej - Kostolanská, Katarína - Juřica, Jan
PY - 2020
TI - Therapeutic Drug Monitoring of Sunitinib in Gastrointestinal Stromal Tumors and Metastatic Renal Cell Carcinoma in Adults-A Review
JF - THERAPEUTIC DRUG MONITORING
VL - 42
IS - 1
SP - 20-32
EP - 20-32
PB - LIPPINCOTT WILLIAMS & WILKINS
SN - 01634356
KW - sunitinib
KW - N-desethylsunitinib
KW - mRCC
KW - GIST
KW - therapeutic drug monitoring
KW - toxicity-adjusted dosing
UR - https://journals.lww.com/drug-monitoring/Abstract/2020/02000/Therapeutic_Drug_Monitoring_of_Sunitinib_in.3.aspx
L2 - https://journals.lww.com/drug-monitoring/Abstract/2020/02000/Therapeutic_Drug_Monitoring_of_Sunitinib_in.3.aspx
N2 - Background: Sunitinib is an inhibitor of multiple receptor tyrosine kinases and is a standard-of-care treatment for advanced and metastatic renal cell carcinoma and a second-line treatment in locally advanced inoperable and metastatic gastrointestinal stromal tumors. A fixed dose of the drug, however, does not produce a uniform therapeutic outcome in all patients, and many face adverse effects and/or toxicity. One of the possible causes of the interindividual variability in the efficacy and toxicity response is the highly variable systemic exposure to sunitinib and its active metabolite. This review aims to summarize all available clinical evidence of the treatment of adult patients using sunitinib in approved indications, addressing the necessity to introduce proper and robust therapeutic drug monitoring (TDM) of sunitinib and its major metabolite, N-desethylsunitinib. Methods: The authors performed a systematic search of the available scientific literature using the PubMed online database. The search terms were "sunitinib" AND "therapeutic drug monitoring" OR "TDM" OR "plasma levels" OR "concentration" OR "exposure." The search yielded 520 journal articles. In total, 447 publications were excluded because they lacked sufficient relevance to the reviewed topic. The remaining 73 articles were, together with currently valid guidelines, thoroughly reviewed. Results: There is sufficient evidence confirming the concentration-efficacy and concentration-toxicity relationship in the indications of gastrointestinal stromal tumors and metastatic renal clear-cell carcinoma. For optimal therapeutic response, total (sunitinib + N-desethylsunitinib) trough levels of 50-100 ng/mL serve as a reasonable target therapeutic range. To avoid toxicity, the total trough levels should not exceed 100 ng/mL. Conclusions: According to the current evidence presented in this review, a TDM-guided dose modification of sunitinib in selected groups of patients could provide a better treatment outcome while simultaneously preventing sunitinib toxicity.
ER -
DEMLOVÁ, Regina, Miroslav TURJAP, Ondřej PEŠ, Katarína KOSTOLANSKÁ and Jan JUŘICA. Therapeutic Drug Monitoring of Sunitinib in Gastrointestinal Stromal Tumors and Metastatic Renal Cell Carcinoma in Adults-A Review. \textit{THERAPEUTIC DRUG MONITORING}. PHILADELPHIA: LIPPINCOTT WILLIAMS \&{} WILKINS, 2020, vol.~42, No~1, p.~20-32. ISSN~0163-4356. Available from: https://dx.doi.org/10.1097/FTD.0000000000000663.
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