Early stage kidney cancer can achieve good disease control through surgery, allowing patients to achieve long-term survival or even cure. However, when kidney cancer reaches an advanced stage, treatment is often tricky and surgery can only be used as an adjuvant treatment. Currently, targeted drugs are mainly used to slow down disease progression and prolong survival as much as possible.
Sorafenib and sunitinib are currently the most widely used targeted drugs for kidney cancer in China. The target is usually found only in tumor cells and rarely expressed in normal cells, so the toxic side effects of targeted drugs on normal tissue cells are relatively small. However, as a foreign substance to the body, targeted drugs, like other drugs, may cause allergic reactions and fever. And sorafenib and sunitinib, as multi-targeted drugs, can also cause a wide range of toxic side effects due to the large number of targets they inhibit. Therefore, attention should be paid to regular follow-up and examination during treatment to detect and manage toxic side effects in a timely manner.
Which patients are not suitable for treatment with sorafenib and sunitinib?
Before giving a patient treatment with sorafenib and sunitinib, the physician will perform a thorough physical assessment to determine if there are any contraindications. Patients who have the following conditions are usually not candidates for treatment with sorafenib and sunitinib
- Unstable angina;
- Recent myocardial infarction, cerebral infarction, and cerebral hemorrhage;
- Congestive heart failure;
- refractory hypertension;
- Active peptic ulcer;
- Severe coagulopathy, or severe bleeding at any site.
In addition, patients with peripheral blood leukopenia or thrombocytopenia and abnormal liver function should also be evaluated by a physician to determine if they can receive targeted therapy.
What tests are needed before targeted therapy?
Before targeted drug therapy, the doctor will first take a medical history to find out if the patient has hypertension, cardiovascular disease, bleeding and drug allergy. The patient is also advised to undergo blood work, liver and kidney function, coagulation, thyroid function, urine, electrocardiogram, echocardiogram for organ function, and imaging tests such as CT or MRI, bone scan, etc. of appropriate sites (e.g., lung, brain) to evaluate the tumor.
What are the adverse effects of sorafenib? How do I deal with them?
Sorafenib can cause a variety of adverse reactions. Common ones include skin reactions in the hands and feet, rash, diarrhea, malaise, increased blood pressure, hair loss, and in a few patients, hoarseness, fever, abnormal liver or kidney function, hypothyroidism, and leukopenia and thrombocytopenia.
To prevent cardiovascular adverse events due to hypertension, blood pressure should be monitored daily when starting sorafenib therapy, and less frequently if hypertension does not occur or after blood pressure stabilizes. Follow-up should be intensified at the beginning of treatment, and blood, urine, liver and kidney function and thyroid function should be reviewed to detect and manage adverse effects in a timely manner.
What are the adverse effects of sunitinib? How do you deal with them?
Similar to sorafenib, sunitinib can cause a variety of adverse reactions, including skin reactions in the hands and feet, rash, diarrhea, malaise, elevated blood pressure, mucositis, fever, yellowing of the skin, edema, etc. There is also a high incidence of leukopenia and thrombocytopenia, hypothyroidism, and in a few patients, abnormal liver or kidney function and proteinuria. In addition, one should be alert to the possibility that sunitinib may cause a decrease in cardiac function.
Likewise, blood pressure should be monitored daily when starting sunitinib therapy, and the frequency of monitoring can be gradually reduced if hypertension does not develop or if blood pressure stabilizes. Regular blood monitoring should be emphasized early in treatment to detect thrombocytopenia in a timely manner, as well as monitoring urinary routine, liver and kidney function, and thyroid function to detect other suspected side effects.
To prevent a decrease in cardiac function caused by sunitinib, the doctor may recommend regular echocardiography, and patients should also be seen for cardiac function checks at any time if they experience shortness of breath after activity during treatment.
Do targeted drugs have to be used all the time?
Some patients have experienced significant tumor shrinkage after treatment with targeted drugs and have asked if they can stop taking them, but studies have found that tumors can grow back after stopping targeted drugs. Therefore, continued use of targeted drugs is needed to provide continued tumor suppression and control of the disease.
When affordable, the clinical recommendation is that targeted therapy should not be discontinued after tumor shrinkage and can be used until tumor progression (at which point treatment regimens often need to be adjusted) or intolerable side effects occur.