RESUMEN
Sorafenib, a multi-targeted kinase inhibitor, is approved in Europe for the treatment of patients with advanced renal cell carcinoma whose treatment with an interferon or interleukin-2-based therapy has previously failed, or who are unsuitable for such therapy. Unlike some first-generation anti-cancer therapies, sorafenib is generally associated with moderate and manageable adverse events. Some of the most common adverse events include a hand-foot skin reaction, diarrhoea and rash. As nurses provide an interface between the patient and the clinical team, it is important that they understand how sorafenib-related adverse events impact on patients. It is equally vital that nurses are able to recognize and manage these adverse events. Our experience has shown that with patient education, early reporting, monitoring and treatment, the adverse events of sorafenib therapy can be easily and effectively managed. Optimal adverse event management helps ensure treatment compliance and ensures that patients receive maximum benefit from therapy.
Asunto(s)
Antineoplásicos/efectos adversos , Bencenosulfonatos/efectos adversos , Carcinoma de Células Renales/tratamiento farmacológico , Neoplasias Renales/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Piridinas/efectos adversos , Alopecia/inducido químicamente , Alopecia/enfermería , Carcinoma de Células Renales/enfermería , Diarrea/inducido químicamente , Diarrea/enfermería , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/enfermería , Fatiga/inducido químicamente , Fatiga/etiología , Femenino , Humanos , Neoplasias Renales/enfermería , Masculino , Persona de Mediana Edad , Niacinamida/análogos & derivados , Educación del Paciente como Asunto , Compuestos de Fenilurea , SorafenibRESUMEN
PURPOSE: As a group of European nurses familiar with treating patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) using targeted/chemo- therapies, we aimed to review strategies for managing adverse events (AEs) associated with one targeted therapy, sorafenib. METHOD: Focusing on the AEs we considered the most difficult to manage (hand-foot skin reaction [HFSR], diarrhoea, fatigue and mucositis/stomatitis), we reviewed the literature to identify strategies relevant to sorafenib. Given the paucity of published work, this included strategies concerning targeted agents in general. This information was supplemented by considering the wider literature relating to management of these AEs in other tumour types and similar toxicities experienced during conventional anti-cancer therapy. Together with our own experience, this information was used to compile an AE management guide to assist nurses caring for patients receiving sorafenib. RESULTS: Our collated experience suggests the most commonly reported AEs with sorafenib and other targeted agents are HFSR, diarrhoea, fatigue, rash and mucositis/stomatitis; these generally have an acute (appearing at â¼0-1 months) or delayed onset (appearing at â¼3 months). Most management strategies in the literature were experience-based rather than arising from controlled studies. However, strategies based on controlled studies are available for HFSR and mucositis/stomatitis. CONCLUSIONS: Evidence, especially from controlled studies, is sparse concerning management of AEs associated with sorafenib and other targeted agents in RCC/HCC. However, recommendations can be made based on the literature and clinical experience that encompasses targeted and conventional therapies, particularly in the case of non-specific toxicities e.g. diarrhoea and fatigue.
Asunto(s)
Antineoplásicos/efectos adversos , Bencenosulfonatos/efectos adversos , Diarrea/enfermería , Erupciones por Medicamentos/enfermería , Fatiga/enfermería , Terapia Molecular Dirigida/efectos adversos , Mucositis/enfermería , Evaluación en Enfermería/métodos , Piridinas/efectos adversos , Carcinoma Hepatocelular/tratamiento farmacológico , Carcinoma de Células Renales/tratamiento farmacológico , Ensayos Clínicos Fase III como Asunto , Diarrea/inducido químicamente , Erupciones por Medicamentos/etiología , Europa (Continente) , Fatiga/inducido químicamente , Dermatosis del Pie/inducido químicamente , Dermatosis del Pie/enfermería , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/enfermería , Humanos , Neoplasias Renales/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Mucositis/inducido químicamente , Niacinamida/análogos & derivados , Compuestos de Fenilurea , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Sociedades de Enfermería , SorafenibRESUMEN
Metastatic renal cancer remains hard to treat and the treatment is generally palliative. However, high-dose interleukin-2 (HD IL-2) produced 5% to 10% complete remissions and most of these were durable. With the advent of newer treatments with less toxicity, the role of HD IL-2 is uncertain. We present here a case series of 72 patients with metastatic renal cancer given first-line treatment with HD IL-2. From 2003 to 2006, the patients were offered treatment with HD IL-2 irrespective of their histologic features (retrospective cohort). From 2006 to 2008, the treatment was only offered to patients after stratification into risk groups based on histologic criteria (prospective cohort). In the early series, the response rate to HD IL-2 was 27% (8/30), but with prospective stratification of patients by histology the response rate was 52% (21/40) in the group with favorable histologic features. Combining outcome for all patients with the favorable histology (including those identified retrospectively) 49% (28/57) responded with 25% (14/57) achieving a complete remission and these seem durable. Patients with metastatic renal cancer should be carefully assessed for their suitability to undergo treatment with first-line systemic therapy with HD IL-2 as in carefully selected patients it has a high-rate response and durable remissions.