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Nebenwirkungsmanagement von Tyrosinkinaseinhibitoren in der Urologie

Gastrointestinale Nebenwirkungen

Side effect management of tyrosine kinase inhibitors in urology

Gastrointestinal side effects

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  • 1 Citations

Zusammenfassung

Durch die Einführung der Tyrosinkinaseinhibitoren (TKI, „smart drugs“) vor nunmehr einem Jahrzehnt hat sich die Behandlung des metastasierten Nierenzellkarzinoms maßgeblich verändert und verbessert. Die verschiedenen Medikamente dieser Klasse zeigen ein teilweise ähnliches Nebenwirkungsprofil, von denen gastrointestinale Beschwerden einen großen Teil ausmachen und den Patienten in seinem Wohlbefinden erheblich stören können. Die verschiedenen – teilweise auch simultan auftretenden – Nebenwirkungen stellen den behandelnden Arzt vor verschiedene Herausforderungen. Einerseits sollten zur Verhinderung einer Progression Dosisreduktionen und Therapieunterbrechungen unbedingt vermieden werden, andererseits sind Nebenwirkungen nur bis zu einem gewissen Grad für den Patienten tolerabel. Für die Erstellung der folgenden Übersichtsarbeit haben wir zahlreiche Publikationen als Grundlage gewählt, um eine einfache Übersicht über die Häufigkeit auftretender Nebenwirkungen unter den Therapeutika Axitinib, Cabozantinib, Pazopanib, Sorafenib und Sunitinib zu geben. Darüber hinaus wird ein Leitfaden entwickelt, der symptomorientiert aufzeigt, welche konservativen Behandlungs-/Präventionsmöglichkeiten für gastrointestinale Nebenwirkungen zur Verfügung stehen. Weiterhin wird dargestellt, in welchem Fall Dosismodifikationen oder Therapieunterbrechungen notwendig sein können und wie man anschließend die Therapie schnellstmöglich wieder eskaliert.

Abstract

For approximately one decade, tyrosinkinase inhibitors (TKIs, smart drugs) have dramatically changed and improved the treatment of patients suffering from metastasized renal cell carcinoma. However, the different drugs have substantial side effects. Especially gastrointestinal symptoms may be problematic for patients. These side effects represent a challenge for the physician. On the one hand, dosage modifications and treatment interruption should be avoided to minimize the risk for progression. On the other hand, only mild side effects are tolerable for the patient. Based on a literature review, a clear overview of the incidence of possible side effects for the drugs axitinib, cabozantinib, pazopanib, sorafenib, and sunitinib is provided. Furthermore, we give a practical guide on how to prevent and treat the different gastrointestinal side effects. Finally, it is pointed out when dosage modifications or interruption of treatment are necessary and how to expeditiously re-escalate the treatment after mitigation of side effects.

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Correspondence to PD Dr. med. B. Keck.

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Interessenkonflikt

B. Keck: Berater/Referententätigkeit: Pfizer, Novartis, GlaxoSmithlinke, Janssen Cilag, Sanofi. B. Rink: Berater für Pfizer, Bayer, Novratis und BMS.

V. Lieb, M. Rink, D. Sikic und B. Keck geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Lieb, V., Rink, M., Sikic, D. et al. Nebenwirkungsmanagement von Tyrosinkinaseinhibitoren in der Urologie. Urologe 55, 805–812 (2016). https://doi.org/10.1007/s00120-016-0090-9

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Schlüsselwörter

  • Axitinib
  • Cabozantinib
  • Pazopanib
  • Sorafenib
  • Sunitinib

Keywords

  • Axitinib
  • Cabozantinib
  • Pazopanib
  • Sorafenib
  • Sunitinib