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Hematologic toxicities of sunitinib in patients with gastrointestinal stromal tumors: a systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Sunitinib offers a significant survival benefit to patients with imatinib-resistant gastrointestinal stromal tumors (GIST). However, the incidence and risk of sunitinib-induced hematologic toxicities in such a population are often overlooked and have not been well characterized. This meta-analysis was performed to assess the summary incidence and risk of hematologic toxicities secondary to sunitinib in patients with GIST.

Methods

Searches were performed in PubMed, Embase, Cochrane Library, and Web of Science as well as ClinicalTrials.gov to identify relevant studies up to April 2022. Studies with adequate safety profile, including anemia, neutropenia, and thrombocytopenia, were included to calculate the pooled incidence, relative risk (RR), and corresponding 95% confidence intervals (CIs). This study was registered with PROSPERO under number CRD42022328202.

Results

A total of 2593 patients from 13 studies were included in the present meta-analysis. For patients with GIST assigned to sunitinib, the overall incidences of all-grade anemia, neutropenia, and thrombocytopenia were 26.2% (95% CI, 14.9–39.4%), 41.8% (95% CI, 29.0–55.1%), and 36.4% (95% CI, 22.8–51.1%), respectively. Regarding high-grade (grades 3 and 4) events, there were 4.7% (95% CI, 3.8–5.6%) for anemia, 9.3% (95% CI, 5.6–13.7%) for neutropenia and 5.0% (95% CI, 2.9–7.3%) for thrombocytopenia. Compared to placebo arms, sunitinib was related to an increased risk of high-grade neutropenia with an RR of 10.39 (95% CI, 1.53–70.72; p = 0.017).

Conclusions

Sunitinib carries a relatively high incidence of hematologic toxicities and a substantial increased risk of high-grade neutropenia in patients with GIST. Appropriate prevention and management seem to be inevitable.

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Data availability

All datasets or codes used during the study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank the provision of financial support by the Jiangxi Provincial Department of Science and Technology.

Funding

This study was supported by the Jiangxi Provincial Department of Science and Technology (no. 20201BBG71008).

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Authors and Affiliations

  1. School of Pharmacy, Nanchang University, Nanchang, China

    Xuehui Jiang, Qun Fu & Kaisaner Rexiti

  2. Department of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang, China

    Xuehui Jiang, Qun Fu, Hongwei Peng, Kaisaner Rexiti, Xiaohua Wei & Song Tao

  3. School of Pharmacy, Fujian Medical University, Fuzhou, China

    Fangfang Xiong

  4. Department of Pharmacy, Linyi Central Hospital, Linyi, China

    Yan Jing

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Contributions

All authors contributed to the manuscript. Xuehui Jiang designed this study and drafted the manuscript. The literature search and data analysis were performed by Xuehui Jiang and Fangfang Xiong. Qun Fu, Hongwei Peng, Yan Jing, and Kaisaner Rexiti reviewed data for this study. Xiaohua Wei and Song Tao critically revised the manuscript.

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Correspondence to Xiaohua Wei or Song Tao.

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384_2022_4214_MOESM1_ESM.tif

Supplementary file1 (Fig. 1 Incidences of all-grade hematologic toxicities stratified by different sunitinib dosing methods TIF 1707 KB)

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Jiang, X., Xiong, F., Fu, Q. et al. Hematologic toxicities of sunitinib in patients with gastrointestinal stromal tumors: a systematic review and meta-analysis. Int J Colorectal Dis 37, 1525–1534 (2022). https://doi.org/10.1007/s00384-022-04214-7

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