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Symptoms from treatment with sunitinib or sorafenib: a multicenter explorative cohort study to explore the influence of patient-reported outcomes on therapy decisions

Supportive Care in Cancer volume 22, pages 2371–2380 (2014)Cite this article

Abstract

Purpose

Optimal long-lasting treatment with sunitinib and sorafenib is limited by dose modifications (DMs) due to adverse events (AEs). These AEs may be underrecognized and their influence on health-related quality of life (HRQL) underestimated. Improved insight into the relationship between AEs and therapy decisions is needed. To improve decision making around managing symptoms and reduce DMs, this study was set up to explore the influence of patient-reported symptoms on therapy decisions.

Methods

In this multicenter cohort study, patient characteristics, reasons for and different forms of used dose modifications, and AEs were prospectively obtained from cancer patients on sunitinib/sorafenib treatment. Used instruments to get insight into AEs were the patient-scored Utrecht Symptom Diary (USD) and the professional-scored Common Terminology Criteria for AEs version 3.0.

Results

Median total treatment duration in 42 patients was 16 weeks. Median time till dose modification was 10 weeks. DMs occurred mostly due to multiple mild AEs. By using the USD, a higher prevalence of most AEs was found compared to the literature. Sixty percent of the patients experienced a decreased HRQL due to multiple AEs.

Conclusions

Because severe AEs due to sunitinib/sorafenib treatment seldom occur, it is more important to focus on treating and preventing multiple mild AEs with higher impact on HRQL, when trying to avoid dose modifications. Using patient self-reported measurement methods helps to early recognize symptoms and to differentiate among symptom intensities. This systematic approach might help to achieve the optimal dosing, which might improve PFS and OS.

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Conflict of interest

J.J. Koldenhof has received honoraria and served on an advisory board for Bayer Schering Pharma and Pfizer. The remaining authors have no potential conflict of interest to declare. All authors state that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

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Affiliations

  1. Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    J. J. Koldenhof, P. O. Witteveen, M. Walraven & S. C. C. M. Teunissen

  2. Amsterdam School of Health Professions, Academic Medical Center, Amsterdam, The Netherlands

    R. de Vos

  3. Department of Medical Oncology, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    C. N. Tillier

  4. Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands

    H. M. W. Verheul

Authors
  1. J. J. Koldenhof
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  2. P. O. Witteveen
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  3. R. de Vos
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  4. M. Walraven
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  5. C. N. Tillier
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  6. H. M. W. Verheul
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  7. S. C. C. M. Teunissen
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Correspondence to J. J. Koldenhof.

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Koldenhof, J.J., Witteveen, P.O., de Vos, R. et al. Symptoms from treatment with sunitinib or sorafenib: a multicenter explorative cohort study to explore the influence of patient-reported outcomes on therapy decisions. Support Care Cancer 22, 2371–2380 (2014). https://doi.org/10.1007/s00520-014-2223-2

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  • DOI: https://doi.org/10.1007/s00520-014-2223-2

Keywords

  • Advanced cancer
  • Dose modifications
  • Patient-reported outcome
  • Sorafenib
  • Sunitinib
  • Symptom intensity