Korean J Gastroenterol.  2013 Jun;61(6):347-350. 10.4166/kjg.2013.61.6.347.

A Case of Pneumatosis Intestinalis Associated with Sunitinib Treatment for Renal Cell Carcinoma

Affiliations
  • 1Department of Internal Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea. sypark1011@hotmail.com

Abstract

Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.

Keyword

Pneumatosis Intestinalis; Sunitinib; Advanced renal cell carcinoma

MeSH Terms

Aged
Antineoplastic Agents/adverse effects/*therapeutic use
Carcinoma, Renal Cell/*drug therapy
Drug Administration Schedule
Humans
Indoles/adverse effects/*therapeutic use
Intestinal Perforation/*diagnosis/etiology/surgery
Kidney Neoplasms/*drug therapy
Lung/radiography
Male
Pneumatosis Cystoides Intestinalis/*diagnosis/etiology
Positron-Emission Tomography
Pyrroles/adverse effects/*therapeutic use
Tomography, X-Ray Computed
Antineoplastic Agents
Indoles
Pyrroles

Figure

  • Fig. 1. Chest radiography showed free air (black arrow) at perihepatic area.

  • Fig. 2. Abdomen radiography showed small bowel dilatation.

  • Fig. 3. Abdominal CT. (A) CT scan showed linear pneumatosis (black arrow) in the small bowel without associated soft-tissue bowel wall thickening. (B) CT scan showed linear rings of pneumatosis (white arrow) in the small bowel. (C) CT scan showed pneumoperitoneum (white arrow).


Reference

References

1. Porta C, Paglino C, Imarisio I, Bonomi L. Uncovering Pandora's vase: the growing problem of new toxicities from novel anti-cancer agents. The case of sorafenib and sunitinib. Clin Exp Med. 2007; 7:127–134.
Article
2. Feldman DR, Martorella AJ, Robbins RJ, Motzer RJ. Re: Hypothyroidism in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst. 2007; 99:974–975.
Article
3. Takahashi D, Nagahama K, Tsuura Y, Tanaka H, Tamura T. Sunitinib-induced nephrotic syndrome and irreversible renal dysfunction. Clin Exp Nephrol. 2012; 16:310–315.
Article
4. Faivre S, Delbaldo C, Vera K, et al. Safety, pharmacokinetic, and antitumor activity of SU11248, a novel oral multitarget tyrosine kinase inhibitor, in patients with cancer. J Clin Oncol. 2006; 24:25–35.
Article
5. Hoshino Y, Hasegawa H, Ishii Y, et al. Two cases of bowel perforation associated with sunitinib treatment for renal cell carcinoma. Int J Clin Oncol. 2012; 17:412–416.
Article
6. Kollmannsberger C, Soulieres D, Wong R, Scalera A, Gaspo R, Bjarnason G. Sunitinib therapy for metastatic renal cell carcinoma: recommendations for management of side effects. Can Urol Assoc J. 2007; 1(2 Suppl):S41–S54.
Article
7. Sivendran S, Liu Z, Portas LJ Jr, et al. Treatmentrelated mortality with vascular endothelial growth factor receptor tyrosine kinase inhibitor therapy in patients with advanced solid tumors: a metaanalysis. Cancer Treat Rev. 2012; 38:919–925.
Article
8. Hur H, Park AR, Jee SB, Jung SE, Kim W, Jeon HM. Perforation of the colon by invading recurrent gastrointestinal stromal tumors during sunitinib treatment. World J Gastroenterol. 2008; 14:6096–6099.
Article
9. Flaig TW, Kim FJ, La Rosa FG, Breaker K, Schoen J, Russ PD. Colonic pneumatosis and intestinal perforations with sunitinib treatment for renal cell carcinoma. Invest New Drugs. 2009; 27:83–87.
Article
10. Jarkowski A 3rd, Hare R, Francescutti V, Wilkinson N, Khushalani N. Case report of pneumatosis intestinalis secondary to sunitinib treatment for refractory gastrointestinal stromal tumor. Anticancer Res. 2011; 31:3429–3432.
11. Coriat R, Ropert S, Mir O, et al. Pneumatosis intestinalis associated with treatment of cancer patients with the vascular growth factor receptor tyrosine kinase inhibitors sorafenib and sunitinib. Invest New Drugs. 2011; 29:1090–1093.
Article
12. Raut CP, Posner M, Desai J, et al. Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. J Clin Oncol. 2006; 24:2325–2331.
Article
13. Ruka W, Rutkowski P, Nowecki Z, Dziewirski W. Emergency surgery due to complication during molecular targeted therapy in advanced gastrointestinal stromal tumors (GIST). Nowotwory. 2010; 60:1e–7e.
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