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Sunitinib for Pancreatic Neuroendocrine Tumors

Insights From: Matthews H. Kulke, MD, Harvard Medical School; Jonathan R. Strosberg, MD, Moffitt Cancer Center; James C. Yao, MD, University of Texas MD Anderson Cancer Center
Published: Thursday, Jan 07, 2016


Sunitinib is an anti-angiogenic tyrosine kinase inhibitor that targets the vascular endothelial growth factor receptor. Treatment with the agent has been associated with an improvement in progression-free survival (PFS) compared with placebo for patients with pancreatic neuroendocrine tumors (pNETs). In a pivotal clinical trial, median PFS was 11.4 months in the sunitinib arm versus 5.5 months in the placebo arm.

Sunitinib has also been shown to slow tumor growth and result in tumor shrinkage for patients with pNETs, says Matthew H. Kulke, MD. While the phase III study did not achieve statistical significance due to an unplanned interim analysis, most experts consider sunitinib to be an active drug, says James C. Yao, MD. Sunitinib is FDA approved for the management of pNETs, and is now among the standard treatments for patients with advanced disease. Common adverse events with sunitinib include hypertension, fatigue, rash, and diarrhea.

There may be some indication that highly vascular tumors on CT or MRI scans may respond better to an anti-angiogenic agent, such as sunitinib, says Jonathan R. Strosberg, MD, but this still needs to be validated. Determining which patients should receive sunitinib or the mTOR inhibitor everolimus often depends on an individual’s comorbidities. Sunitinib may be preferred over everolimus in patients with severe uncontrolled diabetes, hyperglycemia, or potential lung concerns that may lead to pneumonitis, while sunitinib may not be the first choice in individuals with recent thromboembolic events or uncontrolled hypertension.
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Sunitinib is an anti-angiogenic tyrosine kinase inhibitor that targets the vascular endothelial growth factor receptor. Treatment with the agent has been associated with an improvement in progression-free survival (PFS) compared with placebo for patients with pancreatic neuroendocrine tumors (pNETs). In a pivotal clinical trial, median PFS was 11.4 months in the sunitinib arm versus 5.5 months in the placebo arm.

Sunitinib has also been shown to slow tumor growth and result in tumor shrinkage for patients with pNETs, says Matthew H. Kulke, MD. While the phase III study did not achieve statistical significance due to an unplanned interim analysis, most experts consider sunitinib to be an active drug, says James C. Yao, MD. Sunitinib is FDA approved for the management of pNETs, and is now among the standard treatments for patients with advanced disease. Common adverse events with sunitinib include hypertension, fatigue, rash, and diarrhea.

There may be some indication that highly vascular tumors on CT or MRI scans may respond better to an anti-angiogenic agent, such as sunitinib, says Jonathan R. Strosberg, MD, but this still needs to be validated. Determining which patients should receive sunitinib or the mTOR inhibitor everolimus often depends on an individual’s comorbidities. Sunitinib may be preferred over everolimus in patients with severe uncontrolled diabetes, hyperglycemia, or potential lung concerns that may lead to pneumonitis, while sunitinib may not be the first choice in individuals with recent thromboembolic events or uncontrolled hypertension.
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