S9Sunitinb, hypertension and renal function: a monocentric experience

Background: sunitinib and other antiangiogenetics (AAG) have been shown to significantly increase blood pressure (BP). AAG-related hypertension (AAG-HTN) may be defined as a new diagnosed HTN or worsening of a pre-existing one. If not correctly managed it may lead to major cardiovascular (CV) events (i.e. acute coronary syndrome and stroke) and to AAG withdrawal. Preservation of renal function may be crucial for both AAG and antihypertensive treatments. Patients and Methods: between 1st March 2012 and 1st May 2017, at Treviglio Hospital (Italy) all patients (pts) receiving sunitinib underwent a basal multidisciplinary evaluation. BP and renal function (estimated glomerular filtration rate [e-GFR], and basal 24h microalbuminuria) were monitored before, during and after sunitinib treatment. Results: 20 pts (median age 63.5yrs, range 49-83, male/female=15/5) were evaluated, all being affected by renal cancer (clear cell=16; papillary=3, poorly differentiated=1), 2 pts had also colo-rectal adenocarcinoma. All pts but 3 underwent radical nephrectomy. Basal e-GFR was >89 ml/min*1.73mq in 3pts, 60 to 89 in 10, <60 in 6 (not available in 1); basal 24-h microalbuminuria (evaluable in 10pts) was normal in 2 pts, 30-300mg/24h in 7 (median=45mg/24h), and > 300 in 1. Evaluation at 6 months and at the end of sunitinib showed stable (6pts) or improved (5pts) e-GFR, 6 months worsen with subsequent improvement in 2pts, and worsened e-GFR in 7(35%). Overall 65% of pts had stable or improved e-GFR. Eleven pts had a pre-existing diagnosis of HTN(55%), 5 of them requiring an adjustment of antihypertensive therapy before sunitinib because of uncontrolled HTN. Importantly, a new diagnosis of HTN before sunitinib was done in 4pts(20%). After sunitinib initiation, AAG-HTN was observed in 14(70%). HTN control was obtained in 12 out of 13 evaluable pts(92%). All classes of antihypertensive drugs were used, but all pts received an inhibitor of the renin-angiotensin-aldosterone system (RAAS). The number of drugs/patient to control AAG-HTN, was 1(N = 2), 2-3(N = 6), 4-5(N = 5). Conclusions: The high rate of HTN diagnosed before sunitinib introduction (20%) and that of AAG-HTN (70%) suggest the crucial role of a careful multidisciplinary basal evaluation of pts. Renal function should be carefully monitored, but in most of pts e-GFR is stable or even improved. These results suggest that sunitinib and RAAS inhibitors may be used safely, thus resulting in a better management and outcome of pts.