Risk of mucocutaneous toxicities in patients with solid tumors treated with sunitinib: a critical review and meta analysis

Abstract

Introduction: we performed a systematic review and meta-analysis of mucocutaneous toxicities associatedwith sunitinib, an oral multi-tyrosine kinase inhibitor. Methods: eligible studies included randomized Phase II and III trials of patients with solid tumors on sunitinib daily, describing events of hand–foot syndrome, skin rash, stomatitis, and skin and hair discoloration. Results: the relative risk (RR) of all-grade hand–foot skin reaction, skin rash, stomatitis, skin and hair discoloration were 2.12 (95% CI: 1.28–3.51; p < 0.004), 1.33 (95% CI: 1.15–1.54; p < 0.0002), 1.88 (95% CI: 1.36–2.59; p = 0.0001), 16.6 (95% CI: 4.18–64.94 p < 0.003), 4.42 (95% CI: 0.8–24.5; p < 0.09); respectively. Conclusions: our meta-analysis has demonstrated that sunitinib is associated with a higher risk of developing all-grade hand–foot skin reaction, skin rash, stomatitis and skin discoloration compared with control. Clinicians should be aware of these risks and perform regular clinical monitoring.

Keywords:

• hand–foot skin reaction
• meta-analysis
• mucocutaneous toxicities
• skin rash
• stomatitis
• sunitinib
• tyrosine kinase inhibitors.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• We performed a systematic review and meta-analysis of mucocutaneous toxicities associated with sunitinib, an oral multi-TKI.

Methods:

• Eligible studies included randomized Phase II and III trials of patients with solid tumors on sunitinib daily describing events of hand–foot syndrome, skin rash, stomatitis and skin and hair discoloration.

Results:

• The relative risk of all-grade hand–foot skin reaction, skin rash, stomatitis, skin and hair discoloration were 2.12 (95% CI: 1.28–3.51; p < 0.004), 1.33 (95% CI: 1.15–1.54; p < 0.0002), 1.88 (95% CI: 1.36–2.59; p = 0.0001), 16.6 (95% CI: 4.18–64.94 p < 0.003) and 4.42 (95% CI: 0.8–24.5; p < 0.09), respectively.

• Clinicians should be aware of these risks and perform regular clinical monitoring.