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Adapted from the NCI Cancer Bulletin, vol. 5/no. 1, Jan. 8, 2008 (see the current issue ³).

Dr. Ming Hui Chen of Harvard Medical School in Boston, Mass., and her colleagues retrospectively analyzed the medical records of 75 GIST patients treated at the Dana-Farber Cancer Institute during a phase I/II study. A total of 11 percent of patients had a cardiovascular event - two patients had heart attacks and six others experienced heart failure. In addition, 47 percent of patients developed hypertension - systolic and diastolic blood pressure increased during the first cycle of treatment - and 20 percent had reduced heart function.

Most cardiac problems including hypertension were manageable and the majority of patients with heart failure resumed sunitinib therapy. Histories of coronary artery disease and/or hypertension were predictors of cardiovascular events.

Cardiac side effects have been reported ⁷ for other successful targeted cancer drugs such as trastuzumab ⁸ (Herceptin®) and bevacizumab ⁹ (Avastin®). The study supports a growing view that oncologists and cardiologists need to work together to identify the cardiac side effects of new, targeted drugs and to manage cardiac health throughout therapy.

"The paradigm remains to treat the cancer while caring for the heart," said Dr. Chen, a cardiologist who specializes in the cardiac health of adult cancer patients. She noted that although the cardiotoxicity in this study was not seen in phase III trials, the patients may be more similar to patients in the general population now being treated with sunitinib.

A letter in the January 3, 2008, New England Journal of Medicine reports on 14 patients with metastatic renal cell carcinoma who also experienced rapid, marked increases in blood pressure during treatment with sunitinib. The effect was revealed by home blood-pressure monitoring and had been missed during routine office visits.

"Our study suggests that rapid and large increases in blood pressure should be anticipated in patients who are treated with sunitinib," conclude the authors from Hôpital Européen Georges Pompidou in Paris.

Glossary Terms

Having to do with the heart and blood vessels.

A disease in which there is a narrowing or blockage of the coronary arteries (blood vessels that carry blood and oxygen to the heart). Coronary artery disease is usually caused by atherosclerosis (a build up of fatty material and plaque inside the coronary arteries). The disease may cause chest pain, shortness of breath during exercise, and heart attacks. The risk of coronary artery disease is increased by having a family history of coronary artery disease before age 50, older age, smoking tobacco, high blood pressure, high cholesterol, diabetes, lack of exercise, and obesity. Also called CAD and coronary heart disease.

A type of tumor that usually begins in cells in the wall of the gastrointestinal tract. It can be benign or malignant. Also called gastrointestinal stromal tumor.

A blood pressure of 140/90 or higher. Hypertension usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called high blood pressure.

Having to do with metastasis, which is the spread of cancer from the primary site (place where it started) to other places in the body.

A trial to study the safety, dosage levels, and response to a new treatment.

A study to compare the results of people taking a new treatment with the results of people taking the standard treatment (for example, which group has better survival rates or fewer side effects). In most cases, studies move into phase III only after a treatment seems to work in phases I and II. Phase III trials may include hundreds of people.

The most common type of kidney cancer. It begins in the lining of the renal tubules in the kidney. The renal tubules filter the blood and produce urine. Also called hypernephroma.