KINASE INHIBITORS

Diagnosis and Treatment

Mrs. T is a 65-year-old female who was diagnosed with renal cell carcinoma (RCC). She has a known history of coronary artery disease (CAD) and experienced a myocardial infarction (MI) 1 year ago. Her healthcare team decided to start her on sunitinib to treat her RCC.

Cardiovascular Toxicity Mitigation and Management

Prior to starting the sunitinib, Mrs. T’s APP conducted a thorough screening for hypertension. Per guidelines from the Angiogenesis Task Force of the National Cancer Institute Drug Steering Committee, patients’ blood pressure (BP) should be measured at baseline, weekly during the first treatment cycle, and every 2-3 weeks for the duration of treatment. One week after beginning sunitinib, Mrs. T’s BP increased from a baseline of 138/78 mm Hg to 165/90 mm Hg, indicating hypertension.

Mrs. T’s APP started her on the ACE inhibitor lisinopril based on her prior history of CAD and MI. She was instructed to keep a log of daily BP monitoring at home and call the clinic if her systolic BP was 140 mm Hg or greater after 3 days of taking the ACE inhibitor. Mrs. T returned to clinic after 2 weeks, and her BP was 150/86 mm Hg. Lab work showed a BUN of 19 and creatinine of 1.05. Mrs. T’s APP switched her to lisinopril plus hydrochlorothiazide, and after 1 week, her BP had decreased to 130/72 mm Hg. Her BP continued to remain controlled without interrupting her sunitinib therapy.