Adverse events from targeted therapies in advanced renal cell carcinoma: the impact on long-term use.

What's known on the subject? and What does the study add? The side-effect of targeted agents is known. The clinician should be aware of the side-effects of targeted agents and how to prevent/diminish them, particularly in sequential and combination therapies. The aim of this review is to help physicians tailor targeted treatments for advanced renal cell carcinoma to suit patient needs and ensure maximum overall duration of response to therapy by providing a summary of the frequency and time of onset of adverse events (AEs) and by raising awareness of AE profiles. A PubMed literature search was performed, and papers on targeted therapy-related AEs were reviewed. The frequency, severity and management of targeted therapy-related AEs are discussed. Manageable AEs commonly reported with all the approved targeted agents include: fatigue, gastrointestinal disorders (diarrhoea, nausea, vomiting), hypertension, skin and subcutaneous tissue disorders. Life-threatening AEs are less common than manageable AEs and are usually class specific. Data suggest that long-term treatment with well-established targeted agents does not result in increased or unexpected AEs. Caution is required with regard to the long-term use of newer targeted agents for which there are no long-term tolerability data or clinical experience. Studies have reported that the type and frequency of observed AEs associated with sequential tyrosine kinase inhibitor (TKI) use are similar to those reported in the literature for TKI monotherapy. Having an awareness of the AE profiles of targeted agents allows the development of effective management strategies. Generally, more extensive clinical experience has accumulated, and AE profiles are more predictable, for well-established targeted agents.