Table 3.
Clinical Characteristics of Individual Patients Experiencing Left Ventricular Dysfunction While on Sunitinib
| Patient | Age (yrs) | Gender | Baseline Cardiac Medications | Sunitinib Starting Dose (mg) | Baseline LVEF (%) | Maximum LVEF Decline (%)a | Maximum Change in Biomarker (pg/ml)b | HF Symptoms | New Cardiac Medications | Sunitinib Continued | LVEF Recovery | Recovery LVEF (%) | Timing of LVEF Recovery | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 55 | M | BB, Statin, Diuretic | 50 | 49.9 | 10.1 | TnI: −4.1 BNP: −504 |
Fatigue, Dyspnea | None | Yes | N/A | N/A | N/A | Expired from RCC prior to subsequent ECHO |
| 2 | 43 | M | Statin | 50 | 53.4 | 17.2 | TnI: +227.5 BNP: +3.9 |
Fatigue | BB, CCB | Yes | Yes | 43.8 | Wk 33 | Changed RCC therapy wk 30 secondary to disease progression |
| 3 | 56 | F | None | 50 | 53.1 | 14.1 | Unk | Fatigue, Dyspnea, PND | None | Yes | Yes | 67.6 | Initial recovery Wk 15; Full recovery by Wk 52 | SU dose reduction and changed to 2/1 schedule wk 15 |
| 4 | 41 | F | None | 50 | 51.7 | 14.7 | TnI: +0.5 BNP: +5.2 |
Fatigue, Ankle Swelling | None | Yes | Yes | 50.9 | Wk 33 | SU dose reduction and changed to 2/1 schedule wk 15 |
| 5 | 61 | M | ASA, ARB, CCB, Diuretic | 50 | 47.1 | 12.0 | TnI: +3.8 BNP: +3.8 |
Fatigue | Clonidine BB |
Yes | Yes | 57.9 | Wk 33 | |
| 6 | 66 | M | CCB | 50 | 55.0 | 12.0 | TnI: +0.7 BNP: +23.6 |
Fatigue, Ankle Swelling | ARB, diuretic BB |
No | Yes | 52.0 | Wk 33 | Changed RCC therapy wk 12 secondary to disease progression |
| 7 | 46 | M | None | 37.5 | 53.5 | 11.5 | TnI: −22.4 BNP: +15.6 |
Fatigue, Dyspnea | ACEi | Yes | Yes | 52.6 | Wk 15 | |
| 8 | 45 | M | ASA | 50 | 49.7 | 12.5 | TnI: +0.3 BNP: −9.5 |
Fatigue, | None | Yes | Yes | 46.2 | Wk 33 | Changed to 2/1 schedule wk 15 |
| 9 | 56 | M | BB, CCB, Other | 50 | 62.1 | 15.8 | TnI: +9.2 BNP: +1726 |
None | None | Yes | N/A | N/A | N/A | Expired from RCC prior to subsequent ECHO |
For all patients with the exception of patient 4, LV dysfunction was detected at week 3.5. For patient 4, this was detected at 15 weeks.
Maximum change in biomarker from baseline visit (i.e. biomarker value at follow-up visit – biomarker value at baseline visit)
Abbreviations: LVEF, left ventricular ejection fraction; LV, left ventricular; BB, beta-blocker; ASA, aspirin; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; ACEi, angiotensin converting enzyme inhibitor; Statin, HMG CoA reductase inhibitor; TnI, high sensitivity cardiac troponin I; BNP, B-type natriuretic peptide; HF, heart failure; RCC, renal cell carcinoma; ECHO, echocardiography; SU, sunitinib; N/A, not applicable