{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:34:08Z","timestamp":1791196448616,"version":"4.1.0"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2008,10,1]],"date-time":"2008-10-01T00:00:00Z","timestamp":1222819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Learning Objectives<\/jats:title>\n                  <jats:p>After completing this course, the reader should be able to: Evaluate the recommended clinical doses and the associated safety data for targeted therapies in RCC.Identify clinical circumstances for which dose modifications should be considered in RCC patients treated with targeted therapies.Employ prescribing guidelines for the management of drug-related toxicities.<\/jats:p>\n                  <jats:p>CME This article is available for continuing medical education credit at CME.TheOncologist.com<\/jats:p>\n                  <jats:p>The targeted therapies sunitinib, sorafenib, temsirolimus, and bevacizumab (when used in combination with interferon-\u03b12a) have dramatically improved outcomes for patients with advanced renal cell carcinoma (RCC). Clinical application of these novel agents outside the trial setting, however, may present some challenges for treating individual patients with unique needs. In some patients, dose modifications may be considered for potential drug interactions and for management of severe cases of hematologic or nonhematologic toxicities. The more common grade 3 or 4 side effects with sunitinib and sorafenib include hypertension, fatigue, hand\u2013foot syndrome, elevated lipase, lymphopenia, and neutropenia. Congestive heart failure is a less common but serious side effect that warrants treatment discontinuation. Temsirolimus exhibits a different side-effect profile, with the more common grade 3 or 4 side effects being metabolic in nature (i.e., elevated triglycerides, elevated glucose, hypophosphatemia) as a result of its inhibitory effects on the mammalian target of rapamycin\u2013regulated lipid and glucose pathways. Asthenia, rash, and dyspnea also occur in patients receiving temsirolimus. Virtually all of the side effects associated with these agents can be managed effectively in the majority of patients with medical treatment or supportive interventions. Recognition and prompt management of side effects are important to avoid unnecessary dose reductions that may result in suboptimal efficacy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2008-0120","type":"journal-article","created":{"date-parts":[[2008,10,7]],"date-time":"2008-10-07T00:25:21Z","timestamp":1223339121000},"page":"1084-1096","source":"Crossref","is-referenced-by-count":176,"title":["Targeted Therapies for Metastatic Renal Cell Carcinoma: An Overview of Toxicity and Dosing Strategies"],"prefix":"10.1093","volume":"13","author":[{"given":"Thomas E.","family":"Hutson","sequence":"first","affiliation":[{"name":"a Baylor University Medical Center, Sammons Cancer Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Figlin","sequence":"additional","affiliation":[{"name":"b City of Hope National Medical Center, Duarte, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Kuhn","sequence":"additional","affiliation":[{"name":"c University of Texas Health Science Center, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Motzer","sequence":"additional","affiliation":[{"name":"d Memorial Sloan-Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2008,10,6]]},"reference":[{"key":"2021122208575090300_R1","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1634\/theoncologist.12-9-1070","article-title":"Commentary: Oncologic drugs in patients with organ dysfunction: A summary","volume":"12","author":"Superfin","year":"2007","journal-title":"The Oncologist"},{"key":"2021122208575090300_R2","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1200\/JCO.2006.06.3602","article-title":"Sunitinib: From rational design to clinical efficacy","volume":"25","author":"Chow","year":"2007","journal-title":"J Clin Oncol"},{"key":"2021122208575090300_R3","doi-asserted-by":"crossref","first-page":"7215","DOI":"10.1158\/1078-0432.CCR-06-2254","article-title":"Targeting von Hippel-Lindau pathway in renal cell carcinoma","volume":"12","author":"Patel","year":"2006","journal-title":"Clin Cancer Res"},{"key":"2021122208575090300_R4","first-page":"327","article-title":"In vivo antitumor activity of SU11248, a novel tyrosine kinase inhibitor targeting vascular endothelial growth factor and platelet-derived growth factor receptors: Determination of a pharmacokinetic\/pharmacodynamic relationship","volume":"9","author":"Mendel","year":"2003","journal-title":"Clin Cancer Res"},{"key":"2021122208575090300_R5","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1200\/JCO.2005.02.2194","article-title":"Safety, pharmacokinetic, and antitumor activity of SU11248, a novel oral multitarget tyrosine kinase inhibitor, in patients with cancer","volume":"24","author":"Faivre","year":"2006","journal-title":"J Clin Oncol"},{"key":"2021122208575090300_R6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1200\/JCO.2005.02.2574","article-title":"Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma","volume":"24","author":"Motzer","year":"2006","journal-title":"J Clin Oncol"},{"key":"2021122208575090300_R7","doi-asserted-by":"crossref","first-page":"2516","DOI":"10.1001\/jama.295.21.2516","article-title":"Sunitinib in patients with metastatic renal cell carcinoma","volume":"295","author":"Motzer","year":"2006","journal-title":"JAMA"},{"key":"2021122208575090300_R8","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1056\/NEJMoa065044","article-title":"Sunitinib versus interferon alfa in metastatic renal-cell carcinoma","volume":"356","author":"Motzer","year":"2007","journal-title":"N Engl J Med"},{"key":"2021122208575090300_R9","unstructured":"Figlin \u00a0RA, Hutson \u00a0TE, Tomczak \u00a0P et al. Overall survival with sunitinib versus interferon (IFN)-alfa as first-line treatment of metastatic renal cell carcinoma (mRCC). 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Cardiotoxicity associated with the cancer therapeutic agent sunitinib malate. 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