Metastatic renal cell carcinoma: the first report of unilateral fundus hemorrhage induced by sorafenib

Abstract

// Zhi Yong Li 1, 2, 3, * , Xin Xiang Fan 4, * , Yan Jun Wang 1, 2, 3, * , Kai Yao 1, 2, 3 , Zhuo Wei Liu 1, 2, 3 , Wen Tao Pan 1, 2, 3 , Yun Lin Ye 1, 2, 3 , Ping Yang 1, 2, 3 , Yi Chuan Huang 4 , Zhi Ming Wu 1, 2, 3 , Fang Jian Zhou 1, 2, 3 1 State Key Laboratory of Oncology in Southern China, Guangzhou, China 2 Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou, China 4 Department of Urology, Sun Yat-Sen Memorial Hospital, Guangzhou, China * These authors contributed equally to this work Correspondence to: Zhi Ming Wu, email: wuzhim@sysucc.org.cn Fang Jian Zhou, email: zhoufj@sysucc.org.cn Keywords: RCC, sorafenib, TKIs, CRVO, unilateral Received: December 07, 2015      Accepted: March 28, 2016      Published: May 11, 2016 ABSTRACT Background: Renal cell carcinoma (RCC) is the most common type of kidney tumor with increasing incidence. Tyrosine Kinase Inhibitors (TKIs) are considered important treatment in the management of metastatic RCC. Some previous studies demonstrated that sorafenib treatment is associated with a significantly increased risk of potentially life-threatening adverse events, like bleeding. But bleeding at the fundus site is the rarest type of hemorrhage. As for TKIs’ risk of bleeding, how we distinguish the degree of bleeding and what optimal strategies should we take to manage bleeding, needs to be studied systematically. Results: With a long-term exposure (17 months) to sorafenib, he experienced blurred vision in his right eye and was hospitalized. The patient’s diagnosis was central retinal vein occlusion (CRVO) of the right eye. Unfortunately sorafenib was terminated. Materials and Methods: The authors describe the first case of unilateral fundus hemorrhage induced by sorafenib. A 42-year-old man was diagnosed metastatic left RCC, with clinical stage and prognostic risk being assessed as T4N1M1 and intermediate. He received a radical left nephrectomy and retroperitoneal lymph node dissection, with taking the oral multi-targeted TKI, sorafenib (800 mg daily) from 7 months to 7 days before the surgery and 7 days after the surgery restarting again until the occurrence of fundus hemorrhage. Conclusions: In this patient, long-term exposure to sorafenib possibly has increased the risk of fundus hemorrhage. This article provides us a previously undescribed morbidity associated with sorafenib, which reminds us of understanding the risk of bleeding and how this complication might be managed systematically.