Sunitinib‐induced hyperammonaemia in a patient with pancreatic neuroendocrine tumour

• Published in: Journal of clinical pharmacy and therapeutics Vol. 38; no. 4; pp. 327 - 329
• Main Authors: Shea, Y.‐f., Chiu, W.‐y. J., Mok, M.‐y. M., Hung, I. F.‐n., Yau, C.‐c. T.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.08.2013; Hindawi Limited
• Subjects: Aminoacid disorders; Biological and medical sciences; Errors of metabolism; Gastroenterology. Liver. Pancreas. Abdomen; Humans; hyperammonaemia; Hyperammonemia - chemically induced; Indoles - adverse effects; Indoles - therapeutic use; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Metabolic diseases; Middle Aged; Neuroendocrine Tumors - blood; Neuroendocrine Tumors - drug therapy; neuroendocrine tumours; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - drug therapy; Pharmacology. Drug treatments; Pyrroles - adverse effects; Pyrroles - therapeutic use; sunitinibs; Tumors; Antineoplastic agent; Human; Pancreatic tumor; Enzyme; Tyrosine kinase inhibitor; Transferases; Hyperammonemia; Enzyme inhibitor; Ammonia; Metabolic disorder; Sunitinib; hyperammonaemia; Digestive diseases; neuroendocrine tumours; Multikinase inhibitor; Antiangiogenic agent; Neuroendocrine tumor; Protein-tyrosine kinase; Pancreatic disease; sunitinibs
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12054

Summary What is known and objective Sunitinib can improve progression‐free survival and overall survival in patients with advanced pancreatic neuroendocrine tumor (PNET). From clinical trial, most commonly reported adverse events of sunitinib were neutropenia (12%), diarrhea (10%), asthenia (7%), erythrodysesthesia (7%), hypertension (7%) and thrombocytopenia (6%). Case summary We report a patient with PNET with liver metastases who developed hyperammonemia with a low dosage of sunitinib probably contributed by the presence of liver metastases. What is new and conclusions We would like to draw attention to the potential risk of sunitinib induced hyperammonemic encephalopathy even with a low dosage of sunitinib. The absence of sunitinib‐induced hyperammonemia during its initial course does not rule out this possibility if there is increased in liver metastases. We suggest checking the ammonia level if patient on sunitinib presented with altered sensorium even if the liver function is normal.