Management of Sunitinib in Patients with Elevated Creatinine

Assessment and Management Algorithm

• Sunitinib should be temporarily discontinued when serum creatinine reaches 2.3 mg/dL, as this represents a significant elevation that requires evaluation and monitoring before considering resumption of therapy 1, 2
• Evaluate for other potential causes of elevated creatinine including recent IV contrast, medications, fluid status changes, and urinary tract infections 2
• With creatinine of 2.3 mg/dL (which falls into the Grade 2 renal toxicity range of 2-3 times baseline), sunitinib should be temporarily held 1, 2
• Consult nephrology for further evaluation and management recommendations 2
• Monitor creatinine weekly after discontinuation to assess for improvement 2
• Consider resuming sunitinib only if renal function improves to Grade 1 or less (typically less than 1.5 times baseline) 2