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Crit Rev Oncol Hematol. 2014 Jul;91(1):35-46. doi: 10.1016/j.critrevonc.2014.01.002. Epub 2014 Jan 17.

Systematic review of the side effects associated with tyrosine kinase inhibitors used in the treatment of gastrointestinal stromal tumours on behalf of the EORTC Quality of Life Group.

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Cancer Sciences, University of Southampton, Southampton SO16 6YD, UK. Electronic address:
Cancer Sciences, University of Southampton, Southampton SO16 6YD, UK.
Health Outcomes Research Unit, Gimema, 00161 Rome, Italy.
Department of Medical Psychology, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Swansea Centre for Health Economics, Swansea University, Swansea SA2 8PP, UK.
European Organisation for Research and Treatment of Cancer Quality of Life Department, 1200 Brussels, Belgium.


Tyrosine kinase inhibitors (TKIs) have revolutionised the treatment of advanced gastrointestinal stromal tumours (GISTs). Imatinib is approved as first line therapy and sunitinib is used in cases of imatinib resistance or intolerance. Compared with conventional treatments, TKIs are delivered over longer periods of time and are more specific in their targets (i.e., molecularly targeted), thus presenting different side effect profiles. We review the safety profiles of imatinib and sunitinib, documenting a total of 95 side effects including patient based as well as medically defined outcomes. Gastrointestinal complaints, particularly diarrhoea and nausea, oedema, fatigue and haematological disorders, notably anaemia, are amongst the most prevalent side effects. While there is overlap between the side effect profiles of imatinib and sunitinib, important differences emerge in the frequencies of oedema, hypertension, thyroid functioning, muscle and joint pains, as well as skin and oral conditions. Awareness of potential side effects is informative to both clinician and patient in terms of treatment decision making and can have important implications for treatment adherence and clinical outcome.


Gastrointestinal stromal tumour; Imatinib; Side effects; Sunitinib; Symptoms; Tyrosine kinase inhibitors

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