Sunitinib-induced sudden hearing loss

Excerpt

A 53-year-old woman diagnosed with grade 1 ileal neuroendocrine tumor (NET) and synchronous liver and retroperitoneal metastases was first treated with right hemicolectomy in December 2012. She was also treated with monthly lanreotide for carcinoid syndrome (120 mg subcutaneously). Because of disease progression, she was included in the SUNLAND randomized phase II trial (NCT01731925) that investigated sunitinib versus placebo in combination with lanreotide 120 mg. Sunitinib (37.5 mg daily) was initiated on August 14, 2013. Fifteen days later, she consulted for right-side hearing loss and tinnitus, as well as rotatory vertigo. At this point unblinding of treatment allocation was requested. Clinical examination found left rotatory nystagmus and right-sided hearing loss. Neurological and otoscopic examinations were normal. Tonal audiometry found a massive right-sided hearing loss (−90 dB; Fig. 1) and speech audiometry a complete intelligibility loss, evidencing cophosis. Sunitinib was discontinued, and the patient was treated with high-dose corticosteroids without success. Additional examinations, including cerebral magnetic resonance imaging and computed tomography scan of the temporal bone, were negative and without signs of posterior leucoencephalopathy or right ear morphological anomaly. Biological tests for pathogenic agents, including VZV, HSV, and Lyme disease, were normal. The diagnosis of right-sided sudden hearing loss due to sunitinib was made, and was declared to the pharmacovigilance system of the national health authorities (Agence National de Sécurité du Médicament et des Produits de Santé) in March 2014. Physical therapy was initiated and led to progressive improvement of vertigo, but not of hearing loss. The patient continued lanreotide; carcinoid syndrome was partially controlled. She received peptide receptor radionuclide treatment in 2014. Disease is currently stable, but right-sided deafness has been complete since August 2013.

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