Sunitinib induced hypertension, thrombotic microangiopathy and reversible posterior leukencephalopathy syndrome.

A 54-year-old female with suboptimally controlled hypertension(RR 150/90) and an imatinib-resistant gastrointestinal stromalcell tumor, had been on treatment with sunitinib malate (Sutent,previously known as SU011248; Pfizer, NY), a vascular endothelialgrowth factor receptor (VEGFR)/c-kit/platelet-derived growthfactor receptor (PDGFR)/Flt3 tyrosine kinase inhibitor. Thedrug was given orally daily 50 mg for a 4-week-on, 2-week-offschedule since November 2005. During the 4-week-on cycles, thrombocytopeniawas present, but the platelet counts restored to normal valuesin the 2-week-off schedule (Figure 1). On treatment with sunitinib,20% regression of the tumor was seen. On 22 June 2006, in herlast week of