Confusion of therapeutic approaches. In reply.

In their contribution, Ivanyi et al. discuss the potential cardiotoxic side effects of the tyrosine kinase inhibitors sunitinib and sorafenib. They describe the side effect of this treatment—namely, restricted left-ventricular ejection fraction (1)—which was reported in what is thus far the only published one full-text study, as a sequela of uncontrolled arterial hypertension, rather than of the treatment itself. The authors cite two studies that have been publish in abstract form. We thank our correspondents for their comments; in this context we regard the proactive regulation of blood pressure as specious. We refer readers to the study cited in our article (1), product information from Germany regarding both substances, which describes heart failure as a “common” side effect for sorafenib (product information, sorafenib) and “occasional” for sunitinib (product information, sunitinib). Furthermore, we wish to point out that patients who receive treatment with tyrosine kinase inhibitors are described as “stage a heart failure” patients by many authors (2, 3). In sum, this is consistent with the proposed algorithm of repeated controls (medical history, physical examination, which obviously includes blood pressure measurement, ECG, and echocardiography), which is set out in Figure 3 (4). Ivanyi et al. subsequently criticize the “confusion of curative and palliative treatments” and the “lack of discrimination between acute, sporadically occurring, and cumulative cardiotoxicities” in our article. We think that regular monitoring of cardiotoxic side effects is necessary, independent of the therapeutic intention (curative or palliative) or the time of onset, since therapy-related heart failure changes the therapeutic approach, independent of curative or palliative intent. Last, but not least, heart failure adversely affects a patient’s quality of life.