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A 54-year-old male with cytokine-refractory metastatic renal cell carcinoma was admitted because of respiratory distress and hypotension. Five years earlier, he has been treated with alpha interferon (IFN) and interleukin-2 (two cycles of 6 weeks, sc) for bone, mediastinal lymph node and pulmonary metastases. Six months before admission, sunitinib (50 mg/day during 4 weeks followed by 2 weeks of rest) was initiated for disease progression and a partial response (according to Response Evaluation Criteria in Solid Tumors criteria) was obtained after 3 months. Sunitinib was well tolerated with a grade 2 fatigue (NCI—CTC version 2). As cardiovascular risks, only a well-controlled chronic hypertension (carvedilol 25 mg/day) was recorded and sunitinib did not worsen blood pressure. He did not have symptoms or past medical history of ischemic cardiomyopathy. At admission, the patient was still taking sunitinib.

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