Tolvaptan for paraneoplastic SIADH in small cell lung cancer: a scoping review.

Authors

Victoria L Cammann, Menzi Sheryl, Thomas Fürst, Andreas W Jehle

Published in

Cancer treatment and research communications. Volume 47. Pages 101233. Apr 30, 2026. Epub Apr 30, 2026.

Abstract

Hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH) occurs in approximately 25 % of patients with small cell lung cancer (SCLC). Tolvaptan has emerged as a promising option to treat SIADH in such patients. Here, we analyse the current literature on tolvaptan for managing paraneoplastic SIADH in SCLC.
PubMed, EMBASE, Cochrane, and Web of Science were searched for studies that enrolled patients with paraneoplastic SIADH in SCLC and were treated with tolvaptan until December 2024.
Out of 155 studies identified by database searches, 29 studies comprising 86 patients were included in this scoping review. The mean age was 64 years, 38.4 % were female, and 32.6 % patients had extensive disease. The median sodium concentration before initiation of tolvaptan was 117 mmol/L (IQR, 113 -121 mmol/L). Starting doses of tolvaptan ranged from 1.875 mg/day to 15 mg/day, with most patients receiving 7.5 mg/day or 15 mg/day. An initial response to tolvaptan was reported in all included cases. The median treatment duration with tolvaptan was 8 days (IQR 5 - 150 days). Side effects of tolvaptan were reported in 8.1 % of cases (N = 7) and included plasma sodium overcorrection (N = 5), extreme thirst and polyuria (N = 1), and dry mouth with episodic dizziness (N = 1). Among the included studies, five patients with secondary failure to tolvaptan were identified. Three of these cases were accompanied by very high arginine vasopressin (AVP) or copeptin concentrations and a progression in tumor burden.
In SCLC patients with paraneoplastic SIADH, tolvaptan is a welcome addition to the treatment armamentarium for hyponatremia. The use of tolvaptan demands considerable expertise to avoid plasma sodium overcorrection. Secondary failure to tolvaptan can occur and should prompt further investigations to detect tumor progression.

PMID:
42119219
Bibliographic data and abstract were imported from PubMed on 13 May 2026.

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