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Sunitinib (Sutent®)

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OncoLink
Last Modified: April 20, 2012

Pronounced: soo-NI-ti-nib
Classification: Multikinase Inhibitor

About Sunitinib

Sunitinib is a type of targeted therapy. This means it targets something specific to the cancer cells, therefore decreasing side effects caused by damage to the healthy cells. Sutinib works by blocking 2 processes that allow cancer cells to grow:

• Interfering with a protein that promotes cell division
• Blocking the VEGF receptor, which is responsible for angiogenesis, or the development of a blood supply to the tumor. This removes the tumor's source of nutrients.

How to Take Sunitinib

Sunitinib comes as a capsule to take by mouth with or without food. The dose and schedule is determined by your healthcare provider and is based on the type of cancer you have. Take sunitinib at around the same time every day.

The blood levels of this medication can be affected by certain foods and medications, so they should be avoided. These include: grapefruit, grapefruit juice, dexamethasone, carbamazepine, rifampin, phenytoin, St. John's wort, and phenobarbital. Be sure to tell your healthcare provider about all medications and supplements you take.

Possible Side Effects of Sunitinib

There are a number of things you can do to manage the side effects of Sunitinib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4°), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bath daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your doctor or nurse before scheduling dental appointments or procedures.
• Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. You may take acetaminophen (Tylenol).
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Read the thrombocytopenia tip sheet for more information.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
• Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.

Mouth Ulcers (Sores)

Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
• If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.

Read the mouth ulcer tip sheet for more information.

Skin Changes

In clinical trials, some patients developed a yellow discoloration of the skin and/or hair. This was thought to be related to the yellow color of the drug. However, yellowing of the skin or eyes can be a sign of liver problems and should be reported to your healthcare team.

Hand and Foot Syndrome (HFS)

HFS is a skin reaction that appears on the palms of the hands and/or the soles of the feet as a result of certain chemotherapy agents. It can start as a feeling of tingling or numbness in the palms and/or soles and progress to swelling, redness, peeling skin, and tenderness or pain. Notify your healthcare team right away if you notice any of these signs of HFS. Learn more about HFS on OncoLink.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication or for at least 2 weeks after stopping the medication. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. It is not known if this medication passes into breast milk and harm a baby, therefore you should not breastfeed while taking this medication.

High Blood Pressure

High blood pressure (hypertension) occurred in clinical trials with sunitinib. Patients should have their blood pressure checked periodically during therapy. Any hypertension should be treated appropriately. In cases of severe hypertension, sunitinib should be stopped until blood pressure is controlled. Signs of hypertension to report to your team include: blurry vision, nosebleed, headache and fatigue.

Heart Toxicity

In clinical trials, some patients developed heart failure (congestive heart failure). Patients with a history of cardiac problems should have their heart function tested prior to starting this therapy, as well as during therapy if any symptoms arise. If heart function decreases or symptoms arise, sunitinib should be stopped. Symptoms should be reported to the healthcare team include: shortness of breath, weight gain or swelling, cough or weakness.

Thyroid Problems

Hypothyroidism (under active thyroid) can occur while taking this medication. Your doctor will perform blood tests to check the function of your thyroid and treat this side effect if it develops. Symptoms of hypothyroidism include: tiredness, feeling cold, weight gain, hair loss, depression, dry hair and skin, irregular menstrual periods and muscle cramps.

Other Side Effects

This medication may interfere with wound healing. The manufacturer recommends stopping the drug before any surgical procedure and not restarting until there is adequate wound healing.

This medication can cause heart rhythm abnormalities (arrhythmias) caused by a prolonged QT interval. If you are at risk for this, your healthcare provider will monitor you for heart problems.

Bleeding has occurred in patients taking this medication, including bleeding in the GI tract, lungs, urinary tract and brain (stroke). Let your healthcare provider know if you develop any bleeding, including nosebleeds, coughing up blood, vomiting blood or coffee ground appearing vomit, blood in the stool or black stools. If you experience changes in your speech or balance, confusion, difficulty walking, vision changes or numbness on one side of the body, call 911 right away.