Sunitinib – Oral

Sunitinib is a cancer medication that works by preventing cancer cells from getting oxygen supply, thus causing them to starve and die.

Overview

Sunitinib works as a targeted therapy. It belongs to a group of drug that inhibits the receptor of protein tyrosine kinase. Protein kinase is a kind of enzyme that is responsible for the growth of cancer cells. Sunitinib blocks the protein kinase to stop cancer from growing. It stops a tumor from growing or shrink it. It works by inhibiting the activity of vascular endothelial growth. It is an antiangiogenesis inhibitor because it can stop the making of blood vessels.

Sunitinib is a medication utilized for cancer treatment. It works by preventing the growth and spread of cancer in the body. Sunitinib treats specific kinds of tumors found in the pancreas, kidneys, or digestive system.

How Sunitinib Works

Sunitinib is a medicine designed to target cancer. Targeted therapy is the product of more than 100 years of research on how to differentiate normal cells from cancer cells.

Cancer medications often work by killing the quickly dividing cells because cancer cells are known to divide quickly. However, this treatment is flawed because some normal cells divide quickly also. Consequently, the patient experiences numerous side effects.

This is where targeted treatment comes in. It seeks other unique characteristics of cancer cells. Scientists were able to distinguish the normal cells from cancer cells. The information is utilized to target cancer cells only in the treatment. The result is lesser side effects to the patient. Every type of targeted treatment works differently but they all prevent the cancer cell from growing, dividing, repairing and communicating with other cells.

There are three types of targeted therapies designed to attack the cancer cells. The first kind targets the inside of the cancer cell and disrupts its functions. The second kind target the receptors outside the cancer cells. The last kind targets the blood vessels that provide oxygen to the cancer cells, causing them to starve from oxygen and die. Sunitinib belongs to this third type.

Sunitinib is designed to target enzymes in the blood vessels as well as the tumor cells. Some of these target cells are believed to be involved in angiogenesis or the making of blood vessels. Research is still conducted on which cancers are treated best with Sunitinib.

Conditions Treated

  • Gastrointestinal Stromal Tumor (GIST)
  • Advanced renal cell cancer
  • Advanced pancreatic neuroendocrine tumor

Type of Medication

  • Kinase inhibitor

Side Effects

Sunitinib can cause liver damage or life-threatening problems to the liver. If the patient has an existing liver disorder or problem, it is important that he or she should let the doctor know as using Sunitinib may lead to fatal consequences. Call the doctor right away if symptoms of liver problems occur, such as (but not limited to) jaundice or yellowish tinge in the eyes and skin, dark-colored urine, weakness or tiredness, stools become clay-colored, upper stomach pain, nauseous and itchiness.

The patient needs to undergo frequent liver function testing while using Sunitinib. He or she should comply with the laboratory requirements to monitor his or her progress and to prevent unwanted side effects.

Some patients may experience side effects from using Sunitinib. The doctor can often predict the side effects when it comes to the onset, length, and seriousness. Side effects can be reversed. They go away once treatment is completed.

Side effects are managed quickly. Others may take time. There are things that a doctor can do to either prevent them or reduce the effects.

The side effects that are common (usually manifest in more than 30% of patients treated with Sunitinib) are the following:

  • Lethargy or fatigue
  • Nausea
  • Vomiting
  • Diarrhea
  • Heartburn
  • Changes in taste
  • High blood pressure
  • Low count of blood (white blood cells, red blood cells, and platelets may reduce) - when this happens, the patient needs monitoring as this may make him or her at risk of contracting infections, bleeding or anemia.
  • Skin discoloration - this could be caused by the yellow color of the medicine.

Less common symptoms often experienced by 10 to 29% of patients include the following:

  • Reduced appetite
  • Increase levels of liver enzymes
  • Lethargy or weakness
  • Headaches
  • Constipated
  • Pain in the abdomen
  • Dryness of skin
  • Fever
  • Bleeding
  • Inflammation in feet and ankles
  • Feeling dizzy
  • Increase in levels of lipase and amylase
  • Feeling dizzy
  • Difficulty in breathing
  • Feeling in pain
  • Flatulent
  • Skin rashes
  • Pain or peeling of skin on palm of hand and sole of foot also called hand-foot syndrome
  • Dehydrated
  • Reduced levels of potassium
  • Increased bilirubin levels
  • Changed in color of hair
  • Coughing
  • Loss of hair
  • Hypothyroidism

A rare side effect which occurs in 2-3% of patients taking Sunitinib is blood clots. This is a serious side effect because blood clots can cause a possibly fatal condition called pulmonary embolus or stroke.

The patient should always tell the doctor if he or she experiences any side effect. Doing so could prevent any possible life-threatening complications.

The patient should call the doctor right away if he or she experiences a fever of more than 100.4° F (38° C) or chills, as this could be a symptom of infection.

Dosage

Sunitinib is taken as a capsule by mouth. It is not sold over-the-counter. It is available through a prescription from a doctor only.

Sunitinib can be taken with or without food. Do not consume grapefruit or grapefruit juice along with Sunitinib as this may interact with the drug.

Sunitinib dosage that is prescribed by the doctor will rely on various factors, such as the medical history of the patient, any allergies, existing medical conditions, and the type of cancer the patient has. The doctor will use the information provided by the patient to determine the exact dosage and frequency of using the medication.

Dosage Forms & Strengths

Sunitinib comes in capsule form with the following strengths:

  • 12.5mg
  • 25mg
  • 50mg

Drink plenty of water while taking Sunitinib, unless the doctor tells the patient otherwise.

Do not stop taking the medicine unless the doctor tells you so.

The patient should take Sunitinib as prescribed. Do not change the dosage. Do not use more than or less than what is required, or change the length of time and the frequency of using the medicine.

The doctor may sometimes change the dosage to ensure that the patient gets the desired effects.

The standard dosage for Sunitinib is once per day. Sunitinib may sometimes be used for 4 weeks then stopped for the next 2 weeks. The 6 week period is referred to as a cycle of treatment. This treatment is repeated for as long as sunitinib continues to work.

The doctor will prescribe the number of complete treatment cycles a patient needs. This is based on the patient’s medical condition.

Take Sunitinib as it is. Do not chew it, crush or open the capsule. If the medicine is crushed or broken, it could be harmful if it gets to the patient’s skin. If it gets into the skin, wash it immediately and thoroughly to remove the medicine from the skin.

If a patient misses a dose, take it as soon as possible. If it is time for the next dose, then skip the missed dose. Do not double the dosage as this may cause an overdose. Symptoms of overdose are similar to the severe symptoms.

Sunitinib Dosing information

  • Standard Adult Dosage of Sunitinib for Treatment of Renal Cell Carcinoma:

50 mg taken by mouth once a day on a schedule of 4 weeks on treatment followed by 2 weeks off or the usual cycle of treatment.

The medicine can be taken with or without food.

  • Standard Adult Dosage of Sunitinib for Treatment Gastrointestinal Stromal Tumor:

50 mg by mouth or orally once a day on a schedule of 4 weeks on treatment followed by 2 weeks off or the usual cycle of treatment.

This dosage is used for treating gastrointestinal tumor after disease progression on or becoming intolerant to imatinib.

  • Standard Adult Dosage of Sunitinib for Treatment of Pancreatic Cancer:

37.5 mg taken by mouth or orally once a day

Important: This dosage needs to be taken continuously without having to stop for 2 weeks or doing the off-treatment period. It can be taken with or without food.

This dosage is used to treat patients with pancreatic neuroendocrine tumors (pNET) with metastatic or unresectable locally advanced cancer.

Interactions

Grapefruit and grapefruit juice can have interactions with sunitinib. Avoid the fruit during treatment. Consuming these fruit while taking Sunitinib may cause life-threatening side effects. Ask the doctor about consuming grapefruit.

Sunitinib may interact with other drugs. It is important to inform the doctor if he or she is taking the following medications:

  • Dexamethasone
  • Isoniazid (used to treat tuberculosis)
  • Nefazodone
  • Imatinib
  • St. John's Wort
  • Antibiotics such as rifabutin, clarithromycin, rifampin, rifapentine, erythromycin, or telithromycin
  • Antifungal medications such as itraconazole, ketoconazole, miconazole, or voriconazole
  • A barbiturate medicine such as phenobarbital, secobarbital, and others
  • Heart or blood pressure medication such as nicardipine or quinidine
  • HIV/AIDS medicine such as delavirdine, atazanavir, etravirine, fosamprenavir, indinavir, nelfinavir, nevirapine, saquinavir, efavirenz, or ritonavir
  • Medicines to treat narcolepsy, such as armodafinil or modafinil
  • Medication to treat osteoporosis or Paget's disease of bone, such as risedronate, alendronate etidronate, pamidronate, ibandronate, tiludronate, or zoledronic acid
  • Seizure or convulsion medications including as felbamate, carbamazepine, oxcarbazepine, primidone, or phenytoin.

This list is not comprehensive. There may be other drugs that may interact with Sunitinib. Tell the doctor all the medications being used to prevent undesirable side effects.

Warnings

Before taking Sunitinib, the patient should inform the doctor of any allergies. The patient might be allergic to the contents of Sunitinib. Not telling the doctor about it could cause unnecessary side effects.

The patient should inform the doctor about any liver problems he or she has. Sunitinib may cause serious problems or it could be fatal to a patient with liver problems.

The patient should also inform the doctor of any medications he or she is taking such as herbal, prescription, supplements, over-the-counter, topical and others.

The patient should not take aspirin, or products that contain aspirin unless the doctor allows the patient to do so.

Do not use St. John's Wort, an herbal preparation that may cause an increase in metabolism and will consequently reduce Sunitinib effects.

The patient should not get vaccinations while using Sunitinib without the informing the doctor first.

The patient should let the doctor know if she is pregnant or planning to get pregnant. Sunitinib falls under FDA’s pregnancy category D which can pose dangerous risks to the unborn baby. Pregnant women should not take Sunitinib because it can possibly harm the fetus.

Men and women should use contraceptives or birth control while using Sunitinib. It is recommended not to get pregnant while undergoing treatment to prevent harmful effects to the unborn baby. Condoms are highly recommended while using Sunitinib.

Lactating women should stop breastfeeding while using Sunitinib as this may pass in the milk, which the infant consumes. The contaminated milk may harm the infant.

The patient may have an increased risk of losing fertility after taking Sunitinib. The woman may have a hard time getting pregnant. The man may not be able to father a child. If the patient is planning to get pregnant or father a child, the doctor may suggest ways to do so such as storing the sperm or egg before starting the treatment.

The patient could be at risk of contracting an infection so it is advisable to stay away from crowds. Patients should avoid contact with people who receive live vaccines orally if by mouth, including babies. Babies are vaccinated with rotavirus through the mouth. The patient should not change the baby’s diapers or wear gloves when changing diapers. Always wash hands right after changing diapers. Rotavirus stays in the baby’s urine for up to 2 weeks. This can cause the patient taking Sunitinib to get ill.

Washing hands often is highly recommended for both patients and caregivers.

Drinking alcohol should be minimized or stopped completely while taking Sunitinib.

Monitoring and Testing

The patient requires regular thorough medical check-up by the doctor. This is done to determine the response of the patient and the medication’s effects. The patient needs to do a complete blood count (CBC) and determine functions of some organs such as the kidneys, liver, and thyroid.

To ensure if a patient can take Sunitinib safely, he or she should inform the doctor of any of existing conditions such as:

  • Existing liver or kidney disorders
  • Heart conditions, high blood pressure, arrhythmia or heart rhythm disorder
  • Seizures
  • A bleeding problem or blood-clotting disorder
  • A thyroid or adrenal gland problem
  • A history of Long QT syndrome
  • A history of heart attack, stroke, blood clots, congestive heart failure, or coronary artery disease

If the patient needs to undergo surgery or a dental procedure, he or she should inform the doctor about taking Sunitinib. The patient may need to stop taking it for a short time until the dental treatment or surgery is over. Sunitinib can cause slow healing of a wound. Ask the doctor when to resume taking Sunitinib after the surgery.

The patient needs medical tests at the start of every 4-week treatment. This is to ensure that the patient is responding to the medicine and not experiencing any life-threatening side effects.

The patient should stop taking Sunitinib and call the doctor immediately if the following symptoms show: pain in the chest, getting too dizzy or fainting, rapid heartbeat or arrhythmia, swelling, shortness or difficulty of breathing, feeling numb or weak all of a sudden, vision changes, difficulty speaking, bruise easily, bloody urine or stools, coughing up blood, changes in weight, lethargy, lack of menstrual periods, stomach pain, dark-colored urine, and yellowing of the skin or eyes.

Some patients taking sunitinib may experience jaw bone loss, also known as osteonecrosis of the jaw. Symptoms of this condition include pain in the jaw, swelling, feeling numb, loose teeth, infection in the gum, or healing after injury or surgery in the gums may take time to heal.

The chances of developing osteonecrosis of the jaw are higher in patients taking Sunitinib who are treated for cancer or have previously been treated with steroids, radiation or chemotherapy. Other conditions that may lead to developing osteonecrosis of the jaw include blood clotting illnesses, anemia (low red blood cells), a pre-existing dental problem, or patients using medications for treating or preventing osteoporosis.

Caregivers looking after patients should wear gloves. Wash hands immediately and thoroughly after handling the patient. Sunitinib passes through all kinds of bodily fluids such as urine, sweat, and feces. Get rid of gloves and other materials that got contaminated with the patient’s fluids.

Clothes that the patient soiled should be washed separately in the laundry to avoid contamination.

Storage

  • Store Sunitinib at room temperature. Do not expose it to heat or moisture. Do not freeze or refrigerate.
  • Keep the lid of the container tightly locked to prevent children and pets from getting to it.
  • Keep it out of children’s reach. Sunitinib is harmful if ingested by a child.
  • Dispose expired or unneeded medicines safely. Ask the pharmacist or community garbage disposal department how to do so.

Summary

Sunitinib is effective in targeting cancer cells in gastrointestinal tumor or GIST, advanced renal cell cancer, and advanced pancreatic neuroendocrine tumor. It is a targeted therapy which focuses only on interfering with the rapid growth and division of cancer cells, not the normal cells, thus minimizing the possible side effects. However, patients should be cautious when using Sunitinib. This is a powerful medicine that can curb angiogenesis or formation of blood vessels. Patients should talk to a doctor first to see if the medicine works in their medical condition.

If the patient has liver problems, he or she should inform the doctor. Sunitinib can increase the risks of incurring liver illnesses and for patients with existing liver conditions, this could be fatal. The doctor may come up with alternative therapy for such patients.

Pregnant women are advised not to use Sunitinib as this drug is Category D and could harm the unborn baby. Both men and women should use contraceptives to prevent pregnancy during treatment. Sunitinib may also cause infertility in both men and women. Men may not be able to father a child after treatment. Women may not get pregnant. If the patient plans on having a baby or fathering a child, he or she should discuss options in case of infertility.

Sunitinib passes through different body fluids such as urine, sweat, and feces. Lactating mothers should avoid breastfeeding when taking this medicine. Caregivers should wear gloves when handling the patient’s fluids. They should get rid of gloves and other materials contaminated with the patient’s fluids. Soiled clothes of the patients need to be washed separately from other dirty laundry.

Treatment often involves taking Sunitinib once a day for 4 weeks then stops for the next 2 weeks. Then resume this treatment cycle again, for as long as the drug is effective. Patients are advised to drink plenty of water during the treatment.

Patients should undergo different laboratory tests such as complete blood count (CBC) while taking Sunitinib. This is to determine if Sunitinib is working or if the patient is responding to the medication. Also, so the doctor can assess any side effects the medication has on the patient particularly on the liver functions.

Patients may experience different side effects while using Sunitinib. Call the doctor right away if the side effects are severe. Not all patients experience side effects. The doctor can find ways to prevent or minimize the side effects of Sunitinib.

Resources
Last Reviewed:
January 29, 2018
Last Updated:
January 27, 2018