Sunitinib

You will be given sunitinib as capsules to take at home.

During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information. 

During treatment you will have regular blood samples taken. This is to check things such as: 

• the level of your blood cells 
• how well your liver and kidneys are working.

Sunitinib comes as capsules you can take at home. Take sunitinib with a glass of water at the same time each day. It can be taken with or without food, but do not take it with grapefruit or grapefruit juice. You usually take sunitinib for as long as it is controlling the cancer.

Always take your capsules exactly as your nurse or pharmacist explains. This is important to make sure they work as well as possible for you.

If you have kidney cancer or a GIST, you usually take sunitinib once a day for 4 weeks, followed by 2 weeks without the drug (rest period). This makes up a cycle of treatment that lasts for 6 weeks.

If you have a pancreatic neuroendocrine tumour (pancreatic NET), you usually take sunitinib once a day every day, with no days off.

If you forget to take the capsules you should take the missed dose as soon as possible within the same day. If a full day has gone by, let your doctor or nurse know. Do not take a double dose.

Other things to remember about your capsules:

• Keep them in the original package and at room temperature, away from heat and direct sunlight.
• Keep them safe and out of sight and reach of children.
• If you are going on holiday, make sure you have plenty of capsules to take with you.
• If you are sick just after taking the capsules, contact the hospital. Do not take another dose. 
• If your treatment is stopped, return any unused capsules to the pharmacist.

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is called neutropenia.

An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

• a temperature above 37.5°C 
• a temperature below 36°C
• you feel unwell, even with a normal temperature
• you have symptoms of an infection.

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.

If the number of platelets is low, you may bruise or bleed easily. You may have:

• nosebleeds
• bleeding gums
• heavy periods
• blood in your urine (pee) or stools (poo)
• tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. You may need a drip to give you extra platelets. This is called a platelet transfusion.

This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may feel:

• very low in energy
• breathless 
• dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

You may feel sick with this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started. 

If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Some people have indigestion or acid reflux (acid coming up from the stomach into the gullet) when taking sunitinib. Tell your doctor if you have this as they can prescribe treatment to help.

If you get a severe pain in your tummy (abdomen), feel sick or are being sick, contact the hospital for advice.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• your mouth or throat is sore, or affecting how much fluid you can drink or food you can eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

• sucking sugar-free sour or boiled sweets
• eating cold foods
• eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

This is called palmar-plantar or hand-foot syndrome. It usually gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve any symptoms you may have. It can help to:

• keep your hands and feet cool
• moisturise regularly
• avoid tight-fitting socks, shoes and gloves.

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

The medicine in sunitinib is yellow and it may make your skin look yellow. Your skin may also become lighter in colour. Some people get a rash, or notice skin redness, dryness or itching. Tell your doctor or nurse if your skin is affected. They may give you treatments to help, such as creams for your skin.

Very rarely, people may have a severe skin reaction. The symptoms can include large blisters, peeling skin or sores in your mouth. You may also have a fever (high temperature). If this happens, contact the hospital straight away or go to your nearest emergency department (A&E).

Your hair may become lighter in colour. Sometimes hair becomes thinner during treatment.

Sunitinib may cause dizziness. Tell your doctor or nurse if this is a problem. Do not drive or operate machinery if you have dizziness.

This treatment may cause high blood pressure (hypertension). You will have your blood pressure checked regularly. Some people may need to take tablets to control their blood pressure. Sometimes, if your blood pressure is too high and cannot be controlled, this treatment may be stopped permanently.

If you are already on treatment for your blood pressure, you will have regular blood pressure checks to make sure it stays under control. Talk to your doctor if you have any concerns.

This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:

• are gaining weight 
• have swelling in your face, legs or ankles.

They can give you advice and treatment to help.

Sunitinib can affect the thyroid gland. You will have regular blood tests to check how well your thyroid is working during treatment. Possible symptoms of thyroid changes include:

• tiredness
• feeling depressed
• difficulty concentrating
• weight gain
• constipation
• feeling cold
• dry skin
• dry hair.

Tell your doctor if you notice any of these symptoms.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

You may feel breathless or develop a cough. Contact your doctor for advice if you develop these symptoms.

Some people have back pain or joint pain while having treatment. Less commonly, sunitinib can cause muscle pain or cramps. Your doctor can prescribe painkillers to help with pain.

Some people find it difficult to sleep when taking sunitinib. Tell your doctor if you are having difficulty sleeping.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax^®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.