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 the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes 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. Contact the hospital straight away on the 24-hour contact number you have been given if:

• your temperature goes over 37.5°C (99.5°F)
• you suddenly feel unwell, even with a normal temperature
• you have symptoms of an infection
• your temperature goes below 36°C (96.8°F).

Symptoms of an infection include:

• feeling shivery and shaking
• a sore throat
• a cough
• breathlessness
• diarrhoea
• needing to pass urine (pee) a lot, 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 needed, your doctor may reduce or delay your treatment for a short time, until your cell count increases.

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 or purple spots on the skin that may look like a rash.

Tell your doctor if you have any unexplained bruising or bleeding. 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 have symptoms such as:

• pale skin
• lack of energy
• feeling breathless
• feeling dizzy and light-headed.

Tell your doctor or nurse if you have these symptoms.

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. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.

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

If you have diarrhoea:

• try to drink at least 2 litres (3½ pints) of fluids each day
• avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
• contact the hospital for advice.

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 for advice. Your doctor can give you drugs called laxatives to help.

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 a day or 2. But if your appetite does not come back after a few days, or if you are losing weight, tell your nurse or dietitian. 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.

If your mouth or throat is sore:

• tell your nurse or doctor – they can give you a mouthwash or medicines to help
• try to drink plenty of fluids
• avoid alcohol, tobacco, and foods that irritate your mouth and throat.

Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.

You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.

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, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.

Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes. But for some people they may never go away. Talk to your doctor if you are worried about this.

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.

You may gain weight, or your face, ankles and legs may swell. This improves slowly after your treatment has finished. Your doctor may give you drugs to help reduce the swelling.

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. They may give you painkillers to help.

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 when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:

• medicines you have been prescribed
• medicines you buy in a shop or chemist
• vitamins, herbal drugs and complementary therapies.

Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.

You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.

Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.

Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus (covid) vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations. 

If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.

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 will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.

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

Your doctor or nurse can give you more information.

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.

If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.