Sunitinib (Sutent®) is a targeted therapy drug used to treat kidney cancer, gastrointestinal stromal tumours (GISTs) and pancreatic neuroendocrine tumours (PNETs).
Sunitinib (Sutent®) is a targeted therapy drug used to treat a type of kidney cancer called renal cell carcinoma. It is also used to treat gastrointestinal stromal tumours (GISTs) and pancreatic neuroendocrine tumours (PNETs)). It is best to read this information with our general information about the type of cancer you have.
Sunitinib belongs to a group of targeted therapy drugs known as cancer growth inhibitors.
Sunitinib can also stop cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, so the tumour shrinks or stops growing.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
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 will 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 will usually take sunitinib once a day, continuously, with no days off treatment.
There are some important things to remember when taking your tablets:
- If you forget to take your tablets, take them as soon as you remember. If it’s nearly time for your next dose, forget about the one you missed and carry on as normal. Do not take a double dose.
- Keep tablets in the original package and at room temperature, away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- Get a new prescription before you run out of tablets.
- If you are going on holiday, make sure you have plenty of capsules to take with you.
- If your treatment is stopped, return any unused tablets to the pharmacist.
- If you’re sick just after taking the tablets, tell your doctor. You may need to take another dose. Do not take another dose without telling your doctor, nurse or pharmacist first.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
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 called neutropenia.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have 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.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
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 reduce or delay your treatment for a short time.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
This treatment can cause constipation. 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.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth 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.
Changes to your taste
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.
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.
Changes to your hands and feet
You may develop redness on the palms of your hands and soles of your feet. Sometimes the hands and feet become sore or swollen. Tell your doctor if your hands or feet are affected. They may give you creams that can help. Keep your hands and feet cool, and avoid hot water and tight shoes. Wear gloves to protect your hands when doing housework or gardening.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects 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.
Effects on skin
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). Contact the hospital straight away if this happens or go to your nearest accident and emergency department.
Effects on hair
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.
High blood pressure
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 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.
Build-up of fluid
Some people develop swelling in their arms, legs or around the eyes, because of fluid build-up. Tell your doctor if you notice this. They may prescribe drugs that make you pass more urine (diuretics) to help get rid of some of the fluid.
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:
- feeling depressed
- difficulty concentrating
- weight gain
- feeling cold
- dry skin
- dry hair.
Tell your doctor if you notice any of these symptoms.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Cough or breathlessness
You may feel breathless or develop a cough. Contact your doctor for advice if you develop these symptoms.
Back pain or joint pain
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.
Sunitinib may cause heart changes. These are usually mild and go back to normal when treatment stops. Tell your doctor if you have had heart problems in the past. And contact your doctor straight away if you have any of the following:
- pain or tightness in your chest
- changes in your heartbeat
- swelling in your feet and ankles
These symptoms can be caused by other conditions, but it is important to get your doctor to check them.
Changes in the way the kidneys and liver work
This drug can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before starting sunitinib to check how well your kidneys and liver are working. Changes to your kidneys may cause discoloured urine.
This treatment can increase the chances of a blood clot. A clot can cause:
- pain, redness and swelling in a leg or arm
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Jaw problems (osteonecrosis)
This is a rare side effect. Healthy bone tissue in the jaw can become damaged and die. This is called osteonecrosis of the jaw. It can affect people who have recently had treatment with a type of drug used to strengthen the bones (bisphosphonates).
Gum disease, problems with your dentures and some dental treatments, such as having a tooth removed, can increase the risk of osteonecrosis. So before you start taking sunitinib, you may be advised to have a full dental check-up.
It’s important to look after your teeth during treatment by brushing them regularly and having routine dental check-ups. Always tell your dentist that you’re taking sunitinib.
Some of the symptoms of osteonecrosis of the jaw can include:
- pain, swelling or redness of the gums
- loose teeth
- a feeling of numbness or heaviness in your jaw.
Tell your cancer specialist and dentist straight away if you have any of these symptoms.
Tumour lysis syndrome (TLS)
Rarely, sunitinib may cause the cancer cells to break down very quickly and release uric acid (a waste product) into the blood. The kidneys can usually remove uric acid but may not be able to cope with large amounts. This can cause chemical imbalances in the blood that affect the kidneys and the heart. Doctors call this tumour lysis syndrome (TLS).
People who have a higher risk of TLS may be given drugs to help prevent or reduce this problem. A tablet called allopurinol or a drug called rasburicase (given through a drip), may be given when they start treatment.
If you are going to have an operation
Wounds may take longer to heal while you’re having treatment with sunitinib. You may need to stop taking sunitinib before the operation and not start taking it again for a few weeks afterwards. Your doctor will give you more advice.
If you have diabetes
Sunitinib may lower blood sugar levels. If you have diabetes, you may need to check your blood sugar levels more often. Your doctor will talk to you about how to manage this and you may be referred to a dietitian for some advice.
It’s important to tell your doctor straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Food and medicines
You should avoid grapefruit, grapefruit juice and the herbal remedy St John’s Wort during treatment with sunitinib. This is because they can make it less effective. Some other medicines, including those that you can buy in a shop or chemist, can be harmful to take when you’re having sunitinib. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, supplements, complementary therapies and herbal drugs.
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.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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.