Sunitinib (Sutent®)

Sunitinib (Sutent®) is a targeted therapy drug. It is used to treat kidney cancer, gastrointestinal stromal tumours (GISTs) and pancreatic neuroendocrine tumours (PNETs).

What is sunitinib (Sutent®)?

Sunitinib (Sutent®) belongs to a group of targeted therapy drugs called cancer growth inhibitors. They block certain signals and stop the cancer cells growing. Sunitinib is also an angiogenesis inhibitor. This means it stops cancer cells from developing new blood vessels which helps shrink the tumour or slows its growth.

It is best to read the information about this drug with our general information about targeted therapy drugs and the type of cancer you have.

Sunitinib is used to treat: 

Your cancer doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How sunitinib is given

You take sunitinib as capsules by mouth (orally). You will be given the capsules to take at home. 

During treatment, you usually see a: 

  • cancer doctor 
  • cancer nurse or specialist nurse 
  • 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. 

You will speak to a doctor, nurse or pharmacist before you have treatment. They will ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your targeted therapy.

Taking sunitinib capsules

Take sunitinib with a glass of water at the same time each day. You can take it 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 and any side effects can be managed. 

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 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.

Your course of treatment

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 1 cycle of treatment that lasts for 6 weeks. 

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

About side effects

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects 
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Serious and life-threatening side effects

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Common side effects

Risk of infection

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.

Bruising and bleeding

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.

Anaemia (low number of red blood cells)

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

Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it ends. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired. 

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

Constipation

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. 

Diarrhoea

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.

Feeling sick

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

Indigestion

When taking sunitinib, some people have indigestion or acid reflux (acid coming up from the stomach into the gullet). Tell your doctor if you have this. They can prescribe treatment to help.

Tummy pain

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

Loss of appetite

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.

Sore mouth and throat

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:

  • a sore mouth or throat affects how much you can drink or 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.

Changes to your taste

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.

High blood pressure

Sunitinib can cause high blood pressure in some people. You will have your blood pressure checked regularly. Or you may be given a blood pressure monitor so you can check it at home. You will be shown how to do this.

Some people may need to take medicine to control their blood pressure. Occasionally, if blood pressure is very high and cannot be controlled, sunitinib may be stopped permanently. 

If you already have high blood pressure and are having treatment to control it, you will have regular blood pressure checks. Talk to your doctor if you have any concerns.

Hand-foot (palmar-plantar) syndrome

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

  • be sore
  • be painful, tingle, or swell
  • peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

  • keeping your hands and feet cool by washing in cool water
  • gently moisturising your hands and feet regularly
  • wearing gloves to protect your hands and nails when working in the house or garden
  • wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Numb or tingling hands or feet (peripheral neuropathy)

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.

Skin and nail changes

The medicine in sunitinib is yellow and it may make your skin and nails look yellow. You may develop a rash, redness, dryness or itching. These side effects are usually mild. Your doctor, nurse or pharmacist can advise you about creams or lotions to use, or prescribe medicines to relieve itching.

This treatment can also slightly increase your risk of some types of skin cancer. Always tell your doctor or nurse straight away if you notice any skin changes. If you are out in the sun, use a sun cream with a sun protection factor (SPF) of at least 30 to protect your skin.

Rarely, a much more serious skin condition can develop. You may have a skin rash which then blisters, and your skin can peel. You may also feel unwell with flu-like symptoms such as a high temperature and joint pain. If you have any of these symptoms, contact your doctor or hospital immediately.

Effects on hair

Your hair may become lighter in colour. Sometimes hair becomes thinner during treatment. This will usually go back to normal after you finish treatment. 

Feeling dizzy

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

Fluid build-up

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.

Thyroid changes

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.

Headaches

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.

Effects on the lungs

This treatment can cause changes to the lungs. Tell your doctor if you develop:

  • a cough
  • wheezing
  • breathlessness.

You should also tell them if any existing breathing problems get worse.

Back pain or joint and muscle 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.

Problems sleeping

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

Less common side effects

Effects on the heart

This treatment can affect how the heart works. You may have tests to check how well your heart is working. These may be done before, during and after treatment.

If the treatment is causing heart problems, your doctor may change the type of treatment you are having.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • breathlessness
  • dizziness
  • changes to your heartbeat
  • swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

  • chest pain, pressure, heaviness, tightness or squeezing across the chest
  • difficulty breathing.

Effects on the brain

Rarely, this treatment causes a brain condition that can be serious. You can make a full recovery from this. But it must be diagnosed and treated quickly.

This condition can cause:

  • a headache that does not get better
  • drowsiness or confusion
  • changes in eyesight
  • fits (seizures).

If you have any of these symptoms, it is important to either:

  • contact the hospital straight away on the 24-hour number 
  • go to the hospital straight away. 

You should not drive yourself to hospital.

Effects on the kidneys

This treatment can affect how the kidneys work. This is usually mild and goes back to normal after treatment ends. You will have blood tests and may have a urine sample test to check how well your kidneys are working

Drinking fluids helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Contact the hospital on the 24-hour number if you: 

  • have blood in your urine (pee) 
  • have foamy, frothy or bubbly urine
  • are passing less urine or peeing less often than usual.

Effects on the liver

This treatment can affect how your liver works. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your liver is working.

Changes to your kidneys may cause discoloured urine.

Blood clot risk

Sunitinib may cause a blood clot. Symptoms of a blood clot include: 

  • throbbing pain, redness or swelling in a leg or arm 
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker 
  • suddenly feeling breathless or coughing 
  • sharp chest pain, which may be worse when you cough or take a deep breath.  

If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111. 

A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.  
You can help reduce the risk of developing a blood clot by: 

  • staying active during treatment  
  • drinking plenty of fluids, especially water.  

You may be given anticoagulants to help prevent a clot. 

Jaw problems (osteonecrosis)

Rarely, sunitinib may cause healthy bone tissue in the jaw to become damaged and die. This is called osteonecrosis of the jaw. It is more likely to affect people who have recently had treatment with a drug used to strengthen the bones (bisphosphonates).

Dental problems can increase the risk of osteonecrosis. Before you start sunitinib, your doctor may advise you to have a dental check-up. It is important to look after your teeth and have regular dental check-ups. Always tell your dentist that you are taking sunitinib. 

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 doctor and dentist straight away if you have any of these symptoms.

Tumour lysis syndrome (TLS)

Some people are at risk of developing a condition called tumour lysis syndrome (TLS) during this treatment. When treatment makes large numbers of cancer cells die and break down quickly, they release lots of waste products into the blood. This can affect how well the kidneys work. It may also cause problems with the heart rhythm.

TLS can be prevented. You will have regular blood tests to check for TLS. If you are at risk of TLS, you may have:

  • extra fluids through a drip
  • medicines such as rasburicase through a drip, or allopurinol as tablets.

Drinking at least 2 litres (3½ pints) of fluid a day will also help.

Slow wound healing

Wounds may take longer to heal while you are taking sunitinib. If you are having surgery or teeth removed, you may have to stop taking sunitinib before it and for a few weeks afterwards. Your doctor will give you more advice.

Lower blood sugar levels

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. You may be referred to a dietitian for advice.

Other information

Other medicines

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: 

Vaccinations

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.

Fertility

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.

Contraception

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. 

Breastfeeding

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.

Medical and dental treatment

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.

About our information

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.

Date reviewed

Reviewed: 01 April 2024
|
Next review: 01 April 2026
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Trusted Information Creator - Patient Information Forum

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