Sunitinib (Sutent)

Sunitinib (pronounced sue-nit-i-nib) is a targeted cancer drug. It is a treatment for:

• kidney cancer that has spread to other parts of the body (advanced or metastatic)

• a rare type of sarcoma called gastrointestinal stromal tumour (GIST)

• neuroendocrine tumours of the pancreas

How does sunitinib work?

Sunitinib is a type of targeted drug called a protein kinase inhibitor. Protein kinase is a type of chemical messenger (an enzyme) that plays a part in the growth of cancer cells. Sunitinib blocks the protein kinase. It can stop the growth of a tumour or shrink it down.

How do you take sunitinib?

Sunitinib comes as capsules that you swallow whole, once a day. You can take them with or without food.

Taking capsules

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you take sunitinib?

For kidney cancer and GIST

You might take sunitinib once a day for 4 weeks. You then have a 2 week break, when you don’t take the capsules. This 6 week period is called a cycle of treatment . After 6 weeks, you start a new cycle of treatment.

Some people might have their cycle over 3 weeks instead. This means they take sunitinib daily for 2 weeks followed by a week with no treatment. You then start a new cycle of treatment.

Or they might have sunitinib at a lower amount (dose) with no breaks.

You continue this treatment for as long as it’s working and the side effects aren't too bad.

For pancreatic neuroendocrine tumours

You usually take sunitinib once a day, without any breaks. This continues for as long as the treatment is working and the side effects aren't too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of sunitinib?

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects
• your side effects aren’t getting any better
• your side effects are getting worse

Early treatment can help manage side effects better.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

Each of these effects happens in more than 1 in 10 people (more than 10%). You might have one or more of them. They include:

Breathlessness

You might be

breathless and look pale

Causes of breathlessness that are much less common include:

• changes to the lungs and how well they work
• shortness of breath when exercising

Cough

You may get a cough while you are having treatment.

Bruising and bleeding

This is due to a

drop in the number of platelets in your blood

Sunitinib might also cause bleeding in other parts of the body for different reasons. This is much less common. Contact your healthcare team if you have any abnormal bleeding.

Changes to the levels of thyroid hormones

The level of your thyroid hormones may drop (hypothyroidism). You may feel tired or cold, gain weight, feel sad or depressed, or your voice may deepen.

Less common is an increase of thyroid hormones (hyperthyroidism). This can cause weight loss, a fast heartbeat and anxiety.

You will have regular blood tests to check your thyroid hormone levels.

Loss of appetite

You might

lose your appetite

Difficulty sleeping

If you have difficulty sleeping, it can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Dizziness

This drug might make you feel dizzy. You might also feel dizzy when standing or moving around. Or it might feel like the world is spinning.

Don’t drive or operate machinery if you have this.

Taste changes

Taste changes

Blood pressure changes

Tell your doctor or nurse if you are having treatment for high blood pressure, or if you have headaches, nosebleeds, blurred or double vision or shortness of breath.

Sunitinib can also cause low blood pressure but this much less common. Tell your doctor if you have dizzy spells, feel sick, have problems concentrating or fainting spells.

You have regular blood pressure checks before and during treatment.

Feeling or being sick

Feeling or being sick

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea

Contact your advice line if you have

diarrhoea

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Constipation

Constipation

Indigestion

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Mouth sores and ulcers

Mouth sores and ulcers

Skin changes

Skin problems

Rarely sunitinib can cause a severe skin reaction. This may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.

Let your doctor, nurse or pharmacist know if there are any skin changes. They can let you know what can help to ease the discomfort.

Soreness, redness, peeling on palms or soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

It is advised you should avoid hot water and to wear gloves when performing housework.

You should moisturise your hands and feet regularly whilst on sunitinib. Your team will tell you what moisturiser to use.

Hair changes

Your hair colour might change. For some people, the hair may become grey while having this treatment.

You could lose your hair. But this is less common.

Pain in different parts of your body

You might have pain in your arms, legs, back, tummy (abdomen) and joints. You might also have pain in other parts of the body such as the tongue, muscles, in the back passage (rectum) and around the anus, but this is less common.

Let your doctor or nurse know if you have pain anywhere during or after having treatment. There are lots of ways to treat pain, including relaxation and painkillers.

Tiredness (fatigue)

Tiredness and weakness (fatigue)

Fluid build up in different parts of the body (oedema)

You may have swelling of your face, hands, feet, tummy (abdomen) and around the eyes due to a build up of fluid (oedema).

Less common are:

• a build up of fluid in the lining of the lungs (pleural effusion)
• fluid around the heart

High temperature (fever)

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Inflammation of the bowel

Inflammation of the bowel can cause abdominal pain, bloating or diarrhoea. Speak to your doctor if you have these symptoms.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• heart problems that can cause chest pain, a fast heart beat and shortness of breath

• Increased risk of getting an infection

  is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
• blood clots that can be life threatening signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• a serious reaction to an infection - signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
• unusual feelings (sensations)– such as numbness, tingling, pricking, burning, a creeping skin feeling, or reduced sense of touch
• watery eyes
• piles (haemorrhoids) and pain around the anus
• your kidneys may stop working – symptoms might include not passing enough urine, breathlessness, feeling tired and weak, confused, feeling sick, and you might have swelling of your legs, ankles and feet. This can happen suddenly (acute) or over a long time (chronic).
• depression
• loss of fluid in your body (dehydration)
• low blood sugar levels (hypoglycaemia), symptoms include feeling tired, hungry, thirsty, dizzy, tingling lips, shaking and trembling, fast heartbeat, mood changes such as being tearful, anxious and been easily irritated
• numbness and tingling in fingers and toes
• difficulty swallowing
• burping
• dry mouth
• nail problems such as changes in colour. This can be brown or black lines under the nails.
• weight loss
• hot flushes and sweats
• high levels of uric acid, creatinine and amylase
• high levels of protein in your urine and changes in urine colour that can last for a couple of days
• blocked and dry nose
• swelling, sore (inflamed) lips and the food pipe, which can make eating and drinking painful
• flu-like symptoms such as chills, fever, aching, headaches, sore throat, runny nose, tiredness, feeling or being sick and diarrhoea
• muscle spasms and weakness
• problems with your liver and changes in the levels of liver enzymes, much less common is inflammation of the liver which can cause pain on the right side

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening, alert your nurse or doctor if you notice any of these symptoms
• changes to the blood supply to the brain which can lead to a stroke, symptoms are weakness down one side, slurring of speech and not responding
• a hole in the bowel
• inflammation of the pancreas
• blood in the urine
• slow wound healing

• damage to the jaw bone

  which can cause pain in the mouth, teeth and jaw
• a channel (fistula) between two areas of the body
• inflammation of the gallbladder
• posterior reversible encephalopathy syndrome (PRES) - a rare disorder of the nerves causing headache, fits, confusion and changes in vision - contact your healthteam straight away. This condition is reversible.
• tumour lysis syndrome - changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.

Pregnancy and contraception

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Let your team know straight away if you or your partner falls pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.