Sutent-Sunitnib

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

Uses For This Medication
  • Sunitinib is used to treat adults with gastrointestinal stromal tumors (GIST; rare stomach cancers) which have not responded to treatment with imatinib (Gleevec®), another chemotherapy medication, or who cannot tolerate treatment with imatinib.
  • Sunitinib is also used to treat adults with advanced kidney cancer.
  • Sunitinib is being studied for the treatment of other tumors, including prostate cancer, stomach cancer, and lung cancer.
  • This medication may also be given for other conditions as determined by your doctor.
  How This Medication Works Sunitinib works by blocking the action of several kinases, chemicals (enzymes) in the body that are involved in both tumor cell growth as well as tumor angiogenesis, the development of new blood vessels (i.e. tumor blood supply). In order for a cancer to grow and spread, it must be supplied with oxygen and nutrients by blood vessels. During tumor growth and progression, blood vessels from surrounding tissues develop and help to feed the tumor. Sunitinib works, in part, by blocking, or inhibiting, the development of these blood vessels, thus preventing oxygen and nutrients from reaching the tumor. Benefits Of This Medication For some patients with gastrointestinal stromal tumors (GIST) that have not responded to imatinib, sunitinib has been shown to slow down the growth of the tumor as well as lengthen how long some of these patients live. For some patients with kidney cancer which has not responded to other treatments, sunitinib may reduce the size of the tumor. The benefit of sunitinib in the treatment of other cancers is not yet known. Who Should Not Take This Medication You should not take this medication if you:
  • Are allergic to sunitinib or any of its components
  Precautions To Be Aware Of Before Taking This Medication

Blood related precautions

  • This medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend thatyour treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use Precautions (continued) aspirin, aspirin-containing medications, or aspirin-like medications (for example ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps and bruises. Do not floss your teeth if you have been told your platelets are low.
  • This medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands well and often with soap and water, and brush and floss your teeth daily.
  • Rarely, this medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
  • This medication may increase your risk of bleeding even if your platelet count is normal. In rare cases, the bleeding may be very serious or life threatening. If you experience any excessive bleeding (i.e. nose bleeds, bleeding of the gums, wound bleeding), have a history of bleeding, or are currently taking medication that thins your blood like warfarin (Coumadin®), heparin or lovenox, let your doctor or healthcare provider know. In addition, let your doctor or healthcare provider know if you vomit or cough up blood, or pass black tarry stools as this may be a sign of bleeding of the stomach or lungs.
  Gastrointestinal related precautions This medication may cause nausea, vomiting, and/or diarrhea which can lead to dehydration. Eat small frequent meals, bland foods (for example bananas, rice, apples, toast), and drink plenty of water and fluids that contain electrolytes (e.g. Gatorade, Pedialyte) to avoid dehydration. Contact your doctor or healthcare provider if you have moderate to severe nausea, vomiting or diarrhea. These side effects can be treated with medications.

Organ related precautions

  • This medication can cause heart problems, including a decrease in how well your heart pumps This medication should be used with caution in people with a history of heart attack, angina (or chest pain), heart bypass surgery, stroke, or blood clots in the lungs. Your doctor or healthcare provider will check your heart regularly while you are on this medication to make sure that your heart is working properly. If you have any problems with your heart before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
  •  This medication can cause changes in the ability of your liver and pancreas to work normally. Your doctor or healthcare provider will check your liver and pancreas regularly, usually through blood tests, while you are on this medication to make sure that your liver is working properly. If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects.
  Skin related precautions This medication can cause skin discoloration, including depigmentation (lightening of color) of both the hair and the skin. Other skin related side effects can include dryness, cracking of the skin, or blisters and rash on the palms of the hands and soles of the feet (e.g. hand-and-foot syndrome). This condition can cause the hands or soles of the feet to tingle, become numb, painful, swollen or red. Contact your doctor or healthcare provider if you experience new symptoms, if your symptoms become painful or worsen, or if you are unable to perform routine daily activities as a result of this condition. If you do develop this condition, you should try to protect your feet and hands. Prevent injuring them and avoid prolonged heat (for example taking hot baths) or pressure (for example wearing tight-fitting shoes). In addition, rubbing petroleum jelly (Vaseline or a similar type cream or ointment) on your hands and feet at bedtime and covering them with cotton gloves and/or socks may be helpful. Miscellaneous precautions
  • Rarely, this medication can cause changes in the adrenal and thyroid gland which can lead to a decrease in the natural hormones that your body makes. Symptoms of these hormone changes are nausea, loss of appetite, tiredness, dizziness, difficulty breathing, joint pain, muscle pain, depression, low blood sugar, and low blood pressure. Some patients may not experience any symptoms at all. Your doctor or healthcare provider will monitor you carefully while you are receiving sunitinib. In addition, let your doctor know if you develop any of the symptoms listed above.
  • This medication may increase your blood pressure. Most people usually don’t feel any different when their blood pressure is raised. However, severe increases in blood pressure can cause headache, visual disturbances, confusion, or sleepiness. Contact your doctor or healthcare provider if you have these symptoms. In addition, your doctor or healthcare provider should monitor your blood pressure regularly while you are on this medication.
  • Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
 

Patient specific precautions

  • It is not known if this medication is safe and effective in children.
  Pregnancy and Breastfeeding Precautions This medication may cause fetal harm. When taking this medication and for two weeks after stopping, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant. It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided. Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future. Medication and Food Interactions Before using this medication, tell your doctor or healthcare provider of all prescription or over-the- counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval. Possible interactions can occur with sunitinib and the following foods or medications:
  • Amiodarone (Cordarone®)
  • Aprepitant (Emend®)
  • Atazanavir (Reyataz®)
  • Carbamazepine
  • Clarithromycin (Biaxin®)
  • Dexamethasone
  • Erythromycin
  • Fluconazole (Diflucan®)
  • Grapefruit or grapefruit juice
  • Imatinib mesylate (Gleevec®)
  • Indinavir (Crixivan®)
  • Itraconazole (Sporanox®)
  • Ketoconazole (Nizoral®)
  • Nefazodone (Serzone®)
  • Nelfinavir (Viracept®)
  • Phenytoin (Dilantin®)
  • Phenobarbital
  • Rifampin (Rifadin®)
  • Rifabutin (Mycobutin®)
  • Rifapentin
  • Ritonavir (Norvir®)
  • Saquinavir
  • St.John’s wort
  • Telithromycin
  • Voriconazole (Vfend®)
  NOTE: This list may not include all medications that can have interactions with sunitinib. Side Effects
  • All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
  • You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
  • Side effects can occur when sunitinib is given alone or together with other chemotherapy medications.
The side effects listed below are those reported in patients who were treated with sunitinib alone. More common side effects
  • Skin discoloration (see Precautions To Be Aware Of Before Taking This Medication), rash
  • Fatigue
  • Diarrhea, nausea, vomiting, stomach upset
  • Constipation
  • Sores on the mouth or lips
  • Loss of appetite
  • Taste changes
  • Headache
  • Joint pains
  • Difficulty breathing
  • Bleeding (see Precautions To Be Aware Of Before Taking This Medication)
  • Increase in blood pressure (see Precautions To Be Aware Of Before Taking This Medication)
  Less common side effects
  • Decreased platelet, red blood cell, and/or white blood cell levels (see Precautions To Be Aware Of Before Taking This Medication)
  • Fever
  • Weakness
  • Stomach pain, sore throat
  • Swelling of the arms and/or legs
  • Hand-and-foot syndrome (see Precautions To Be Aware Of Before Taking This Medication)
  • Hair color changes (see Precautions To Be Aware Of Before Taking This Medication), hair loss
  • Dry skin
  • Muscle pain, back pain
  • Cough
  • Increase in enzymes produced by pancreas (see Precautions To Be Aware Of Before Taking This Medication)
  • Dehydration
  Rare side effects This is not a complete list of the rare side effects reported with sunitinib. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
  • Changes in electrolyte levels in the blood, including low potassium, low sodium and low phosphorus
  • Heart problems (see Precautions To Be Aware Of Before Taking This Medication)
  • Hypothyroidism (low thyroid activity)
  • Seizures
  • Blood clots in the legs or lungs
  • Changes in liver function tests (see Precautions To Be Aware Of Before Taking This Medication)
  How To Take This Medication
  • This medication is taken by mouth (orally) and is usually taken once a day with or without food. Take this medication exactly as directed by your doctor or healthcare provider. If you do not understand these instructions, ask your doctor or healthcare provider to explain them to you.
  • It is important that you only use this medication when it’s been prescribed for you. Sharing this medication with someone for whom it is not prescribed could cause harm.
  • If you accidentally take too many pills or someone else accidentally takes your medication, contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
  Proper Storage
  • Store this medication at room temperature.
  • Keep this medication out of the reach of children or pets.
  • Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.