Sunitinib (pronounced sue-nit-i-nib) is a targeted cancer drug and is also known by its brand name Sutent. It is a possible treatment for:
- advanced kidney cancer
- a rare type of sarcoma called gastrointestinal stromal tumour (GIST)
- pancreatic neuroendocrine tumours
How sunitinib works
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 you have sunitinib
Sunitinib comes as capsules that you swallow whole, once a day. You can take them with or without food.
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
When you have sunitinib
For kidney cancer and GIST
You usually 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. This continues for as long as the treatment is 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.
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.
We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.
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. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely 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.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:
Risk of infection
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.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Low 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. You will have regular blood tests to check your thyroid hormone levels.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
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 and dizziness
Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.
High blood pressure
Tell your doctor or nurse if you are having treatment for high blood pressure, or if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
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 treating it once it has started.
Diarrhoea or constipation
Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help.
Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Mouth sores and ulcers
Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.
Skin problems include a skin rash, dry skin and changes to your skin colour. This usually goes back to normal when your treatment finishes.
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.
Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.
Hair colour changes
Your hair colour might change. For some people, the hair may become grey while having this treatment.
Pain in different parts of your body
You might have pain in your arms and legs, back, muscles and joints. 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 and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Swelling in the face, hands and feet
You may have swelling of your face, hands and feet due to a build up of fluid (oedema).
High temperature (fever)
If you get a high temperature, let your health care 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
Each of these effects happens in more than 1 in 100 people (1%). 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
- a blood clot in one of the lung arteries (pulmonary embolism) which can cause difficulty breathing and can be life threatening
- eye problems such as watery eyes and swelling around the eyes
- piles (haemorrhoids) which can cause pain when you open your bowels
- a severe infection called sepsis which can be life threatening
- build up of fluid in the lining of the lungs (pleural effusion)
- loss of fluid in your body (dehydration)
- low blood sugar levels (hypoglycaemia)
- numbness and tingling in fingers and toes
- hair loss
- difficulty swallowing
- heartburn and burping
- bleeding in your gut
- dry mouth
- nail problems such as changes in colour
- weight loss
- hot flushes and sweats
- high levels of minerals in your body, such as 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
- coughing up blood
- inflammation of your lips and the food pipe
- flu like symptoms such as chills
- muscle spasms and weakness
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:
- red, sore and infected skin
- an allergic reaction
- high levels of thyroid hormones (hyperthyroidism)
- changes to the blood supply to the brain which can lead to a stroke
- bleeding in the brain, lungs and tumour site
- fluid around the heart and a heart attack which can be life threatening
- a hole in the bowel
- problems with your liver such as inflammation and changes in the levels of liver enzymes
- 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
- a severe skin reaction that 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
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 father a child 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
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
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 the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
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.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. 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 go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.