Sunitinib

Brand name: Sutent®  

Generic name: Sunitinib 

Other names: SU11248 

Therapeutic Class: multikinase inhibitor (receptor protein-tyrosine kinase inhibitor)  

Manufacturer / Distributor:  Pfizer  

Availability: Sutent is available by prescription only  

FDA Approval: In January 2006, Sutent (Sunitinib) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced renal cell carcinoma (RCC) and gastrointestinal stromal tumors (GIST).  

Indications : Sunitinib is mainly used to treat: 

• kidney cancer that has spread to other parts of the body; 
• Gastrointestinal stromal tumors [rare forms of gastrointestinal (GI) tract cancers] in patients who cannot be or were treated unsuccessfully with imatinib (Gleevec).  

In addition to these conditions above, Sunitinib can be used to treat other medical conditions not mentioned in the article; ask your doctor or pharmacist for more information. 

Dosage form: Sunitinib is available in capsule form to be taken by mouth 

Dosage: usually, Sunitinib is prescribed by an oncologist or physician that has experience in chemotherapy drugs. Basing on your condition, age and body surface area (BSA), your physician will determine the most effective dosage to combat the disease. Take the medication exactly as directed by your doctor, pharmacist or according to the directions on the prescription. Misusing Sunitinib may not only affect its curative effect but also cause serious health problems.   

Usually, the recommended dose is 50 mg, taken by mouth once daily for 4 weeks; each dosing cycle is followed by a 2-week break. Sunitinib can be taken with or without food; however, it is recommended to take it around the same time every day. Do not open, chew or crush the capsules; swallow each capsule whole. If you experience adverse effects, do not change or stop taking the medication without first consulting your doctor.   

Storage:  keep Sunitinib tightly closed in the container it came, out of the reach of children. Store it at room temperature, away from heat, light and moisture. Sunitinib and all other medications should not be used beyond the expiration date printed on the container.   

Overdose:  chemotherapy drugs are strong; overdosing any of them can be fatal. The risk is even higher when the drug is overdosed for a long period of time. In fact, overdosing of certain chemotherapy drugs, including Sunitinib, can lead to death. Even in the absence of overdose, Sunitinib tend to affect the bone marrow, and lead to decreased blood cells count.  It is extremely important that you take Sunitinib as indicated by your physician or pharmacist; don’t ever take more.  

Missing dose: do your best to take the drug around the same time every day; do not miss or take less of it. In case you forget to take a dose, take the missed one as soon as you remember it. However, if it is almost time for your next dose, do not double the next dose to recover the missed one; it can be dangerous. Contact your doctor or wait to go back to your regular schedule.    

Contraindication: Sunitinib is contraindicated or should be used with precaution in the following conditions: 

• allergic to Sunitinib or one of its components 
• children  
• pregnancy  
• breast-feeding  
• history of heart failure 
• angina 
• coronary insufficiency  
• port of vascular clip 
• history of heart failure  or stroke  
• Pulmonary embolism.   

Mechanism of action (MOA): Sunitinib is an inhibitor of tyrosine kinase; it acts by blocking the action of tyrosine kinases, abnormal protein that signals cancer cells to multiply.  

Interactions: if you are taking Sunitinib, it is not safe to eat or take grapefruit, aspirin, vitamins, nutritional supplements, or St. John's wort without first contacting your doctor. Some substances may interact with Sunitinib, and increase the risk of side effects; tell your doctor or pharmacist if you are taking any of the following drugs:  

• clarithromycin (Biaxin)                               erythromycin (E-Mycin, Erythrocin) 
• moxifloxacin (Avelox)                                rifampin (Rifadin, Rimactane) 
• rifabutin (Mycobutin)                                rifapentine (Priftin) 
• telithromycin (Ketek)                                warfarin (Coumadin)
• itraconazole (Sporanox)                             ketoconazole (Nizoral) 
• voriconazole (Vfend)                                 bevacizumab (Avastin) 
• diltiazem (Cardizem, Dilacor, Tiazac...)         verapamil (Calan, Isoptin, Verelan) 
• cimetidine (Tagamet)                                cisapride (Propulsid) 
• dexamethasone (Mymethasone)                  fluvoxamine  
• nefazodone                                             atazanavir (Reyataz) 
• indinavir (Crixivan)                                    nelfinavir (Viracept) 
• ritonavir (Norvir)                                       saquinavir (Invirase) 
• amiodarone (Cordarone)                             disopyramide (Norpace) 
• dofetilide (Tikosyn)                                   procainamide (Procanbid, Pronestyl) 
• quinidine (Quinidex)                                   sotalol (Betapace, Betapace AF) 
• carbamazepine (Carbatrol, Equetro...)           phenobarbital 
• phenytoin (Dilantin, Phenytek)                     pimozide (Orap) 
• thioridazine (Mellaril).   

Side effects: In addition to attacking cancer cells, Sunitinib also interfere with certain normal cells, leading to the development of number of adverse effects. Most common Sunitinib side effects include: 

• weight loss
• hair loss 
• tiredness
• weakness 
• diarrhea 
• constipation
• nausea and vomiting 
• gas and/or heartburn 
• sores on your lips or mouth  
• dry mouth 
• change in taste 
• decreased appetite 
• slow speech 
• depression 
• skin rash 
• muscle or limb pain 
• Pain, burning, numbness, or tingling in the hands or feet.  

If the side effects above persist for weeks, contact your oncologist. In addition, contact your doctor if you experience any of these symptoms: 

• signs of infection: fever, sore throat, chills, etc.
• rapid, irregular, or pounding heartbeat 
• unusual bruising or bleeding 
• black and tarry stools 
• blood in stools or/and urine 
• bloody vomit 
• chest pain 
• sudden weight gain 
• stomach pain or swelling 
• swelling of your feet or ankles 
• swelling, tenderness, warmth, or redness of a leg 
• shortness of breath or difficulty breathing  
• difficulty falling asleep or staying asleep 
• Coughing up bloody mucus.