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Below are vital information about Sutent – sunitinib which patients ought to know.

Use: For treatment of refractory unresectable and/or malignant gastrointestinal stromal tumors (GIST) and advanced kidney cancer (advanced renal cell carcinoma or mRCC).

Cost: RM 20,000 per cycle of treatment which last 4 weeks. Take 4 tablets per day. Rest for 2 weeks before starting a new cycle of 4 weeks.

Effectiveness

• Approval for kidney cancer was based on a review of the drug’s efficacy in reducing tumor size. Approval of the GIST was mainly based on studies showing that sunitinib delay tumor growth.
• Sutent shrank tumors in 26% to 37% of patients, according to the FDA. Studies have not yet shown that Sutent improves survival.
• Liz Szabo, USA TODAY Jan 26, 2006, wrote: Sutent doesn’t cure cancer, but experts say it is an important advance – both for patients and for science. Sutent is a product by Pfizer. Another drug used to treat advanced kidney cancer is Nexavar by Bayer.
• The median OS for patients receiving SUTENT was 26.4 months vs 21.8 months with IFNα (Note: IFN-α has been used extensively in the treatment of metastatic melanoma. Human IFN-α1 is a type I interferon. It is for research use only, not for diagnostic or therapeutic use)

Side effects 
The adverse events included:

• Tiredness, headache, weakness, dizziness
• Diarrhoea, nausea, vomiting, constipation
• Loss of appetite, weight loss
• Change in skin colour or hair colour
• Tingling or rash on palms of hands or soles of feet
• Hand –foot syndrome (Palmar-plantar erythrodysesthesia or PPE) –skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet.
• Rashes, dry skin, skin redness, scaly skin, itchy skin, blister
• Sore tongue, sore mouth, dry mouth
• Upset stomach, abdominal pain, wind, heart burn, indigestion
• Generalized aches and pains, muscle pain, joint pain, back pain, pain in fingers, arms or legs
• Very bad abdominal pain
• Tingling or numbness of hands or feet; pins and needles
• Increased tearing, watery eyes
• Shortness of breath
• Rash, flatulence, dehydration
• Hair loss
• Cough, Nose bleed
• Difficulty sleeping , depression
• Unusual urine colour
• Shortness of breath, wheezing or trouble breathing, chest pain
• Swelling of feet, legs or ankles , leg pain, face or eyelids
• Low potassium levels, increased bilirubin levels
• Flu-like symptoms (chills, fever, sore throat, swollen glands)
• High blood pressure (hypertension)
• Fits, Seizure
• Increased amylase and lipase levels

The most serious adverse events associated with Sutent therapy included

• pulmonary embolism
• thrombocytopenia
• bleeding from the tumor bleeding or bruising under the skin; coughing blood
• febrile neutropenia
• hypertension
• may harm an unborn baby (cause birth defects). Do not become pregnant. Do not breastfeed while taking SUTENT.
• may cause heart problems.
• may cause a hole in the stomach or bowel wall. This could cause symptoms such as painful, swollen abdomen, vomiting or coughing blood, and black, sticky s tools.

Recent research findings on Sutent

•  Researchers in Canada had reported that Sutent accelerated metastatic tumour growth and decreased overall survival in mice receiving short-term therapy (Cancer Cell 15: 232-239. March 2009).
• Using mouse model researchers in Spain and California, USA, also showed that Sutent promoted the incidence of highly invasive tumours. The incidence of liver micrometastases was significantly increased by 3.5-fold in treated animal (Cancer Cell 15:220-231. March 2009).