Kidney Cancer Part 2: Two Oncologists Two Different Opinions – Is Sutent indicated in this case?

LC underwent an operation to remove his right kidney.

Histopathology report dated 19 August 2011 indicated, “Right radical nephrectomy specimen and paracortical node:

  1. Papillary renal cell carcinoma, Stage 3 (pT1b,pN1,pMx).
  2. Paracortical lymph node with tumour metastasis.
  3. The resection margins of ureter and renal vessels are free of tumour.

LC and his family came to CA Care again on 11 September 2011. The following are excerpts of our conversation that evening.

 

 

Sister-in-law:  After the operation, he was referred to the oncologist of the hospital.  So they went to see the oncologist and later went to seek a second opinion of another oncologist.

Chris: What did the first oncologist say?

Wife:  He said, you need to take medication to prevent the cancer from spreading. He needs to take the oral drug, Sutent.

C: How long does he need to take the Sutent?

W: For six months.

C: How much that cost you per month?

W: Approximately RM 13,000 to RM 15,000 – not sure yet.

C: What do you expect to get after taking the drug?

W: The doctor said to control the cancer.

C: Then you went to see another oncologist – what did he say?

W: The second oncologist said there is no need to take any medication. What you need to do is to take care of your body and health. Your diet is also important. Your mind must be relaxed and do not be afraid. Open up your mind. There is no medication to take.

C: Is this person an oncologist?

W: Yes, cancer doctor – an oncologist.

C:Is he really an oncologist?

SIL: He is a new chap. I think he is a new oncologist of the hospital.

W: He is about in his forties.

C: Oh, he will find it hard to earn a living then.

W: He is a very nice person. He advised us to be open minded. You need to have a fighting spirit. You should not be afraid.

C: When you come here, I also tell you the same thing. Did the second oncologist tell you to eat right?

W: Yes, we need to take care of the diet. Don’t eat too much meat.

C: And he told you not to take the oral drug (Sutent)?

W: Yes, yes. And then if you want to take Chinese herbs, it is alright. You can take Chinese herbs.

C: He never gets angry about you taking herbs?

W: No.

C: Oh, so he said you can take Chinese herbs?

W: Yes, since you have no medication to take, and if you believe in the herbalist, go ahead and take his herbs.

C: Did you tell him you wanted to take herbs? And he did not get angry with you?

W: No, the second oncologist agreed with us. But the first oncologist said we cannot take Chinese herbs. But the second oncologist said it is okay to take herbs. But don’t get cheated. If the herbs are not too expensive, go ahead and take them if we have confidence in the herbalist.

C: So, all in all, the second oncologist asked you to take care of yourself, don’t think too much and if you want to take herbs it is okay.

W: He also said we need to exercise.

C: Very good. This oncologist is really a great guy!

SIL: Very good.

Comments

I cannot believe what I have heard! Twice, I asked if the second doctor that they consulted was indeed an oncologist! We salute you doc., for being so open-minded.

Place yourself in LC’s situation. After the operation, he faced a real dilemma. Two different cancer experts provided two divergent opinions. What to do now?  The family came to CA Care for help. Let us get this straight. It is not for us to make decisions for the patient.  Patients need to make their own decisions – because it is you, and you alone, who will have to bear the consequences of that decision.

If you are faced with such a dilemma, we suggest that you ask the following questions and then seek out the answers for yourself. Based on what you learn, make your decision that makes sense to you.

Question 1 to ask yourself:  What is Sutent? What is it used for? Go to Google search.  And you get this: http://www.sutent.com/  This is the official site of the drug company.

Answer: SUTENT is used to treat advanced kidney cancer (advanced renal cell carcinoma or RCC).

Question 2 to ask yourself:  What are the side effects of Sutent?

Answer: You may have side effects or reactions to SUTENT. For many patients, these may be managed. However, some side effects can be serious.

The following are possible side effects

  1. SUTENT can cause serious liver problems, including death.
  2. SUTENT may cause heart problems, including: heart failure, heart muscle problems (cardiomyopathy) and abnormal heart rhythm changes.
  3. SUTENT may cause high blood pressure
  4. SUTENT may cause bleeding sometimes leading to death. Serious bleeding problem such as painful swollen stomach (abdomen), vomiting blood, black sticky stools and bloody urine
  5. SUTENT may cause hormone problems, including thyroid and adrenal gland problem.
  6. Tiredness that worsens and does not go away
  7. Loss of appetite
  8. Heat intolerance
  9. Feeling nervous or agitated, tremors
  10. Sweating
  11. Nausea or vomiting
  12. Diarrhea
  13. Fast heart rate
  14. Weight gain or weight loss
  15. Feeling depressed
  16. Irregular menstrual periods or no menstrual periods
  17. Headache or change in your mental status.
  18. Hair loss
  19. The medicine in SUTENT is yellow, and it may make your skin look yellow. Your skin and hair may get lighter in color
  20. Weakness
  21. Fever
  22. Gastrointestinal symptoms, including diarrhea, nausea, vomiting, mouth sores, upset stomach, abdominal pain, and constipation.
  23. Rash or other skin changes, including drier, thicker, or cracking skin
  24. Blisters or a rash on the palms of your hands and soles of your feet
  25. Taste changes
  26. Pain or swelling in your arms or legs
  27. Cough
  28. Shortness of breath
  29. Bleeding, such as nosebleeds or bleeding from cuts.

Question 3 to ask yourself: If you take Sutent, you run the risk of suffering from the above side effects. Is it worth it? What benefit can you expect from Sutent? Can the drug cure your cancer?

Answer: SUTENT may slow or stop the growth of cancer. It may also help shrink tumors. Take note, it may only. But it may not do what it is supposed to do.

This is one of the research results that were used to justify the use of Sutent for kidney cancer.

Patient and Methods:  Seven hundred fifty treatment-naïve patients with metastatic clear cell RCC were randomly assigned to sunitinib 50 mg orally once daily on a 4 weeks on, 2 weeks off dosing schedule or to IFN-alpha 9 MU subcutaneously thrice weekly.

Results:  Median overall survival was greater in the sunitinib group than in the IFN-alpha group (26.4 v 21.8 months respectively)

Take note of the above research results:

  1. If Sutent was taken, patients survived 26.4 months, if patients took IFN-alpha injections they survived 21.8 months. This means Sutent prolonged survival by only 4.6 months.
  2. To live longer by 4.6 months, you need to spend about RM 15,000 per month. Perhaps for those who can afford to pay, money is not an issue. But for those who are poor, money is a big issue indeed.
  3. Now, if you are still “healthy” – meaning able to eat, sleep, move around and have no pains. Do you think you need to take Sutent? It does not look like you are going to die anytime yet – do you need to survive longer by 4.6 months?
  4. The question which no one can answer is, what happens if you don’t take Sutent at all? Do you die sooner, or do you die later? No research is ever done on that. But based on the possible side effects of Sutent, how sure are we that Sutent really prolong life if compared to no treatment? How sure are we that patients cannot live much longer even without taking Sutent?
  5. Is Sutent a medicine to cure kidney cancer? Nobody is talking about curing kidney cancer. There is no mention of cure at all anywhere in the research report.

Patients, make your own decision. Again, as I have said earlier, whatever you do, make sure that it makes sense to you.

Alert … Beware

I accessed this link on 18 September 2011: http://www.druglib.com/adverse-reactions_side-effects/sutent/seriousness_death/

Sutent (Sunitinib) – Adverse Event Reports – Death

Cases resulting in death (704). You shall see the entry like this …

Possible Sutent side effects / adverse reactions in 40 year old male

Reported by a physician from Turkey on 2010-03-31

Patient: 40 year old male

Reactions: Thrombocytopenia

Adverse event resulted in: death

Suspect drug(s): Sutent

 

Possible Sutent side effects / adverse reactions in 52 year old male

Reported by a physician from United States on 2010-03-31

Patient: 52 year old male, weighing 70.0 kg (154.0 pounds)

Reactions: Renal Cancer, White Blood Cell Count Increased, Disease Progression

Adverse event resulted in: death

Suspect drug(s): Sutent

Read more: Sutent for Advance Kidney Cancer https://cancercaremalaysia.com/2011/09/18/sutent-for-advanced-kidney-cancer/
Lung-Brain Cancer: An Impossible Healing Part 3: Reflection and Confession of a Husband https://cancercaremalaysia.com/2011/09/10/lung-brain-cancer-an-impossible-healing-part-3-reflection-and-confession-of-a-husband/
Read more about Kidney Cancer:  https://cancercaremalaysia.com/category/kidney-cancer/
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