Friday, March 25, 2011

Sutent Chemotherapy, Side Effects - from Navigating Cancer

For the treatment of Liver Cancer

How Sutent chemotherapy is given and possible side effects.

Your treatment is called sunitinib (soon-IT-in-nib) or Sutent® (SOO-tent). It is commonly used to treat advanced kidney cancer as well as gastrointestinal stromal tumors (GIST). It has also been used to treat other diseases. Sunitinib is a new type of drug that targets cancer cells more precisely than chemotherapy drugs. It works both by blocking tumor cells from growing and by stopping new blood vessels (which bring nutrients and oxygen to the tumor to help it grow) from forming.

What Do I Need to Know Before Starting Treatment?

Be sure to tell your healthcare provider about any prescription or over-the-counter products you are taking, including dietary supplements, vitamins, herbal medicines and homeopathic remedies.
Use an effective birth control method while you are taking these drugs. Chemotherapy drugs can cause harm to a fetus, so be sure to tell your healthcare provider right away if you or your partner become pregnant.
Avoid breastfeeding during treatment. It is not known if these drugs pass into breast milk.
Some chemotherapy drugs can cause sterility. Talk with your healthcare provider about your options if you want to have children in the future.
Do not get any immunizations or vaccinations while taking chemotherapy drugs without the approval of your healthcare provider.

What Do I Need to Know Before Starting Sunitinib?

Sunitinib can cause harm to a fetus. Do not become pregnant. If you do, tell your healthcare provider right away and stop taking sunitinib.
Sunitinib can cause heart problems. Tell your healthcare provider if you have shortness of breath, swollen ankles or feet, heart palpitations, or if you feel more tired than usual.
Sunitinib can cause high blood pressure. If you develop high blood pressure, your healthcare provider may give you medicine to help treat it.
Sunitinib can cause holes in the stomach or bowel wall or bleeding from the tumor. Call your healthcare provider right away if you have a painful, swollen abdomen, vomiting or coughing blood, black, sticky stools or fever.
Sunitinib can cause bleeding such as nosebleeds, bleeding from the gums or from wounds. Most bleeds are minor, and usually stop on their own. If you have a nosebleed, sit with your head tipped slightly forward, and pinch the bridge of your nose. Call your healthcare provider if you feel dizzy or faint or if the bleeding doesn’t stop after 10 to 15 minutes.
Your treatment can interact with other substances, including:
  • St. John’s wort
  • Grapefruit and grapefruit juice
  • Rifabutin (Mycobutin®) or Rifampin (Rifadin®)
  • Phenytoin (Dilantin®), Carbamazepine (Tegretol®) or Phenobarbital (Luminal®, Solfoton®)
  • Dexamethasone (Decadron®)
  • Fluconazole (Diflucan®), Itraconazole (Sporanox®), Ketoconazole (Nizoral®), Voriconazole (Vfend®) or
Posaconazole (Noxafil®)
  • Diltiazem, verapamil or nifedipine
  • Clarithromycin and erythromycin
  • Amprenavir (Agenerase®), Atazanavir (Reyataz®), Indinavir (Crixivan®), Nelfinavir (Viracept®), Ritonavir
(Norvir®), Saquinavir (Invirase®) or Delavirdine (Rescriptor®)
  • Nefazodone (Serzone®)
  • Cimetidine (Tagamet®)
Please note this list is a summary and does not contain all possible drug interactions. Contact your healthcare provider if you are taking any medications that can interact with your treatment.
You should not take this treatment if you are allergic to sunitinib or any of its components.

How Is the Treatment Given?

Sunitinib is usually taken once daily with or without food. Try to take sunitinib at around the same time every day. If you miss a dose, skip it and take the next dose as scheduled. Do not take two doses of sunitinib at the same time to catch up after missing a dose.
Your treatment is usually given in a 6-week cycle. Sunitinib should be taken once every day for the first 4 weeks (days 1-28); then it should be stopped for the next 2 weeks (days 29-42) to complete the cycle. Following this, the next 6-week cycle begins.
It is important to take sunitinib exactly as prescribed. Do not stop the medicine or change the dose without talking with your healthcare provider.
Store sunitinib at room temperature away from children and pets. If you take too much sunitinib, contact your healthcare provider, local poison control center or emergency room right away.
You may be given medicines to help prevent and control nausea and vomiting before you receive your treatment. These medicines may be given either by mouth or by injection into a vein.
Do not share your medication with others. Sharing this medication with anyone else could be harmful.

When Should I Call My Healthcare Provider?

Call your healthcare provider right away if you have any of the following symptoms:
  • Shaking chills or fever of 100.5 degrees F or higher
  • Unusual bleeding, easy bruising or pinpoint red spots on your skin
  • Vomiting that is severe or lasts several hours
  • Painful or frequent urination or blood in your urine
  • Diarrhea that causes an additional four bowel movements a day, diarrhea that lasts more than one day, diarrhea at night or diarrhea with fever, cramps or bloody stools
  • Irregular or rapid heart beat, chest pain, chest tightness or shortness of breath
  • Dizziness or feeling lightheaded
  • Inability to eat or weight loss

What Are the Possible Side Effects?

All drugs can cause side effects, but every person reacts differently to each drug. The following chart lists the possible side effects that can occur with your treatment, how to recognize and minimize symptoms and possible treatments. The side effects are grouped by how often the side effect occurs: Common (occurs in more than 25 percent of patients), Less Common (occurs in 5 to 25 percent of patients) or Rare (occurs in less than 5 percent of patients).
Side EffectHow to Minimize Side EffectPossible Treatments

Nausea/Vomiting (Common. Symptoms are generally mild.)

  • Feeling queasy or sick to your stomach
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Eat food cold or at room temperature so the smell of food will not bother you.
  • Avoid fried, spicy or fatty foods.
  • Eat and drink slowly.
  • Drink plenty of liquids during the day, but to avoid bloating, drink small amounts of liquid during meals.
  • You will be given medicine to help reduce nausea and vomiting.

Diarrhea (Common. Symptoms are generally mild to moderate.)

  • Loose or watery stools several times a day
  • Abdominal cramping, gas and bloating
  • Eat small, frequent meals and bland foods—such as bananas, rice, applesauce and toast.
  • Avoid caffeine; alcohol; raw fruits and vegetables; raw eggs; undercooked meats; spicy, fatty and greasy foods; milk and dairy products; foods that cause gas, such as beans and other legumes; high fiber and high-fat foods; foods left un-refrigerated for more than two hours (one hour for egg dishes and cream or mayonnaise-based foods); bulk laxatives; and stool softeners.
  • Drink eight to ten glasses of clear liquids every day.
  • Your healthcare provider may prescribe medicine to help treat diarrhea.

Mouth Sores and Pain (Common. Symptoms are generally mild to moderate.)

  • Pain, swelling and redness of the mouth, tongue and throat
  • “Coated tongue”
  • Difficulty talking, swallowing or eating
  • Bleeding ulcers and infection
  • Brush teeth two to four times a day using a soft bristle brush and fluoride toothpaste.
  • Use non-waxed dental floss daily.
  • Ask your healthcare provider to recommend a mouthwash that does not contain alcohol.
  • Sip water during the day and use sugar-free candy or gum to keep your mouth wet.
  • Eat food cold or at room temperature.
  • Eat soft or pureed food.
  • Avoid food that is acidic, spicy, salty, dry or rough, such as toast.
  • You may be given medicine to help treat pain.
  • You may be given medicine to treat fungal or viral infections.

Anorexia or Appetite Loss

(Less Common. Weight loss is generally minimal.)

  • Not having an appetite
  • Feeling too nauseated to eat
  • Metallic or medicinal taste
  • Change in taste causing dislike for certain foods
  • Try eating six to eight small meals or snacks each day instead of three larger meals.
  • Vary your diet and try new foods and recipes.
  • Take a walk before meals, when possible. This may make you feel hungrier.
  • Eat with friends or family. When eating alone, listen to the radio or watch TV.
  • Cook dinners ahead of time and freeze them in small portions so that cooking smells are minimized.
  • Let others help with food, but ask that foods be prepared in small portions that can be frozen. And don’t hesitate to let them know which foods to avoid.
  • Add mild spices to change flavor.
  • It might be helpful to have a program, such as Meals on Wheels, deliver food to you.
Rash (Common. Symptoms are generally mild.)
  • Usually mild and short-lived
  • Generally appears on the arms and trunk (occasionally on the face)
  • May be itchy
  • May appear as a flat, discolored area on the skin or as a small raised bump
  • Avoid prolonged exposure to heat.
  • Use creams or moisturizers regularly. Try wearing cotton gloves on your hands.
  • Avoid using perfume, cologne or aftershave since these products can be irritating to the skin
  • Your healthcare provider may prescribe creams (mild steroids, antihistamines or antibiotics) to help treat the rash.
  • The rash may improve on its own without any treatment.

Bleeding (Common)

  • Unusual bleeding, easy bruising
  • Black or tar-like stools
  • Blood in your urine
  • Pinpoint red spots on your skin
  • Bleeding gums or nosebleeds
  • Avoid aspirin and aspirin-like drugs, such as ibuprofen.
  • Use caution with sharp objects, such as razors and nail cutters.
  • Avoid activities that can cause cuts, bumps and bruises.
  • You may be given medicine to increase your platelet count.
  • Your healthcare provider may decrease your dose or delay further treatment.

Hand-Foot Syndrome (Less Common. Symptoms are generally mild to moderate.)

  • Swelling or redness in the hands and feet that can prevent normal activity
  • Cracked or peeling skin
  • Tingling, numbness or pain in the hands or soles of the feet
  • Wear gloves to wash dishes.
  • Avoid using harsh household cleaners.
  • Avoid prolonged exposure to heat or pressure.
  • Use creams or moisturizers regularly. Try covering your hands with cotton gloves.
  • Avoid perfume, cologne or aftershave since these products can be irritating to the skin.
  • Your healthcare provider may prescribe a cream to help with skin reactions.
  • Your healthcare provider may decrease your dose or delay further treatment.

Constipation (Less Common. Symptoms are generally mild.)

  • Difficulty in passing stools
  • Decrease in the normal frequency of bowel movements
  • Small, hard dry stools
  • Bloating, gas, cramps and pain
  • Drink plenty of fluids to help loosen your bowels. Drink warm or hot liquids if you do not have mouth sores.
  • Your healthcare provider may suggest eating foods that are high in fiber, such as bran, vegetables, whole wheat breads and fruit. Add prunes or prune juice, which act like laxatives.
  • Exercise can help loosen bowels.
  • Your healthcare provider may recommend a stool softener.

Infection (Less Common)

  • Fever and chills
  • Painful urination
  • Sore throat and cough
  • Nasal congestion
  • Swelling or redness of the skin at the site of a wound
  • Wash your hands often.
  • Brush and floss your teeth daily.
  • Clean cuts right away with warm water, soap and antiseptic.
  • When your white blood cell count is low, stay away from crowds and people with colds or other illnesses.
  • You may be given medicine to increase your white blood cell count.
  • You may be given an antibiotic to treat or prevent infection.
  • Your healthcare provider may decrease your chemotherapy dose or delay further chemotherapy.

Anemia (Rare)

  • Fatigue or weakness
  • Dizziness
  • Pale skin
  • Feeling out of breath
  • Feeling cold
  • Plan rest periods throughout the day.
  • Organize daily activities so that you conserve your energy.
  • Try to eat a well balanced diet and drink plenty of fluids.
  • Stand up slowly to avoid getting dizzy.
  • You may be given medicine to increase your red blood cell count.
  • Your healthcare provider may decrease your dose or delay further treatment.

What Are The Other Possible Side Effects?

The chart below lists additional side effects found with this treatment. It does not list all possible side effects. For more information, talk with your healthcare provider.
Common Side EffectsLess Common Side EffectsRare Side Effects
  • Rash
  • Fatigue or weakness
  • Altered taste
  • Indigestion
  • Abdominal, muscle or joint pain
  • Headache or dizziness
  • Cough or shortness of breath
  • Insomnia
  • Skin or hair discoloration
  • Blood clots
  • Liver problems including liver failure

Tuesday, March 22, 2011

FDA revives Oxigene's thyroid cancer drug hopes, shares surge - Yahoo! News

FDA revives Oxigene's thyroid cancer drug hopes, shares surge

(Reuters) – Oxigene Inc said U.S. health regulators indicated that its experimental thyroid cancer drug may warrant further development, cheering investors a month after the company stopped enrollment in a drug trial.

Oxigene shares jumped 41 percent in morning trade on Monday, after the company said the U.S. Food and Drug Administration (FDA) found that data from a mid/late-stage trial for the drug, Zybrestat, was suggestive of possible clinical activity.

Last month, the company had cut about half of its workforce to cut costs and focus on key assets. It also planned to stop enrollment in the mid/late-stage trial for the drug.

"With this important FDA visibility ... Oxigene must now clearly define its path forward from a funding standpoint either by delivering a major partnership or by giving investors the confidence that they can fund the way forward," Roth Capital Partners analyst Joseph Pantginis said.

The company said it is reviewing its options for further development of the drug and the additional funding needed through strategic partnerships and equity financing.

Oxigene will have to do a new trial to seek regulatory approval for Zybrestat, the FDA had said in a March 16 meeting.

Also the trial protocol agreement decided upon at the start of the study is no longer valid, Oxigene said in a statement.

The special protocol agreement provides a company with a written agreement that the design and analysis of a trial are adequate to support a marketing application submission with the regulator.

Another small-cap company developing a thyroid cancer drug is Exelixis Inc, while AstraZeneca is also trying to get its new thyroid cancer pill approved by the U.S. regulator.

Oxigene shares were up 29 percent at $2.34 in late morning trade. They reached a high of $2.57 earlier in the session, making them one of the top gainers on Nasdaq on Monday.

(Reporting by Esha Dey in Bangalore; Editing by Gopakumar Warrier)

Wednesday, March 2, 2011

In thyroid cancer cells, scientists look for repeats in DNA as evidence of radiation exposure

It has been known for some time that exposure of the head and neck to radiation therapy increases the subsequent risk of thyroid cancer. Now, a pair of researchers from Germany and the UK are looking into the likelihood that papillary thyroid cancer - which features DNA changes that were once thought to be due to aging - can be caused by radiation exposure.

Their results, which appeared in the journal Clinical Oncology, suggest that it may be feasible to test papillary thyroid cancer samples for copy number alterations (CNAs), which could indicate damage caused by ionizing radiation.

CNAs are variations in the sequence of base pairs found in the DNA of a human cell. While some CNAs are relatively harmless, others may cause serious health risks.

The authors of the new study noted that when scientists sequence the genes of tumor cells, CNAs are often found within their DNA. That principle holds true for papillary thyroid cancer, which is the most common type of thyroid cancer, according to the Columbia University Medical Center.

Papillary thyroid tumors account for at least 70 percent of all diagnosed cases of thyroid cancer, the Center specifies.

In the new medical review, the authors suggested that researchers consider looking for the CNAs that papillary thyroid cancer cells have in common, since their discovery might provide biomarkers that diagnosticians could use to determine how the cancer originated.

They said that the only effective way to determine which CNAs are radiation-related is to compare the sequencing results from a number of closely related cancer study cohorts. By "closely related," the researchers meant that papillary cancer CNAs should be studied based on samples taken from patients who are very similar in age, health status and genetic background.

The team also made suggestions for maximizing the potential of comparative genetic study, such as sequencing DNA with the best integrity or the least degradation from fresh biopsies or blood samples.

Researchers concluded that compiling a list of radiation-caused CNAs will have a number of benefits in the detection and treatment of papillary thyroid cancer.

Currently, nearly 1,700 Americans die of thyroid cancer each year, according to the National Cancer Institute.

Dr. Coomer and Radioactive Iodine

Women's Health

Dr. Coomer Turns to Nuclear Medicine to Fight Cancer

By Faith Heaphy
Published February 28, 2011
When Dr. Cynara Coomer became radioactive, she didn’t glow with power like the superheroes we see on the big screen. She didn’t gain any superhuman strength or the ability to fly either. Instead she got the boost she needed to fight thyroid cancer.
“It was a very strange experience when I took the pill,” said Coomer, a Fox News Medical A Team member. “I was in this room with the doctor who was two feet away from me – as soon as I took the pill, everybody just backed off – it was a very isolating feeling.”
After noticing a lump on her throat and being diagnosed with papillary thyroid cancer, Coomer, chief of breast surgery at Staten Island University Hospital, had her thyroid removed. In the weeks following the surgery, the next step in treating the cancer was to turn to nuclear medicine.
“Radioactive iodine is used to treat two conditions,” said Dr. Joseph Machac, director of nuclear medicine at Mount Sinai Medical Center in New York City. “An overactive thyroid and the treatment of thyroid cancer.”
According to Machac, this iodine would ensure that any remaining thyroid tissue in Coomer would be removed so she could make a full recovery from cancer.
In February, Coomer began these radioactive iodine treatments. First in small doses, then increased amounts. In addition, she learned to adjust to a drastically different diet.
“In order to prepare the patient, we need to lower the amount of natural iodine in the diet to avoid competition,” Machac told
For the treatment to work successfully, patients need to significantly reduce their iodine intake from food for two weeks before the treatment and the next three days after the treatment.
“The diet is very restrictive,” Coomer said. “You really have to make your food in order to know what is going in your food.”
Since she was not allowed to eat anything that contained regular salt, Coomer focused on eating meats and vegetables.
“It's actually a really healthy diet,” said Coomer. “I'm not a good diet person, but doing it for medical reasons certainly gets you to be committed to it because if I had to do this just to lose weight, I would have given up a long time ago.”
On Feb. 16, Coomer swallowed the radioactive iodine pill. According to Machac, the pill released two types of radiation: short range beta, which actually treats the thyroid cancer, and gamma radiation, which is similar to X-rays. Because of the risky nature of this radiation, Coomer was required to distance herself from those around her.
“For the first three days we advise our patients with this kind of dose to maintain a distance of about 10 feet from other people, which means basically being in a separate room,” said Machac.
In preparation, Coomer stockpiled everything she thought she would need in the basement of her home, including dishes, sheets and books.
This available space, Coomer later reflected, was really something that made the challenge of no human contact more bearable.
“I have thought about people who haven't been so fortunate to have such a good living situation and have had to be hospitalized for the first three or four days, and I think that would have been very difficult and certainly very isolating,” Coomer said.
Although it was tough being away from her baby daughter and husband, Coomer appreciated the mental break from her practice and was even able to indulge in a few reality TV shows.
“Now I understand what the “Jersey Shore” is that people are talking about,” Coomer said. “I never knew why people liked the Kardashians, now I know! That certainly numbed my mind for a little while and passed the hours.”
After the treatment, Coomer faced a few residual symptoms including a dry mouth, which was something expected considering that iodine travels though the salivary glands. But overall, Coomer felt the benefits of the treatment far outweighed any sort of immediate discomfort because it limited the possibility of future surgeries.
“By doing the radioactive iodine treatment, I reduced my recurrence rate dramatically and that will hopefully benefit me for the rest of my life,” she said.

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