Sutent Chemotherapy, Side Effects - from Navigating Cancer

Sutent

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 Effect	How to Minimize Side Effect	Possible 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 Effects	Less Common Side Effects	Rare 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