Sunitinib (SUTENT)

Renal cell carcinoma, metastatic

Gastrointestinal stromal tumor, advanced or metastatic

Pancreatic neuroendocrine tumor, advanced or metastatic

Renal cell carcinoma, metastatic

• Option 1 Dose – Oral: Every 6 weeks - 50 mg once daily (4 weeks of treatment followed by 2 weeks off) until disease progression or unacceptable toxicity
• Option 2 Dose – Oral: Every 3 weeks - 50 mg once daily ( 2 weeks of treatment followed by 1 week off) until disease progression or unacceptable toxicity

Gastrointestinal stromal tumor, advanced or metastatic

• Option 1 Dose – Oral: Every 6 weeks - 50 mg once daily (4 weeks of treatment followed by 2 weeks off) until disease progression or unacceptable toxicity
• Option 2 Dose – Oral: Every 3 weeks - 50 mg once daily ( 2 weeks of treatment followed by 1 week off) until disease progression or unacceptable toxicity

Pancreatic neuroendocrine tumor, advanced or metastatic

• Dose – Oral: 37.5 mg once daily until disease progression or unacceptable toxicity

Available as 12.5 mg, 25 mg and 50 mg hard gelatin capsules. An oral liquid formulation may be compounded for patients unable to swallow the capsules, please discuss with your pharmacy team. Store 20 at 25ºC.

Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a VEGF (vascular endothelial growth factor) inhibitor and a KIT inhibitor

Take with or without food

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Hypertension, Fatigue, Yellow discoloration of the skin, Hypothyroidism, Diarrhea, Mucositis/stomatitis , Nausea.

Less Common: Left ventricular ejection fraction decrease, Hair discoloration, Hand-foot skin reaction, Osteonecrosis of the jaw, Bleeding events, Dermatologic adverse reactions.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, sodium, potassium, creatinine, total protein, albumin, bilirubin, alkaline phosphatase, urine analysis, TSH.

Before each cycle during treatment: CBC & differential and platelets, urine analysis, creatinine, uric acid, ALT, Bilirubin. TSH every other cycle or if clinically indicated.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• May increase the risk for QT interval prolongation. Avoid concurrent therapy with drugs associated with QTc prolongation and/or Torsades de pointes, if possible. If unavoidable, monitor for QT prolongation or cardiac arrhythmias.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Patients on IV bisphosphonates are at higher risk of osteonecrosis of the jaw.
• Patients with a recent history of cardiac events should be monitored for signs and symptoms of congestive heart failure onset and evaluated for decreased left ventricular ejection fraction.
• Yellow discolouration of the skin occurs in approximately 30% of patients. This is due to the yellow color of the drug and its metabolite. It is reversed when the drug is discontinued. Yellow discoloration of the urine has also been reported with skin discoloration.
• Hypertension is common with VEGF inhibitors. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions.
• Thyroid dysfunction, in particular hypothyroidism, may occur with this treatment. Monitor for signs and symptoms of thyroid dysfunction and manage as clinically appropriate.
• Impaired wound healing is associated with VEGF inhibitors, drug may need to be held and restarted if patient requires surgery, discuss with team.

BC Cancer. BC Cancer Drug Manual. Sunitinib. Vancouver, British Columbia: BC Cancer Agency. Available at http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Sunitinib_monograph.pdf. Updated July 1, 2019 Accessed January 22, 2024.

Lexicomp. Sunitinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/371693?cesid=8uVsOxT8LS5&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DSunitinib%26t%3Dname%26acs%3Dfalse%26acq%3DSunitinib. Updated January 24, 2024. Accessed January 29, 2024.

Cancer Care Ontario. Sunitinib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44001. Updated October 2020. Accessed January 22, 2024.Pfizer Canada Inc.

SUTENT® Product Monograph. Kirkland, Quebec: Pfizer Canada Inc. Updated July 11, 2019