Sutent is the second-line approved treatment for Gastrointestinal Stromal Tumor and is prescribed when treatment with the first-line drug, Gleevec (Imatinib) is no longer effective or cannot be tolerated. The two drugs work differently, so someone who has had increased or, severe, side effects with Gleevec may not experience the same difficulties with Sutent. However, some patients may encounter some significant side effects from Sutent, and these should be discussed with your doctor as you begin treatment.
Some of the known side effects include hypertension, dry skin, loss of taste, diarrhea, fatigue and lightening of body hair. Not everyone experiences all of these side effects. Many people only get one or two and some get none, of those that do, many find they can decrease over a period of weeks or months.. Working with your doctor, these side effects can be managed in many cases. Blood pressure medication, for example, can be used to treat hypertension. Creams, especially those containing Urea, can help with the dry skin and the foot blisters some patients report.
One way of managing and even preempting side effects, is to discuss with your doctor the beginning dosage regimen options when first prescribed Sutent. The drug can be given in a dosage of 50 mg a day for four weeks, followed by a two-week “Washout” period. Many GIST specialists believe that a continuous dose of 37.5 mg a day is better tolerated and works just as well in most cases. Even then, titrating up to the full dose helps the body in becoming accustomed to the drug slowly, thus making it easier to tolerate. For instance, since Sutent is available in 12.5 mg capsules, talk to your oncologist about starting on 12.5 mg for a few days, then 25 mg a few days more, and then the full dose, can greatly increase your ability to tolerate the drug giving it the greatest opportunity to do its job. Of course, every situation is different and taking time to ramp up to full dosage must be balanced against any progression that might be occurring. Some patients progressing quickly might not have as much time to slowly increase the dose. This is something that must be discussed with your doctor.
When taking Sutent, the time of day may be important if you work outside the home or are very active. Taking it at night with a meal may work better as many have said sleeping through the fatigue is better than dealing with it during the day. Others found they felt better taking it with lunch. You may take Sutent with or without a meal. Everyone is different so you may have to experiment to see which way is best for you.
Staying hydrated is very important if diarrhea is an issue. Some people find milk products and fatty, fried, or spicy foods to cause an increase in bowel issues while on Sutent. Keeping a food chart to watch for patterns of stomach upset is helpful to choose which foods might trigger discomfort. You should also make sure to remain upright for an hour after taking the pills to avoid further stomach upset. Lying down immediately after taking any oral chemo medication can cause the pill to settle in the same area of the stomach each time, thus irritating the lining and possibly causing long term issues.
The possible side effects of Sutent include:
- Weakness (asthenia)
- Mouth sores/loss of taste
- Skin discoloration
- Hair color changes
- Hypothyroidism (low thyroid)
- Hand and Foot syndrome
Less common, but more severe sutent side effects include:
- Liver toxicity
- Heart toxicity
- Prolonged QT interval
- Osteonecrosis of the jaw
In an interview with the Life Raft Group, we asked Dr. Witteles, a cardiologist at Stanford, to comment about the type of monitoring he recommends for patients on Sutent. Dr. Witteles recommended:
- Close monitoring of blood pressure.
- Treatment of all hypertension, including mild hypertension. (over 140/90 mm Hg).
- Cardiac monitoring at baseline and every three months (previous cardiac risk factors might require closer monitoring).
- For patients with previous heart problems – very close monitoring at a tertiary care center. (specialized heart care center).
- Investigational monitoring of biomarkers might include BMP and Troponin
According to Witteles, patients without a previous history of heart problems won’t necessarily need to be seen by a cardiologist. The oncologist can order cardiac monitoring tests such as an echocardiogram or a MUGA scan. However, if those tests find abnormalities, then it’s time to get a cardiologist involved in the treatment plan.