SC (TK826) was a 53-year-old male. He had a history of pains in his right shoulder for almost a year. An X-ray did not show any problem. Then in October 2008, his right hand became weak. MRI showed tumour in his spine – T1 / T2. Titanium stent inserted to support the crushed T1. Further investigation indicated the primary as cancer of the kidney. He received 20 radiation treatments. In spite of the treatment, the tumour grew bigger and spread to his liver, lungs and abdomen. He was started on Sutent in January 2009. As of 3 February he had started on the second cycle of Sutent. In spite of the drug, MRI on 11 February 2009 showed a large mass in C3 to C7 and there were more metastases in T1/T2 and T5/T6.
This video was recorded on 9 February 2009. Sadly, SC died on 30 April 2009.
SC suffered the following side effects:
1. Lost of appetite.
2. Diarrhoea up to 10 times per day.
3. Swelling of face.
4. Ulceration of mouth.
5. Yellowing of skin.
6. Difficulty breathing.
7. Peeling of skin in the feet and hands.
Below are vital information about Sutent – sunitinib which patients ought to know.
Use: For treatment of refractory unresectable and/or malignant gastrointestinal stromal tumors (GIST) and advanced kidney cancer (advanced renal cell carcinoma or mRCC).
Cost: RM 20,000 per cycle of treatment which last 4 weeks. Take 4 tablets per day. Rest for 2 weeks before starting a new cycle of 4 weeks.
• Approval for kidney cancer was based on a review of the drug’s efficacy in reducing tumor size. Approval of the GIST was mainly based on studies showing that sunitinib delay tumor growth.
• Sutent shrank tumors in 26% to 37% of patients, according to the FDA. Studies have not yet shown that Sutent improves survival.
• Liz Szabo, USA TODAY Jan 26, 2006, wrote: Sutent doesn’t cure cancer, but experts say it is an important advance – both for patients and for science. Sutent is a product by Pfizer. Another drug used to treat advanced kidney cancer is Nexavar by Bayer.
• The median OS for patients receiving SUTENT was 26.4 months vs 21.8 months with IFNα (Note: IFN-α has been used extensively in the treatment of metastatic melanoma. Human IFN-α1 is a type I interferon. It is for research use only, not for diagnostic or therapeutic use)
The adverse events included:
• Tiredness, headache, weakness, dizziness
• Diarrhoea, nausea, vomiting, constipation
• Loss of appetite, weight loss
• Change in skin colour or hair colour
• Tingling or rash on palms of hands or soles of feet
• Hand –foot syndrome (Palmar-plantar erythrodysesthesia or PPE) –skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet.
• Rashes, dry skin, skin redness, scaly skin, itchy skin, blister
• Sore tongue, sore mouth, dry mouth
• Upset stomach, abdominal pain, wind, heart burn, indigestion
• Generalized aches and pains, muscle pain, joint pain, back pain, pain in fingers, arms or legs
• Very bad abdominal pain
• Tingling or numbness of hands or feet; pins and needles
• Increased tearing, watery eyes
• Shortness of breath
• Rash, flatulence, dehydration
• Hair loss
• Cough, Nose bleed
• Difficulty sleeping , depression
• Unusual urine colour
• Shortness of breath, wheezing or trouble breathing, chest pain
• Swelling of feet, legs or ankles , leg pain, face or eyelids
• Low potassium levels, increased bilirubin levels
• Flu-like symptoms (chills, fever, sore throat, swollen glands)
• High blood pressure (hypertension)
• Fits, Seizure
• Increased amylase and lipase levels
The most serious adverse events associated with Sutent therapy included
• pulmonary embolism
• bleeding from the tumor bleeding or bruising under the skin; coughing blood
• febrile neutropenia
• may harm an unborn baby (cause birth defects). Do not become pregnant. Do not breastfeed while taking SUTENT.
• may cause heart problems.
• may cause a hole in the stomach or bowel wall. This could cause symptoms such as painful, swollen abdomen, vomiting or coughing blood, and black, sticky s tools.
Recent research findings on Sutent
Researchers in Canada had reported that Sutent accelerated metastatic tumour growth and decreased overall survival in mice receiving short-term therapy (Cancer Cell 15: 232-239. March 2009).
Using mouse model researchers in Spain and California, USA, also showed that Sutent promoted the incidence of highly invasive tumours. The incidence of liver micrometastases was significantly increased by 3.5-fold in treated animal (Cancer Cell 15:220-231. March 2009).