Sunitinib

Indications

Sunitinib is used for: Leukemia, Renal cell carcinoma, Gastrointestinal stromal tumor, Meningioma

Adult Dose

Hepatic Impairment Mild to moderate impairment: Dose adjustment not necessary for initial dose; monitor subsequent doses Severe impairment: Not studied

Child Dose

Safety and efficacy not established

Renal Dose

Renal Impairment No dose adjustment necessary

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity, Renal impairment

Precautions

CHF, HTN, history of QT interval prolongation, patients taking antiarrhythmics or w/ preexisting cardiac disease, bradycardia or electrolyte disturbances, hemorrhagic events, hypothyroidism. Perform CBC & physical exam. May affect ability to drive or operate machinery. Pregnancy.

Pregnancy-Lactation

Interactions

Increased plasma conc w/ strong CYP3A4 inhibitors (eg ketoconazole, ritonavir, itraconazole, erythromycin, clarithromycin, grapefruit juice). Decreased plasma conc w/ strong CYP3A4 inducers [eg rifampin, dexamethasone, phenytoin, carbamazepine, phenobarb, St. John's wort (Hypericum perforatum)]. Anticoagulants eg warfarin, acenocoumarol (periodically monitor platelets, prothrombin time/INR & physical exam).

Adverse Effects

Side effects of Sunitinib : >10% Dyspepsia (MRCC 46%),Altered taste (MRCC 43%; GIST 21%),Fatigue (GIST 42%; MRCC 74%),Diarrhea (GIST 40%; MRCC 55%),Rash (MRCC 38%; GIST 14%),Vomiting (MRCC 37%; GIST 24%),Constipation (MRCC 34%; GIST 20%),Skin discoloration (MRCC 33%; GIST 30%),Abdominal pain (GIST 33%; MRCC 20%),Nausea (GIST 31%; MRCC 54%),Anorexia (MRCC 31%; GIST 33%),Mucositis/stomatitis (GIST 29%; MRCC 53%),Dyspnea (MRCC 28%; GIST 10%),HTN (MRCC 28%; GIST 15%),Arthralgia (MRCC 28%; GIST 12%),Bleeding (MRCC 26%; GIST 18%),Headache (MRCC 25%; GIST 13%),Asthenia (GIST 22%),Lymphopenia (MRCC 21%),Fever (GIST 18%; MRCC 15%),Limb pain (MRCC 18%),Back pain (MRCC 17%; GIST 11%),Myalgia (MRCC 17%; GIST 14%),Cough (MRCC 17%; GIST 8%),Dry skin (17%),Hair color changes (17%),Neutropenia (MRCC 13%; GIST 11%),Alopecia (MRCC 12%),Hand-foot syndrome (MRCC 12%; GIST 14%),Dehydration (MRCC 11%) 1-10% Venous thrombotic events,Hemorrhoids,Pancreatitis,Flu-like syndrome <1% Hepatotoxicity,Acute renal failure,Adrenal dysfunction

Mechanism of Action

Multikinase inhibitor (including VEGF & PDGF receptor tyrosine kinases) some of which are implicated in tumor growth, angiogenesis, and metastasis.