Sunitinib

How it works

It inhibits multiple receptor tyrosine kinases, including vascular endothelial growth factor receptors and platelet-derived growth factor receptors, producing antiangiogenic and antitumour effects.

Prescribing in practice

• It can cause serious cardiovascular toxicity, including hypertension, reductions in left ventricular ejection fraction and QT-interval prolongation, requiring careful baseline assessment and ongoing monitoring.
• It must be prescribed and managed only by clinicians experienced in the use of anticancer agents, with attention to numerous drug interactions including potent CYP3A4 inhibitors and inducers.
• Hand-foot skin reaction, hypothyroidism, bleeding and hepatotoxicity are recognised adverse effects that may require dose modification or interruption.

Monitoring

Monitor blood pressure, full blood count, liver function and thyroid function regularly, with cardiac assessment as clinically indicated.

Counselling the patient

• Attend for regular blood pressure and blood test monitoring as arranged.
• Report unusual bruising or bleeding, breathlessness, or painful redness and blistering of the hands and feet.
• Effective contraception is needed because the drug can harm a developing baby.

Evidence & guidelines

Sunitinib's use in renal cell carcinoma is supported by NICE appraisal and pivotal trial evidence; follow the SPC and specialist protocols.