Download How Sutent® works

How Sutent® works
You have had Sutent® prescribed by your
doctor. This leaflet will explain the
commonest side effects and suggest
how they can be reduced or treated.
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Sutent® against cancer
Sutent belongs to a group of drugs that, following exhaustive research, have proven to be effective against the type of cancer you have. Cancer is one of our commonest diseases, and the
number of cancer sufferers will increase because we are living longer.
About one in three Swedes will develop some form of cancer during their lifetime. There are
many associations for patients and their families through which you can contact others in a
similar situation. It can sometimes be helpful to talk to someone who has experienced the
things you will now be experiencing.
There are about 200 different forms of cancer, which can differ greatly, and there are also
different variants of the same disease. It is therefore natural that these different diseases are
treated differently. The commonest methods of cancer treatment are surgery, radiotherapy and
chemotherapy; alternatively, a new approach is available in the form of multikinase inhibitors,
which inhibit various signals in the cell that are important to the growth and spread of cancer.
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What is cancer and how does Sutent act?
PDGFR α,-β
What all forms of cancer have in common is uncontrolled division of certain types of cell. For this
growth the cancer cells need oxygen and nutrition, for the provision of which new blood vessels
must be formed. By emitting signals (growth factors, e.g. VEGF) a cancer can ensure that new
blood vessels are formed.
The medicine that you have been given blocks the effect of these growth factors, thereby inhibiting
the cancer’s development. Sutent works by inhibiting various enzymes – tyrosine kinases – and
is therefore called a tyrosine-kinase inhibitor. Sutent is called a “multikinase inhibitor” because it
inhibits several enzymes.
VEGFR-1, -2, -3
SUTENT
VEGFR-1, -2, -3
PDGFR α,-β
SUTENT
SUTENT
SUTENT
The illustration shows how Sutent acts by blocking several tyrosine kinases and controlling molecules that cancer cells need for the growth, dissemination and formation of new blood vessels.
Angiogenesis = the process in the body that supports formation of new blood vessels from existing blood vessels.
Tumour proliferation = tumour growth.
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INHIBITS TUMOUR
PROLIFERATION
INHIBITS
ANGIOGENESIS
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Things to bear in mind
There are some things you must bear in mind when taking your Sutent treatment. Firstly, do
not eat grapefruit or drink grapefruit juice whilst taking your treatment. And do not take natural remedies or anything else containing St John’s wort, as this affects the amount of Sutent in
the blood and may influence the results of your treatment.
Tell your doctor or nurse which other drugs you are taking, not forgetting any
natural remedies or dietary supplements.
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Our strengths
What dosage of Sutent to take
For metastasised/advanced kidney cancers or gastrointestinal stromal tumours (GIST)
The recommended dose of Sutent is 50 mg once a day as part of a four-week treatment regimen. After
these four weeks you have to take a two-week break from treatment, after which you can start a new
treatment cycle. One treatment cycle lasts 6 weeks in total.
SUTENT®
50 mg
Hard gelatin capsules
For neuroendocrine pancreatic tumours
The recommended dose of Sutent is 37.5 mg once a day as part of continuous 28-day treatment regimen. After that, you start the next treatment cycle without a break.
It is very important that you take your capsules in accordance with your doctor’s prescription, and
there is a treatment diary to make it easier for you to ensure you have taken your daily capsule.
You can take Sutent regardless of meals and time of day. Try to make taking the capsules a habit,
and this will make it easier to remember. We suggest you take Sutent in the morning or at the same
time as you take your other drugs.
If you forget to take a capsule do NOT take a double dose the next time – continue
your treatment as usual and tell your doctor.
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SUTENT
25 mg
®
Different dosages for different cancer diseases
Dose regimen with a break for metastasised/
advanced kidney cancer/GIST
Week 1
1
2
3
4
5
6
7
Week 2
8
9
10
11
12
13
14
Week 3
15
16
17
18
19
20 21
Week 4
22 23 24 25 26 27 28
Week 5
29 30 31 32 33 34 35
Do not take SUTENT
Week 6
36 37 38 39 40 41 42
for two weeks. Then
start the cycle again.
Take SUTENT
daily for four weeks
(28 days)
Hard gelatin capsules
Dose regimen without a break for neuroendocrine
pancreatic tumour
SUTENT®
12.5 mg
Hard gelatin capsules
Week 1
1
2
3
4
5
6
7
Week 2
8
9
10
11
12
13
14
Week 3
15
16
17
18
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Week 4
22 23 24 25 26 27 28
Take SUTENT
daily for four weeks
(28 days)
How to deal with any side effects
Sutent is a powerful drug, and to enable you to feel as well as possible during your treatment it
is important for you to know about the commonest side effects so you can reduce them.
It is important to realise that not everyone experiences these symptoms – whether and
to what extent you will suffer from side effects depends entirely on you as an individual.
If you do not tolerate your treatment it is important that you contact your
attending doctor, who will then be able to give you further recommendations.
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The commonest side effects of Sutent
Fatigue
Fatigue is common during cancer treatment. It will usually occur during the latter part of Sutent
treatment, and will abate during the break in treatment.
If you feel tired or weak:
• Try to save your energy (take short naps).
• Try to find the times of day when you feel better, and carry out any planned activities then (use
your treatment diary as an aid).
• Light physical activity, e.g. short walks, is often helpful.
• Try to stick to your daily routines as far as possible. It is important that you be as active as possible and that you endeavour to continue with work and social activities. Take a break and rest
if necessary.
• Try to find the time of day that best suits you (start in the morning and work your way to the
best time).
• Eat well and drink plenty of fluid.
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Nausea and vomiting
Changes in the oral mucosa
Nausea and vomiting may occur during your Sutent treatment. Try to assess how much this
is affecting you and whether it varies. Use the patient diary as an aid. Excellent drugs are currently available to help reduce nausea.
Some people receiving Sutent treatment will experience a feeling of discomfort in the mouth
in the form of changes in taste, tenderness in the mouth or blisters and sores in the oral cavity.
Such symptoms usually decrease with continued use, but in certain cases it may be necessary to
decrease the dose of Sutent. Tell your doctor or contact nurse about your symptoms, but never
change the medication yourself!
It is very important that you maintain good oral hygiene, and try to consult a dental hygienist
before you start your treatment.
Ask your doctor’s advice if you experience nausea or vomiting.
• Avoid spicy, fatty or salty food.
• Hot food can sometimes cause problems, as the unpleasant smell of cooked food can cause
nausea. If so, try cold dishes.
• There are several recipe books for people undergoing cancer treatment, which may include
a good recipe or two.
• Alternative treatments such as acupuncture and relaxation techniques can sometimes help.
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The following tips may also help:
• Suck on a piece of frozen pineapple in the event of symptoms (NB: coldness may be a problem for some people).
• Use local pain relief, e.g. viscous lidocaine, alcohol-free mouthwash and lip salve for sores on
the lips and at the corners of the mouth.
• Use a soft toothbrush (children’s brush) and avoid toothpaste containing peroxide.
• Avoid spicy and sour food.
• Avoid hot/cold drinks and food, as they may in certain instances cause a feeling of discomfort.
• Try using a straw.
• Avoid alcohol and tobacco.
• Protect your lips against drying out.
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Gastric problems
Weight loss
Treatment of cancer can cause diarrhoea or changes in faecal consistency. Both your cancer
and the drugs you are receiving to treat it are potential causes of diarrhoea. Your doctor can
give you treatment to reduce the symptoms of diarrhoea. It is important that you monitor
your bowel function and use the treatment diary to makes notes on bowel function and diarrhoea symptoms.
Any loss of appetite can be the result of several factors, e.g. changes in taste during the treatment, tenderness in the mouth or nausea.
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ontact your doctor or nurse for advice in the event of severe diarrhoea.
• Try to drink at least three litres of clear fluid (e.g. water) a day, divided into small doses.
Avoid drinking large amounts at mealtimes.
• Avoid big meals, spicy, fatty, high-fibre or ‘light’ products, and coffee, alcohol and large
amounts of fruit.
• If you develop a high temperature, dizziness, palpitations, cramps, watery or bloody faeces
or persistent diarrhoea, despite active treatment against diarrhoea, you MUST contact your
doctor, as these symptoms may entail an increased risk of complications, necessitating
hospitalisation.
• Try to reduce your stress levels.
• If you are taking active medication against constipation you should consult your doctor
about taking a break from this medication.
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hoose food that you like, and try out different seasonings. Special cookbooks are available
that recommend suitable recipes for the period of your cancer treatment.
• It is important to eat regularly, but avoid snacking.
• Eat smaller portions (with a high protein and calorie content) regularly.
• Weigh yourself regularly and enter your weight in your treatment diary.
• Create a calm environment at mealtimes.
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Skin changes
In certain instances skin changes may occur during treatment. They will abate
two to three weeks after completion of treatment, but can in some cases be
problematic. Hair and skin pigmentation may also be affected.
Treatment options
• A
void activities that cause increased pressure on the palms of your hands
and soles of your feet.
• Wear loose clothing and comfortable shoes (preferably with a gel inlay)
that do not pinch.
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ook out for dry skin and any other skin changes, and keep you skin well
lubricated right from the start of treatment. Use emollient creams/ointments
(carbamide cream), e.g. Essex cream, or, in more serious instances, something with added cortisone. If you want to use a lotion instead of a cream there
are several options, e.g. Propyless or Caress.
• If you have sensitive skin you can use baby shampoo instead of shower
soap.
• Bathe affected areas with magnesium sulphate dissolved in lukewarm
water.
• A
void high heat and hot water.
• U
se water-based make-up.
• A
void strong sunlight.
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Hair pigmentation will
return after completion
of treatment and during
the rest period. This
means your hair may
develop streaks.
Watch out for hardening
on your hands and the
soles of your feet. This
usually happens on areas under pressure, and
soft, shoes that fit well
or sandals may help.
High blood pressure (hypertension)
In some people Sutent can cause high blood pressure, which is usually treated in the same way
as other types of high blood pressure. If you get a headache or become dizzy this can be the
result of high blood pressure. Regular exercise, weight control and restricted alcohol intake can
reduce the symptoms. It is recommended that you check your blood pressure yourself once a
week and enter it in your treatment diary.
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Notes
Do you want to know more?
www.cancerfonden.se
www.pfizer.se
www.internetmedicin.se
Important names and phone numbers for the hospital
Hospital/Ward
Doctor in charge
Neuroendocrine tumours
www.carpapatient.se
Nurse in charge
Phone number daytime
Phone number nights and weekends
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SUT110314PSE05
Pfizer AB 191 90 Sollentuna. Phone: +46(0)8 - 550 520 00. Fax +46(08) - 550 520 10. www.pfizer.se