sunitinib: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
sunitinib: clinical details
Prescribing considerations
- Treatment should be initiated and supervised by a clinician experienced in anticancer therapy.
- Review cardiovascular disease, hypertension, thromboembolic history, aneurysm risk, bleeding, hepatic or renal disease, thyroid dysfunction, diabetes, planned surgery and dental risk before treatment.
- Avoid potent CYP3A4 inhibitors or inducers where a suitable alternative exists.
- Consider dental examination and preventive dentistry, particularly after previous or concurrent intravenous bisphosphonate exposure.
- Treatment interruption may be necessary around major surgery because wound healing can be impaired.
Contraindications and cautions
- Hypersensitivity to sunitinib or any product excipient.
- Use in severe hepatic impairment is not recommended because it has not been studied.
- Use particular caution with uncontrolled hypertension, significant cardiovascular risk, QT prolongation risk, recent thromboembolic disease, bleeding risk, proteinuria or previous aneurysm/dissection.
Monitoring
- Blood pressure before and during treatment.
- Full blood count at baseline and during treatment.
- Liver function before treatment and during treatment.
- Thyroid function at baseline and periodically.
- Renal function and urinalysis for new or worsening proteinuria.
- Clinical assessment for bleeding, infection, gastrointestinal perforation, heart failure, thromboembolism, skin toxicity and impaired wound healing.
- Consider ECG, electrolytes and left-ventricular function according to cardiac risk.
- Monitor blood glucose closely in people with diabetes because symptomatic hypoglycaemia can occur.
Clinical pharmacology
Sunitinib inhibits multiple receptor tyrosine kinases involved in tumour proliferation and angiogenesis, including VEGFR, PDGFR, KIT, FLT3, CSF-1R and RET. It is metabolised mainly by CYP3A4 to an active metabolite and is eliminated predominantly in faeces.
Formulation and product differences
- The selected product is a hard gelatin capsule containing yellow-to-orange granules.
- The capsule is essentially sodium-free.
- Capsule appearance and excipients can differ between manufacturers and strengths; confirm the supplied product when allergy, dietary or identification questions arise.
sunitinib preparations and strengths
Capsule
Route: Oral
Strengths: 12.5 mg, 25 mg, 50 mg
sunitinib interactions
The oncology team should review prescription, non-prescription and herbal products before and during treatment.
Strong CYP3A4 inhibitors, including itraconazole, clarithromycin and ritonavir
May increase sunitinib exposure and toxicity; an alternative with less CYP3A4 inhibition is preferred where possible.
Grapefruit juice
May increase sunitinib concentrations and should be avoided.
Strong CYP3A4 inducers, including rifampicin, carbamazepine, phenytoin and phenobarbital
May reduce sunitinib exposure and effectiveness; alternative treatment should be considered.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.