For the Patient: UGIPNSUNI Other Names: Palliative Treatment of Advanced Pancreatic Neuorendocrine Tumours using Sunitinib

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For the Patient: UGIPNSUNI Other Names: Palliative Treatment of Advanced Pancreatic Neuorendocrine Tumours using Sunitinib UGI = Undesignated, GastroIntestinal PN = Pancreatic Neuroendocrine Tumours SUNI
For the Patient: UGIPNSUNI Other Names: Palliative Treatment of Advanced Pancreatic Neuorendocrine Tumours using Sunitinib UGI = Undesignated, GastroIntestinal PN = Pancreatic Neuroendocrine Tumours SUNI = Sunitinib ABOUT THIS MEDICATION What is this drug used for? Sunitinib is a drug used in the treatment of pancreatic neuroendocrine tumours. How does this drug work? Sunitinib works by interfering with certain enzymes called tyrosine kinases that play a role in how cells grow, and also helps prevent the growth of new blood vessels from surrounding tissue to a cancer. By doing so, sunitinib helps prevent an increase in the number of cancer cells. INTENDED BENEFITS This drug is being given to destroy and/or limit the growth of cancer cells in your body. This treatment may improve your current symptoms, and delay or prevent the onset of new symptoms. It may take several treatments before your doctor can judge whether or not this medicine is helping. TREATMENT SUMMARY How is this drug given? Sunitinib is usually given once daily. It is a capsule that is taken by mouth. It is taken continuously, as long as you are responding to the drug and not having too many side effects, as determined by your doctor. What will happen when I get my drugs? A blood test is done on a regular basis, to monitor the effects of the drug on your body. The dose and frequency of your treatment may change, based on your blood counts and/or other side effects. The doctor will review the results of the blood test and meet with you each cycle. If you are to proceed with treatment, the appointment would usually be scheduled for the following day. BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 1/6 SIDE EFFECTS AND WHAT TO DO ABOUT THEM Unexpected and unlikely side effects can occur with any drug treatment. The ones listed below are particularly important for you to be aware of as they are directly related to the common actions of the drug in your treatment plan. You doctor will review the risks of treatment and possible side effects with you before starting treatment. The pharmacist will review how to take sunitinib and possible side effects with you on the day you first pick up your medication. SERIOUS SIDE EFFECTS DURING TREATMENT Fever may sometimes occur. Your white blood cells may decrease during your treatment. White blood cells protect your body by fighting bacteria (germs) that cause infection. When they are low, you are at greater risk of having an infection. Your platelets may decrease during your treatment. Platelets help to make your blood clot when you hurt yourself. You may bruise or bleed more easily than usual. MANAGEMENT Take acetaminophen (e.g., TYLENOL ) every 4-6 hours, to a maximum of 4 g (4000 mg) per day. If you have fever plus another sign of infection, call your doctor immediately. Other signs of infection include chills, cough, or burning when you pass urine. To help prevent infection: Wash your hands often and always after using the bathroom. Avoid crowds and people who are sick. Call your doctor immediately at the first sign of an infection such as fever (over 100 F or 38 C by an oral thermometer), chills, cough, or burning when you pass urine. To help prevent bleeding problems: Try not to bruise, cut, or burn yourself. Clean your nose by blowing gently. Do not pick your nose. Avoid constipation. Brush your teeth gently with a soft toothbrush as your gums may bleed more easily. Maintain good oral hygiene. Some medications such as ASA (e.g., ASPIRIN ) or ibuprofen (e.g., ADVIL ) may increase your risk of bleeding. Do not stop taking any medication that has been prescribed by your doctor (e.g., ASA for your heart). For minor pain, try acetaminophen (e.g., TYLENOL ) first, but occasional use of ibuprofen may be acceptable BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 2/6 OTHER SIDE EFFECTS DURING TREATMENT Nausea and vomiting may sometimes occur. Indigestion/heartburn may sometimes occur. Diarrhea may sometimes occur. Constipation may sometimes occur. Tiredness and lack of energy are common. Sore mouth may sometimes occur during your treatment. Mouth sores may occur on the tongue, the sides of the mouth, or in the throat. Mouth sores or bleeding gums can lead to an infection. Taste alteration or loss of sensation of taste may sometimes occur. Loss of appetite may sometimes occur. MANAGEMENT You may be given a prescription for antinausea drug(s) to take before your sunitinib dose. Take only antinausea medication prescribed by your oncologist. It is easier to prevent nausea than treat it once it has occurred, so follow directions closely. Drink plenty of liquids. Eat and drink often in small amounts. Try the ideas in Practical Tips to Help Manage Nausea* Avoid fatty, fried, or spicy foods. Talk to your doctor about taking antacids. To help diarrhea: Drink plenty of liquids. Eat and drink often in small amounts. Avoid high fibre foods as outlined in Food Ideas to Help Manage Diarrhea* Your doctor or pharmacist may recommend a non-prescription diarrhea medication. To help constipation: Exercise if you can. Drink plenty of fluids (8 cups a day). Try the ideas in Suggestions for Dealing with Constipation.* Do not drive a car or operate machinery if you are feeling tired. Your doctor may do a blood test to make sure your thyroid gland is working properly. Try the ideas in Your Bank of Energy Savings: How People with Cancer Can Handle Fatigue.* Brush your teeth gently after eating and at bedtime with a very soft toothbrush. If your gums bleed, use gauze instead of a brush. Use baking soda instead of toothpaste. Make a mouthwash with ½ teaspoon baking soda or salt in 1 cup warm water and rinse several times a day. Try the ideas in Food Ideas to Try with a Sore Mouth*. Try the ideas in Food Ideas to Cope with Taste and Smell Changes.* Try the ideas in Food Ideas to Help with Decreased Appetite.* BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 3/6 OTHER SIDE EFFECTS DURING TREATMENT Skin reactions such as rash, redness or dryness may sometimes occur. Hand-and-foot skin reaction may sometimes occur during sunitinib treatment. The palms of your hands and soles of your feet may tingle, become red, numb, painful, or swollen. Skin may also become dry or itchy. You may not be able to do your normal daily activities if blisters, severe pain, or ulcers occur. Skin or urine may sometimes become yellowish in colour. Hair may sometimes lose its natural colour and become grey or white. Hair loss is rare with sunitinib. If you lose hair, it will back once you stop treatment with sunitinib. Sugar control may sometimes be affected in diabetics. High blood pressure may sometimes occur. This can happen very quickly after starting treatment. MANAGEMENT Moisturizing creams can help prevent or reduce skin dryness. Wear loose-fitting cotton clothing. If skin reactions persist or get worse, contact your doctor. Avoid tight-fitting shoes or rubbing pressure to hands and feet, such as that caused by heavy activity. Avoid tight-fitting jewellery. Avoid shaving off blisters. Clean hands and feet with lukewarm water and gently pat to dry; avoid hot water. Apply a sunscreen with an SPF (sun protection factor) of at least 30. Apply lanolin-containing creams (e.g., BAG BALM, UDDERLY SMOOTH ) to hands and feet, liberally and often. Tell your cancer doctor or your nurse at the next visit if you have any signs of hand-andfoot skin reaction as your dose may need to be changed. This will return to normal once you stop treatment with sunitinib. If hair loss is a problem: Use a gentle shampoo and soft brush. Avoid use of hair spray, bleaches, dyes, and perms. Check your blood sugar regularly if you are diabetic. Your blood pressure will be checked during your visits to your doctor. You may be asked to check your blood pressure frequently between visits. Your doctor may give you medication if your blood pressure is high. Tell your doctor if you are already on blood pressure medication. Your doctor may have to adjust your dose. *Please ask your chemotherapy nurse, pharmacist, or dietician for a copy BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 4/6 INSTRUCTIONS FOR THE PATIENT It is important that you measure your blood pressure frequently at home, in particular in the beginning of your treatment (especially in the first 2 cycles of therapy). Keep a journal of your daily measured blood pressure to submit to your physician with your next visit. Sometimes sunitinib can cause increased blood pressure very quickly after initiation of therapy. It is important to take sunitinib exactly as directed by your doctor. Make sure you understand the directions. You may be given more than one capsule in different strengths to make up your dose. You may take sunitinib with food or on an empty stomach. If you miss a dose of sunitinib, take it as soon as you can if it is within 12 hours of the missed dose. If it is over 12 hours since your missed dose, skip the missed dose and go back to your usual dosing time. If you vomit the dose of sunitinib within 30 minutes of taking it, you can repeat the dose. Let your doctor know as a medication to prevent nausea may be required for future doses. The drinking of alcohol (in small amounts) does not appear to affect the safety or usefulness of sunitinib. It is not known if sunitinib causes sterility in men or menopause in women. If you plan to have children, discuss this with your doctor before being treated with sunitinib. Sunitinib may harm the baby if used during pregnancy. It is best to use birth control while being treated with sunitinib. Tell your doctor right away if you or your partner becomes pregnant. Do not breast feed during treatment. Store sunitinib capsules out of the reach of children, at room temperature, away from heat, light, and moisture. Tell doctors, dentists, and other health professionals that you are being treated with sunitinib before you receive any treatment from them. Medication Interactions Other drugs such as ketoconazole and rifampin may interact with sunitinib. Tell your doctor if you are taking these or any other drugs as you may need extra blood tests or your dose may need to be changed. Check with your doctor or pharmacist before you start taking any new drugs. Avoid grapefruit and grapefruit juice for the duration of your treatment with sunitinib, as these may interact with sunitinib. THE FOLLOWING INFORMATION IS VERY IMPORTANT STOP TAKING SUNITINIB AND SEE YOUR DOCTOR OR GET EMERGENCY HELP IMMEDIATELY IF YOU HAVE: Signs of an infection such as fever (over 100 F or 38 C by an oral thermometer), shaking chills; cough, severe sore throat, productive cough (coughing up thick or green sputum); cloudy or foul smelling urine; painful, tender, or swollen red skin wounds or sores. Signs of bleeding problems such as black, tarry stools; blood in urine; pinpoint red spots BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 5/6 on skin; extensive bruising. Signs of heart or lung problems such as fast or uneven heartbeat, chest pain, chest pressure, shortness of breath or difficulty in breathing, swelling of ankles, or fainting. SEE YOUR DOCTOR AS SOON AS POSSIBLE (DURING OFFICE HOURS) IF YOU HAVE: Severe skin reactions. Signs of anemia such as unusual tiredness, weakness, or dizziness. Pain which is not controlled with acetaminophen (e.g., TYLENOL ). CHECK WITH YOUR DOCTOR IF ANY OF THE FOLLOWING CONTINUE OR BOTHER YOU: Uncontrolled nausea, vomiting, diarrhea, or constipation. For diabetics: uncontrolled blood sugars. Easy bruising or minor bleeding such as nosebleeding. Redness, swelling, pain, or sores on your lips, tongue, mouth, or throat. Skin rash or itching. Watery or puffy eyes. If you experience symptoms or changes in your body that have not been described above but worry you, or if any symptoms are severe, contact: at telephone number: BC Cancer Agency Protocol Summary (Patient Version) UGIPNSUNI 6/6
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