Lucio on Sutent

[skyflower]

Lucio started on Sutent last night and this morning side effects were Cediranib-type fatigue. He's been back to super healthy eating and exercising regularly. Low-sugar diet, lots of raw healthy veggies and sprouts. Does anyone know if drinking green tea will interact with Sutent? It's in a similar class of drugs to Cediranib, and I'm not sure the rationale for Green Tea being a no-no for Cediranib, but it wasn't on the list of restrictions for Sutent. Definitely grapefruit juice is a no.

[Olga]

There is a review article that may be worth reading - they may have something about the food interactions there, they only provide an abstract for free but your oncologist may have an institutional access to it:

Tyrosine kinase inhibitors in treating soft tissue sarcomas: sunitinib in non-GIST sarcomas
Clinical and Translational Oncology
Volume 12, Number 7, 468-472, DOI: 10.1007/s12094-010-0539-z
Blanca Homet Moreno, Elena Garralda Cabanas and Ricardo Hitt
http://www.springerlink.com/content/bj80jx1857472565/

[skyflower]

Thanks Olga, Lucio's next appointment with his oncologist is later this week, so he will be sure to bring it up then.
Side effects- He had a strange itchy red rash appear on his chest, arms and back the first night, so we bought a few different ointments to test on different sides of his body (btw, the Aveeno with Calamine and Pramoxine HCl worked great). It cleared up on its own after 2-3 days and haven't been bothered with since. We used the creams maybe twice...
Food is bland, tasteless. But also his tongue is more sensitive- spicy stuff is spicier. Go figure. even Chipotle's mild salsa was still too spicy
Stomach issues, not as bad as Cediranib (so far, this is only first cycle). He'll have to elaborate, but his belly is tender and pressure is bad.
Fatigue. Late starts in the morning, very hard to get going.

Tomorrow Lucio starts his 2-week Sunitinib holiday. Is there a reason that the standard holiday is 2-weeks? I'm thinking it has something to do with the half-lifes of the Sunitinib and it's metabolites (thanks wikipedia!), is it a personal safeguard against toxic build-up or is it a schedule to continuously shock the tumors, like delaying the ability to develop resistance? i'm guessing it's the former, but we really don't know much about the meds. Is there a reason that Cediranib did not have a holiday schedule?
Lucio is quite big compared to some of the other patients, but he is on the same dosing schedule (4-weeks on/2-weeks off with 37.5-mg / 180 lbs (6'4", he lost a lot of weight on cediranib)). We've been talking about it a lot lately, and wonder if maybe a 1-week break is sufficient for a scheduled holiday, maybe he is too big for continuous dose 25-mg to be beneficial, but he really needs the short break from 37.5-mg. or maybe he should continue on the plan for a 2-week break. I think on R1507 the amount of drug given was a percentage of body mass, and i wonder if that is a factor for sutent, though there are only 4 real dosing options to play with because of the pill forms- 12.5-mg, 25-mg, 37.5-mg, and 50-mg.
He feels activity at the site of the mediastinal mass, just as he had in the first weeks of Cediranib. So we are hopeful about the next chest CT- in the next few months- to back up the feelings he is having. we do not have the benefit of having back-to-back CTs or PETs to see what kind of response he is having, and anyways he has had more than his fair share of diagnostic radiation.
I guess my biggest question is -is there a scientific reason behind having a (specifically) 2-week holiday? and next would be- are there body mass considerations that potentially influence dosage for continuous and on-off schedules?

[peeps]

I have been led to believe the reason for the two week off period is to give your body time to replace the cancer cells killed by the sutent with healthy cells. If too many dead cancer cells are prevalent in the body there is a chance of TLS (Tumour Lysis Syndrome) which occurs when large numbers of neoplastic cells are killed rapidly, leading to the release of intracellular ions and metabolic byproducts into the systemic circulation.
Although TLS is more common with blood cancers it can still be a problem especially if you are taking any alternative cancer treatment as well, such as DCA (Sodium Dichloroacetate).
TLS can be fatal.