1. Which patients can use sunitinib? Which patients should not use it?
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Sunitinib (sotan) is recommended for first-line treatment of advanced clear cell type renal cell carcinoma. However, it should be used with caution in the presence of thyroid dysfunction, significantly decreased left ventricular ejection fraction (LVEF), chronic heart disease (chronic heart failure, coronary artery disease, etc.), and severe uncontrolled hypertension.
2. How do I take sunitinib? How long do I have to take it?
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Sunitinib is administered as 50 mg daily by mouth on a 4/2 regimen (4 weeks on, 2 weeks off).
Some patients who experience hematologic toxicities (decreased neutrophil count, decreased platelet count, anemia, etc.) after receiving the 4/2 dosing regimen of sunitinib may choose the 2/1 regimen (2 weeks on, 1 week off) with improved tolerability and unaffected efficacy.
How long you take the drug depends on when you become resistant to the drug, and non-resistant cases require continuous dosing, just like hypertension treatment, where the drug cannot be stopped to maximize survival.
3. Does sunitinib work in patients with metastasis-free kidney cancer?
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Metastasis-free kidney cancer is defined as limited kidney cancer with tumors confined to the peritoneum of the kidney, including TNM staging of T1 to 2 N0M0.
In May 2016, a double-blind, placebo-controlled, randomized, phase III clinical trial published in the Lancet, a leading international medical journal, showed that patients with metastasis-free kidney cancer treated with adjuvant sunitinib showed no survival benefit compared with placebo, meaning that patients with metastasis-free kidney cancer did not benefit from taking sunitinib.
4. Can I take sunitinib for lung metastases?
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Lung is the most common site of metastasis in kidney tumors. You can take sunitinib for lung metastases from advanced kidney cancer, taking it as described above, with regular follow-up CTs to monitor whether the metastatic lung cancer has shrunk or even disappeared. The drug can be taken as described above, with periodic follow-up CTs during this period to monitor whether the metastatic lung cancer shrinks or even disappears.
5. Can sunitinib cause serious side effects?
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Sunitinib can cause some serious side effects. Some of the serious, potentially life-threatening adverse reactions (III/IV) and their incidence are as follows:
- Hand and foot skin reactions 6% to 17%;
- Diarrhea 4% to 9%;
- hypertension 8% to 12%;
- Thrombocytopenia 10% to 23%;
- Neutropenia 15% to 18%;
- Decreased cardiac ejection fraction 2% to 3%.
6. What if I don’t work on sunitinib?
After the failure of sunitinib as first-line treatment, we can choose second-line treatment options such as axitinib (5 mg twice daily), everolimus (10 mg once daily), and cabozantinib (60 mg once daily, but its not currently available in China and cannot be bought).
In addition, if second-line therapy also fails, then third-line therapy may be an option, but it is mostly in the clinical research phase and it is difficult to determine the efficacy. There have been reports of better outcomes with continued treatment with a change in the dose of sunitinib after failure of second-line therapy.
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7. What is the approximate cost of sunitinib treatment? Is it covered by Medicare? Are there complimentary drugs?
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Sunitinib costs more than $4300 per vial for one week, and is currently covered by health insurance in China, with proportional reimbursement based on the type of health insurance, and the related charity campaign has ended.