Sunitinib

INTRODUCTION

Indications

Gastrointestinal stromal tumor which has progressed on or intolerance to imatinib. Advanced renal cell carcinoma.

Action

Inhibits multiple receptor tyrosine kinases, which are enzymes implicated in tumor growth, abnormal vascular growth. and tumor metastases. Therapeutic Effects: Decreased tumor spread.

Adverse Reactions/Side Effects

CNS: fatigue, dizziness, headache. CV: CHF, hypertension, peripheral edema, thromboembolic events. GI: diarrhea, dyspepsia, nausea, stomatitis, vomiting, altered taste, anorexia, constipation, ↑ lipase/amylase, ↑ liver enzymes, oral pain. Derm: alopecia, hand-foot syndrome, hair color change, rash, skin discoloration. Endo: adrenal insufficiency, hypothyroidism. F and E: dehydration, hypophosphatemia. Hemat: HEMORRHAGE, anemia, lymphopenia, neutropenia, thrombocytopenia. Metab: hyperuricemia. MS: arthralgia, back pain, limb pain, myalgia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately if these signs occur.

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician or nursing staff immediately.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician or nursing staff.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of thromboembolic events, including venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and arterial thrombosis (extreme coldness in the hands and feet, cyanosis, muscle cramping). Notify physician immediately, and request objective tests (Doppler ultrasound, others) if thrombosis is suspected.

• Assess any muscle, joint, back, or limb pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

• Monitor signs of low phosphate levels (hypophosphatemia), including skeletal muscle dysfunction or weakness, respiratory muscle weakness, and mental status changes such as irritability and confusion that progresses to delirium and coma. Report these signs to the physician.

• Report signs of adrenal insufficiency, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

• Monitor and report a decrease in metabolism that might indicate hypothyroidism. These signs typically include bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix ...