Side Effects

After twelve weeks of targeted therapy using the Pfizer drug Sutent, I had a “restaging” CT scan, which happily showed no new tumors, no growth in the existing tumors, and even shrinkage of some existing tumors. In short, the drug has been doing exactly what it was designed to do, and I am happy with the results to date.

Like any drug therapy, of course, the results come at a price, namely, side effects. To summarize for myself as a benchmark but also for readers who may be experiencing similar side effects, I devote this post to a compendium of the side effects I have experienced and how I have dealt and continue to deal with them. Fair warning: There have been quite a few and so this post will be lengthy.

I take Sutent daily for two weeks, then take a rest week, and repeat. During the three-week cycle I can usually count on one-and-a-half to two weeks of feeling few if any side effects. They tend to increase toward the end of the cycle and then last until about halfway through my rest week. After several cycles, this pattern is now reasonably predictable, which is helpful for planning work, travel, and other activity schedules.

Tiredness. A common and noticeable side effect is simply that I tire easily. On days when I’m tired, I moderate activities. Most days I take a rest period after lunch, which on tired days becomes a siesta. Being semi-retired, plus working at home, makes it easy to schedule this type of downtime.

Mouth soreness. Principally my tongue but also my gums become quite sensitive. That demands a switch in diet. No food or drink that is hot, cold, spicy (even mildly), or crunchy. Soups, puddings, applesauce, melty ice cream, and so forth become the order of the day. I have seen reports that some people have had to eliminate caffeine. I haven’t, or at least not entirely, but then I tend to drink only two cups of coffee a day in any case. On sore days I let the coffee (or any hot food or beverage) cool to tepid.

Skin dryness and tenderness. My lips and hands become noticeably dry, and so I use lip balm liberally and slather on Bag Balm as hand cream. When my hands are tender, I avoid spending too much time with them wet (such as washing dishes) and wear gloves for cleaning or gardening. My bamboo-based gardening gloves are a godsend. The dryness, incidentally, extends to the nasal mucosa, which means I get spontaneous nosebleeds. It can be disconcerting to suddenly find oneself dripping blood, but fortunately the nosebleeds are fairly readily stopped. During one cycle the skin of my feet also became tender, but it only happened that one cycle so far. Another issue is that the drug sometimes increases my eczema, which is mostly a minor problem. Fortunately I have a prescription cream that helps relieve it.

Constipation/diarrhea. Initially I was taking Ondansetron as an anti-nausea drug, which was prescribed to be taken one-half hour before the daily Sutent. As I never experienced any nausea at all, I decided to try skipping it. Happily, the Sutent does not produce nausea on its own in my case. The anti-nausea drug, however, made me constipated, and so I took generic Benefiber daily. Sutent on its own, for me, doesn’t produce constipation but something close to its opposite—not full-out diarrhea but loose, occasionally urgent stools. I’m still working to get a good handle on treating the problem, but Benefiber seems to help with this problem as well.

Blood pressure issues. I normally take two prescription drugs to control my high blood pressure, and the second one tends at times to lower my pressure a little too much. While I’m taking Sutent, however, I need to add a third prescription because the targeted therapy drug tends to make my blood pressure run high. Timing when to take or skip the third BP med is a bit of a guessing game. On the whole I prefer to err on the side of having BP readings that are lower rather than higher than normal.

Acidic stomach/esophagus. During the past couple of cycles, eating became rather painful because of excessive sensitivity and acidity. Watching what I eat helps, and so far a few Rolaids have been enough to address the problem, I seldom need to take more than four or five tablets on my worst days. When acidity is running high, I do moderate coffee, opting for about half a cup (tepid) at breakfast and a cooled latte midafternoon. And no alcohol on sensitive days. At other times I can still manage a cocktail in the evening, but light on the alcohol.

Hair issues. The first thing I noticed was that all of the little remaining color in my mustache and goatee disappeared. That doesn’t seem to have happened to the hair on my head; however, that hair does seem to be thinning. I have used a generic form of Rogaine for several years, but it’s never been entirely a winning proposition. So natural thinning may, or may not, be abetted by the targeted therapy drug.

Watery eyes and nose. Sutent tends to make the area around my eyes puffy, especially in the morning. I am prone to tears for no reason at times, and when I eat it’s quite likely that my eyes will weep and my nose will run. Apart from some slight inconvenience, this side effect is merely a nuisance.

Depression. I tend to be somewhat depressive at the best of times; it’s a family characteristic. Mostly it’s manageable and I have only tried anti-depressant medication on two occasions during my life, neither of them in recent years. The cancer drug seems to ramp up any latent depression, but the effect tends to last only for three or four days at a time. During that period I am likely to find myself crying, usually over acts of kindness. It’s odd and embarrassing. But I just put up with the effect and let it pass.

Well, that’s the laundry list. It may be useful in the future for me to look back at this and see whether, or how, things change. For readers, I hope the compendium is somewhat useful. On the whole, my side effects, compared to other reports I’ve read, are fairly light and manageable. I’m certainly grateful for that. And if the drug is successful, then there’s good reason to deal proactively with the side effects.