The new "smart" drugs are a really exciting element of cancer medicine. One of the new molecularly-targeted cancer drugs is Sutent. It is a "multi-targeted kinase inhibitor." A drug that inhibits several proteins involved in triggering replication in cancer cells. Basically, inhibits various kinases, a type of enzyme that transfers phosphate groups from high-energy donor molecules to specific target molecules.

Sutent (sunitinib) is an inhibitor of multiple protein kinases, platelet-derived growth factor (PDGFR), vascular endothelial growth factor receptors (VEGFR), stem cell factor receptor (KIT), FMS-like tyrosine kinase (Flt3), colony stimulating factor (CSF-1R), and the neurotrophic factor receptor (RET). Because these proteins are involved in both tumor proliferation and angiogenesis, Sutent has both anti-tumor as well as anti-angiogenic properties. In addition, because Sutent inhibits multiple kinases, it possesses activity against multiple types of tumors.

Sutent can be used as a second-line drug for tumors that are non-responsive to Gleevec. The proto-oncogene KIT, a tyrosine kinase that is inhibited by Gleevec, is overexpressed in a majority of GISTs. Some patients have suffered relapses due to acquired point mutations in KIT, which prevents Gleevec from binding to the protein. Similar mutations have been characterized in EGFR from Iressa-resistant lung cancer patients.

The largest group of kinases are Protein kinases, which act on and modify the activity of specific proteins. So people will try and get some sort of gene-based test to measure the expression-mutation of these kinases. But something more elemental is going on. Does the drug even enter the cell? Once entered, does it immediately get metabolized or pumped out, or does it accumulate?

Sutent is conveniently pigmented. Brilliant yellow. Easy to see which cells have taken it up. In photomicrographs (two magnifications), it is fairly easy to see that some clones of tumor cells don't accumulate the drug. These cells won't get killed by it. But you wouldn't pick this up with an assay which only measured the kinases themselves. The new EGFRx (TM) Assay measures the net effect of everthing which goes on (Whole Cell Profiling). Are the cells ultimately killed, or aren't they?

Normal chemotherapy kills both cancer cells and healthy normal cells (mainly rapidly-dividing cells). Oncologists try to minimize damage to normal cells and to enhance the cell-killing effect on cancer cells. Too often, this delicate balance is not achieved.

Targeted therapy drugs interfere with specific molecules (receptors and enzymes inside and outside a cancer cell). By focusing on these molecular and cellular changes, targeted cancer drugs go after the "target" in these cells, rather than just all cells. Because of this, "targeted" drugs may be more effective than current treatments, and may be less harmful to normal cells.

Whole cell profiling can discriminate between the activity of different "targeted" drugs and identify situations in which it is advantageous to combine the "targeted" drugs with other types of cancer drugs. Because these new "smart" drugs will work for "some" but not "all" cancer patients who receive them, whole cell profiling can accurately identify patients who would benefit from treatment with molecularly-targeted anti-cancer therapies.

Not only is this an important predictive test that is available, but it is also a unique tool that can help to identify newer and better drugs, evaluate promising drug combinations, and serve as a "gold standard" correlative model with which to develop new DNA, RNA, and protein-based tests that better predict for drug activity.

This kind of technique exists, and might be very valuable, especially when active chemoagents are limited in a particular disease; it makes more sense than ever to test the tumor first. Afterall, cutting-edge techniques can often provide superior results over tried-and-true methods that have been around for many years.

The EGFRx (TM) Assay is the only assay that involves direct "visualization" of the cancer cells at endpoint. This allows for accurate assessment of drug activity, discriminates tumor from non-tumor cells, and provides a permanent archival record, which improves quality, serves as control, and assesses dose response in vitro.

My beautiful mother who is 69 years of age became ill with kidney cancer, had a partial neeufrectomy in september to remove a 6cm tumor-her other kidney never worked-neufrotic-it has now spread to her liver and lung-given 4-6 months to live-will sssstart sutent soon-they say it may exxxxteend her life a few more months-i wwonder if it is worth it-she has alreaddy ssuffered so much. I think there are worse things than death-itss just so hardd to let go-i hate thiss world sometimes

Sonia- Sorry to hear about your mother. I also have kidney cancer and had my left kidney and a large tumor removed on October 13. The cancer has spread to my lungs. I chose to take sutent because it could extend my life by months or perhaps longer. I am on my 3rd week of treatment and the side effects have been minor. The choice of taking or not taking sutent is tough. In my case, I was feeling fine and didn't want to make myself sick for what remaining time I had left. My family wanted me to take the drug to be able to spend more time with them and the grandkids. So far, I think the choice was right. Try to stay positive as it will help your mom through this tough period. Stay in touch and good luck.

My husband is on his 3rd round of Sutent. He has tolerated the drug fairly well but does have side effects. His feet are very sore, fells like blisters under the skin. I put Aveeno cream on his hands and feet to ease the pain. He has lost his taste, his throat gets sore also. He usually does not experience these
problems until about the third week of treatment. Overall he is just glad to still be around, he is into his 8th year of renal cell carsinoma. He had one kidney removed and did fine for 3/12 yrs., but now has mets in his only kidney along with lung and pancreas. He will be scaned in 6 wks to see if this has worked for him. We live one day a a time and give God the thanks to allow us to
see it. We hope and pray for the best for each of you.

Hi Wholmes, My husband had the same feelings as you about taking Sutent. He was doing ok and feared that he would become sick with side effects. The stress of living with advanced kidney cancer is hard but you learn to live one day at a time. It makes me so sad to read the message board but it comforts me somehow to know that we are not alone in this struggle. I wish the best for you and your fammily. It has become a family battle at our house. We are all in this together and I feel blessed to have people who care about us. I Pray that you and the others who are are in this struggle have the same.
God Blessings to all. Wanda

Dear Kidney Cancer Message Board Participants,

Because of all the discussion that has taken place on the message board, Vital Options will be focus on kidney cancer in the second hour of the Sunday, March 18th broadcast, 5-6pm EST, 2-3pm PST.

Please e-mail show questions to info@vitaloptions.org or call 1-800-477-7666 during the broadcast. Additional information about The Group Room can be found at www.vitaloptions.org.

Please let us know how we can help you and your loved ones.

Vital Options & The Group Room cancer talk radio show.

Thank you Wanda- Sorry it took so long to get back to you. I'm starting my second round of Sutent on Monday. It was great to taste food again. Did your husbands side effects, such as loss of taste, sore feet, etc. decrease with after each round of Sutent? I will have CT scans next month. I hope and pray for you and your husband. Keep in touch.

This Sunday, March 18th, on The Group Room cancer talk radio show from 5-6pm ET, 2-3pm PT, the discussion will focus on the treatment of kidney cancer. You are invited to call into the program at 1-800-477-7666 or e-mail questions to info@vitaloptions.org. Because of all the comments and thoughts you have posted on the Vital Options' message board, we hope this upcoming program will be helpful to you.

It was good to hear from you. Steve has not had a reduction of side effects, the third month was an increase in blisters on his hands and feet, but no sores in his mouth, he lost his taste the last two weeks but he has been off for 10 days now and it is slowly returning. It seems as he goes into each month the effects are different. Steve has caught a cold on every round, so try to stay away from people if you can. We have a 8 year old granddaughter so that is very hard. Scans are coming the 27th of March and this time the doctors are ordering a scan of his heart, as you know Sutent can be hard on it.
He has no symtoms I guess they are just being precautious. It is so good to talk to someone. I will pray that your next scans go well, our doctor in Charlotte, NC has seen some good results with this medication so we pray and wait for the results on the 27th. Every day is a blessing, we have been together since we were 16 and 17 so this battle is for both of us, and I pray that you too have support. God bless and hope to hear from you soon.

Hi Wholmes, I hope you are having a good day. My husband went for scans after taking his 3rd round of Sutent. We were able to hear some good news for a change. His tumors are srinking a little!! All of them were repsonding with shrinkage except the one in his kidney. But it remained stable. We consider this to be excellent results and his doctor was pleased too! He will start round 4 on 4-2. I pray that you get good results- please let me know how you are doing. (the one in his pancrease was half the size, PRAISE GOD)
I hope this is encouragement for all of the folks who are reading this and taking Sutent. God bless to all.

Hi Wholmes, I hope you are having a good day. My husband went for scans after taking his 3rd round of Sutent. We were able to hear some good news for a change. His tumors are srinking a little!! All of them were repsonding with shrinkage except the one in his kidney. But it remained stable. We consider this to be excellent results and his doctor was pleased too! He will start round 4 on 4-2. I pray that you get good results- please let me know how you are doing. (the one in his pancrease was half the size, PRAISE GOD)
I hope this is encouragement for all of the folks who are reading this and taking Sutent. God bless to all.

Hi Wholmes, I hope you are having a good day. My husband went for scans after taking his 3rd round of Sutent. We were able to hear some good news for a change. His tumors are srinking a little!! All of them were repsonding with shrinkage except the one in his kidney. But it remained stable. We consider this to be excellent results and his doctor was pleased too! He will start round 4 on 4-2. I pray that you get good results- please let me know how you are doing. (the one in his pancrease was half the size, PRAISE GOD)
I hope this is encouragement for all of the folks who are reading this and taking Sutent. God bless to all.

Hi Rose
my husband jerry has kidney that has spread to theliver. He has had his dose of
sutent for 28 days and has been off for 3 weeks. He had every side effect that
they said he'd have at different times. He lost a lot of weight because of not\being able to eat. He gets a fever late in the afternoon every day. the highest it's been 101.5 F. He has been feeling better and eating better in
the past 2 1/2 weeks since he went off the sutent.
He was supposed to have his kidney removed this past Monday, and because of
some mix-up in the hospital his surgery was cancelled and now we waiting on pins and needles for a new surgery date. We 're hoping that the removal of the
kidney will help slow down the spread of the cancer. Jerry is 75 years old and has never been sick a day in his life other than the usual thing, like a cold etc. We just found out about his cancer Feb 5th 07. and it was like being his
by a Mack truck. We have a hard time getting answers from the drs. call, are
messages always have to go through their nurses. Do you or anyone else out there
know how long the sutent keeps working after one stopes taking it ?
Jerry's next apt. with the Dr. isn't until May 11 and we are very worried that the cancer is spreading because he's not on any meds. now. We feel so helpless
but I guess that's normal. We've never been through anything like this before
so every thing is one new adventure after another. But for the grace of God
maybe we'll get through this, or at least, have a little more time togetgher.
I need a friend
Greta

Hi Greta, I am sorry to hear about Jerry. I was told the drug only stays in your system for a few days after stopping. I guess that is why my husband begins to get his taste back after about a week. If your doctor is not giving you answers maybe you should consider switching to another. Are you close to a bigger hospital that you could get a referral to another oncologist? I would be glad to talk to and maybe we could help each other. My husband Steve is coming up on the 9th anniversary of the onset of renal cell carcinoma. He has had a lot done to him over that time. God bless you and Jerry, I will lift you up to God. Remember when you get scared that God is in control.

Sutent and I have had a very interesting relationship. I divorced Nexavar at the first of the year. That stuff may have been hell on the tumors, but it was more hell on me. After my seventh turn on Sutent the doc had me take three weeks off as I was listless and fatigued. He thought it might be cumulative side effects. By the time I went back on I was feeling much better, so maybe so. He also gave me another round of mild steroids (for my brain mets) and could have made me feel better as well and therefore the fatigue and lack of appetite had nothing to do with Sutent. Boy, Forrest Gump got it right, kidney cancer se's are like a box of chocolates, you never know what you are going to get.

Two years of this has given me a little insight into both medicines, SE's and attitude. Take a look at my blog, if you like, at

www.mpablog.typepad.com/david.foster

My mother began on Sutent this month 50mg doses, after 8 days she had side effects including nausea and weakness.She quit taking the drug and still felt weak a week later thats when she had 3 seizures in the period of 90 minutes.Has anyone here had any seizures after starting this drug? She is 81 years old and never had one before.The MD said that the medicine could have caused this.They have run all kinds(eeg,mri) of tests but found no reasons for the cause

My husband has been on sutent for seven months now. Although the lesions in his lung and intestines have been shrinking he is finding it harder and harder to combat the nausea and vomiting. He also has alot of trouble with cold sweats and fatigue. We have tried many things but nothing seems to help and when we mention it to our doctor he just tells us to suck it up. Not very helpful.

Has anyone had any luck with any anti nausea medication. Also we would like to know if anyone has gone off the medication and then gone back on after a couple of months and had any success.

Right now he is feeling that it is not worth the extra time he might gain from sutent but if we could find something that would help then I would love to have the extra time that could be available.

Man, what a drug. So far it has kept my body tumors at bay (it has no affect on my brain mets, so they zapped them with the gamma-knife. I feel sooo high tech). I have chronicled a two year experience with all the cancer drugs for ARCC (avastin, nexavar and Sutent) in my blog

www.mpablog.typepad.com/david_foster

and that includes all my wars with side effects and the never ending battle with the concerns we all have. You might take a look.

David Foster

Man, what a drug. So far it has kept my body tumors at bay (it has no affect on my brain mets, so they zapped them with the gamma-knife. I feel sooo high tech). I have chronicled a two year experience with all the cancer drugs for ARCC (avastin, nexavar and Sutent) in my blog

www.mpablog.typepad.com/david_foster

and that includes all my wars with side effects and the never ending battle with the concerns we all have. You might take a look.

David Foster

Hi, my husband, Norv, has been on sutent for about 3 months. His hair is thinning, and coming back in curly. He has no taste and not much of an appetite. He had his left kidney removed about 8 years ago and thought all was well. Had no chemo or radiation as they said they had got it all. It showed up again in a polyp in his nose that started bleeding over a year ago. .Had it taken out and after diagnosis said it was renal cell carcinoma. After ctscan, found it has mestasized into his lungs and lymph nodes. Also into right hip. He had radiation on hip and several places on face and back of head. All went away. Ge started out on Nexavar. Felt really bad on it. Nothing shows up on a regular xray just on ctscan. He had been feeling really bad with feet hurting, skin on bottom of feet falling off, etc.on the Nexavar. Now that he is on Sutent All of a sudden last Friday evening, he said "you know I feel better and ever since he is feeling better every day. Doesn't have much strength he says. His hands hurt some and he has been on prednisone so long, his arms are all torn up with skin breaking and bleeding. We are hoping it is in remission or gone away. Good luck to you. Carol