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Sunitinib is an anti-angiogenic pill approved for pancreatic neuroendocrine tumours, kidney cancer and GIST.
Sunitinib is an oral inhibitor of VEGFR1-3, PDGFR, KIT, FLT3 and RET that blocks tumour blood-vessel growth and, in GIST, the KIT driver itself. It is approved for advanced renal cell carcinoma and imatinib-resistant GIST (2006), progressive pancreatic neuroendocrine tumours (2011, 37.5 mg daily continuously) and, little used, as adjuvant therapy in high-risk RCC (S-TRAC, 2017). The pancreatic NET phase 3 (Raymond 2011) showed PFS of 11.4 versus 5.5 months and was stopped early for benefit. In kidney cancer it has been largely displaced by immunotherapy combinations and is the control arm they beat in CheckMate 214, KEYNOTE-426, CheckMate 9ER and CLEAR, while it is still standard second line in GIST. Fatigue, diarrhoea, hand-foot syndrome, hypertension and hypothyroidism are common. For a newcomer, sunitinib defined first-line kidney cancer treatment before immunotherapy.
Oral inhibitor of VEGFR1-3, PDGFR, KIT, FLT3, RET. Connects to VEGF / VEGFR and KIT.
1.Sunitinib slips into a pocket on VEGF / VEGFR.
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026). Generic sunitinib is available.
Multi-source generic on low-cost tiers; usually no prior authorisation. Cash prices without insurance are modest. Plans require the generic.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA169 · SMC advice: sunitinib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Advanced renal cell carcinoma
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
Advanced renal cell carcinoma
Confirmed: the accelerated approval of 2006 converted to traditional approval 1.0 year after it was granted.
| Region | Year | Indication |
|---|---|---|
| US | 2006 | Advanced RCC; GIST after imatinib |
| US | 2011 | Progressive pancreatic NETs |
| US | 2017 | Adjuvant RCC at high risk (S-TRAC), little used |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Diarrhoea | 59% | - |
| Nausea | 45% | - |
| Hypertension | 26% | 10% |
| Hand-foot syndrome | 23% | 6% |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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Sunitinib has the highest level of evidence of any drug for progressive metastatic phaeochromocytoma and paraganglioma, alongside the later approval of belzutifan.
Sunitinib remains the standard second-line treatment, with ripretinib as a better-tolerated alternative, and mutation-guided choice by circulating tumour DNA is being tested prospectively in INSIGHT.
Cabozantinib is the preferred first-line targeted therapy for metastatic papillary renal cell carcinoma; immunotherapy combinations are being tested on top of it.
Immunotherapy plus a VEGF kinase inhibitor is a first-line standard for advanced clear cell kidney cancer in all risk groups; comparable regimens include nivolumab-cabozantinib and lenvatinib-pembrolizumab.
Nivolumab-ipilimumab is a first-line standard for intermediate- and poor-risk clear cell kidney cancer, notable for durable complete responses and treatment-free intervals.
VEGF-directed therapy is the default for non-clear cell disease, with everolimus considered in chromophobe tumours; cabozantinib later became preferred for papillary disease.
The thymoma and thymic carcinoma pages follow this guideline for who gets surgery, radiotherapy and chemotherapy; its central message is that these rare tumours should be discussed in an expert network.
Regorafenib is the standard third-line treatment for GIST after imatinib and sunitinib.
Query for this drug: (TITLE:"Sunitinib" OR ABSTRACT:"Sunitinib" OR TITLE:"Sutent" OR ABSTRACT:"Sutent") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Sunitinib, not a curated reading list.
Shares ASPEN: everolimus versus sunitinib in metastatic non-clear cell renal cell carcinoma, Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Glucagonoma, VIPoma.
Shares A Study of Bempegaldesleukin (NKTR-214: BEMPEG) in Combination With Nivolumab Compared With the Investigator's Choice of a Tyrosine Kinase Inhibitor (TKI) Therapy (Either Sunitinib or Cabozantinib Monotherapy) for Advanced Metastatic Renal Cell Carcinoma (RCC), PAPMET (SWOG 1500): cabozantinib versus sunitinib for metastatic papillary renal cell carcinoma, TFE3-rearranged (translocation) renal cell carcinoma, PAPMET (SWOG S1500).
Shares Pembrolizumab (MK-3475) Plus Epacadostat vs Standard of Care in mRCC (KEYNOTE-679/ECHO-302), Cediranib, Desmoplastic small round cell tumour, Alveolar soft part sarcoma.
Shares KEYNOTE-426: pembrolizumab plus axitinib versus sunitinib for advanced renal cell carcinoma, KEYNOTE-426, Renal cell carcinoma (KEGG map), The angiogenic switch & tumour vessels.
Shares INTRIGUE: ripretinib versus sunitinib in advanced gastrointestinal stromal tumour after imatinib, A Study of Ripretinib vs Sunitinib in Advanced GIST Patients After Treatment With Imatinib, PDGFRA, KIT exon 11-mutant GIST.
Shares Glucagonoma, VIPoma, Somatostatinoma, Grade 3 well-differentiated neuroendocrine tumour.
Shares PAPMET (SWOG 1500): cabozantinib versus sunitinib for metastatic papillary renal cell carcinoma, Savolitinib vs. Sunitinib in MET-driven PRCC., Savolitinib Plus Durvalumab Versus Sunitinib and Durvalumab Monotherapy in MET-Driven, Unresectable and Locally Advanced or Metastatic PRCC, PAPMET (SWOG S1500).
Shares Sunitinib in advanced gastrointestinal stromal tumour after failure of imatinib, GRID: regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib, INTRIGUE: ripretinib versus sunitinib in advanced gastrointestinal stromal tumour after imatinib, PDGFRB.