Klertis (Sunitinib)

Klertis (sunitinib) acts on multiple receptor tyrosine kinases involved in tumor angiogenesis and cell proliferation, making it useful in several oncology settings.

• Renal cell carcinoma: slows disease progression and extends survival in advanced cases.
• Gastrointestinal stromal tumour: reduces tumour growth in patients with unresectable or metastatic disease.
• Pancreatic neuroendocrine tumour: controls tumour growth in advanced, well‑differentiated forms.

• Sunitinib inhibits a spectrum of receptor tyrosine kinases—including VEGFR, PDGFR, KIT, FLT3 and RET—thereby blocking signalling pathways that promote angiogenesis, tumor cell proliferation and survival. By disrupting these pathways, the drug reduces blood‑supply to tumours and impairs their growth potential.

Sunitinib is associated with a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Fatigue: persistent tiredness affecting daily activities.
• Hypertension: elevated blood pressure requiring monitoring.
• Hand‑foot syndrome: redness, swelling or pain on palms and soles.
• Nausea and vomiting: gastrointestinal discomfort.
• Diarrhoea: loose stools that may lead to dehydration.
• Stomatitis: inflammation or ulceration of the mouth.

Serious or Rare Side Effects

• Cardiac failure: reduced heart function, potentially life‑threatening.
• Severe hypertension: sudden, high blood pressure spikes.
• Hepatotoxicity: liver enzyme elevations or liver injury.
• Bleeding events: gastrointestinal or intracranial haemorrhage.
• Thromboembolic events: blood clots in veins or arteries.
• Neutropenia: marked decrease in neutrophil count, increasing infection risk.

Before initiating therapy with Klertis, clinicians should evaluate several safety parameters.

• Blood pressure monitoring: control hypertension before and during treatment.
• Cardiac assessment: baseline and periodic evaluation of left‑ventricular function.
• Liver function tests: monitor transaminases and bilirubin levels.
• Bleeding risk: assess for coagulopathy or concurrent anticoagulant use.
• Hypersensitivity: discontinue if severe allergic reactions occur.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Sunitinib may interact with other medicines, altering its effectiveness or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): increase sunitinib exposure and toxicity.
• Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine): reduce sunitinib levels, compromising efficacy.
• Anticoagulants (e.g., warfarin, direct oral anticoagulants): heighten bleeding risk.

Moderate Interactions (Monitor Closely)

• CYP3A4 substrates with narrow therapeutic index (e.g., cyclosporine, tacrolimus): may require dose adjustments.
• CYP2C9 or CYP2C19 inhibitors (e.g., fluconazole, omeprazole): modestly raise sunitinib concentrations.
• Antihypertensive agents: blood pressure may fall further; monitor and adjust as needed.