×

Sunitinib side effects haven’t sidelined avid runner

BY SHELBY KNOWLES
MDedge News

Axel Reissnecker goes for a run on a wilderness trail near his home in Austin, Texas.
 
Standing in the middle of the road facing an impending stampede, Axel Reissnecker paused to contemplate his next move. The native German had never encountered a herd of 200 cattle in the middle of tall Kansas prairie grass before. He was halfway through his 100-mile-long distance race – one of many he’s completed in his life — when the cattle started running toward him. As they neared, the spooked cattle suddenly split left and right, avoiding the runner.
“It was my toughest race, and quite a memorable experience.” Mr. Reissnecker

The avid athlete and resident of Austin, Tex., has competed in some of the most intense endurance races – from completing the Austin Marathon 10 consecutive times and the Pikes Peak marathon, to running long-distance trail races in Big Sur, Calif.

When Mr. Reissnecker was diagnosed with stage IV renal cell carcinoma, he knew quitting his active lifestyle wasn’t an option.

“I didn’t want my illness to determine what I could do. I really wanted to keep on doing what I love as long as I can, so I tried to keep my routine the same. Of course, it impacts you – I cannot run as fast as I used to – but you learn to live with it,” Mr. Reissnecker said.

He was diagnosed with renal cell carcinoma in September 2012, after finding a lump in his sinuses. A biopsy, followed by uncontrollable bleeding, led to a diagnosis of cancer and surgery to remove the tumor around his sinuses. The next step was a full body scan to locate where the cancer originated. After a diagnosis of metastatic renal cell carcinoma, a second laparoscopic surgery removed Mr. Reissnecker’s left kidney and lymph nodes surrounding it.

Despite his hand-foot syndrome, Reissnecker still runs 100 Kilometer, ultra-marathon races
Renal cell carcinomas have a predilection for the airways and a propensity for bleeding, Mr. Reissnecker’s oncologist, Debra Patt, MD, MPH, said in an interview.

“Kidney cancers metastasize quite a bit to the oropharynx, but the sinuses are a bit more unusual,” said Dr. Patt, vice president of public policy and academic affairs at Texas Oncology and a medical oncologist at Texas Oncology Cancer Center, Austin.

Dr. Patt has been treating Mr. Reissnecker’s cancer with sunitinib (Sutent). Although the multitargeted tyrosine kinase inhibitor can stop or slow the growth of tumors, as well as new blood vessels, it comes with some downsides, including the risk of hand-foot syndrome.

For Mr. Reissnecker, hand-foot syndrome, causing pain and swelling on the soles of his feet, along with the constant pounding of his feet on the trails, made his endurance races all the more challenging.

“One of the first races I competed in after starting the treatments, I didn’t finish,” he said. The hand-foot syndrome, coupled with shortness of breath – another side effect of his cancer treatments – made finishing impossible.

Debra Patt, MD, MPH, MBA, treats Axel Reissnecker for his RCC at her office in Austin, Texas. Dr. Patt is the vice president of Public Policy and Academic Affairs at Texas Oncology and a medical oncologist at Texas Oncology Cancer Center.
“I was peeved,” he said. “But then, I adjusted.”

The hand-foot syndrome comes in waves, Mr. Reissnecker said, so he switched to cycling on some days to keep up his endurance. While the pain is always present, peak days usually mean cycling instead of running. Cycling and spin classes keep the pain in his feet at a minimum: Instead of the intense beating of running and the impact of footstep after footstep, cycling causes a more constant, but bearable, numbness.

He now plans his races around his treatment. But according to Mr. Reissnecker, these are all minor adjustments.

“You learn to live with it,” he said. “One of the things I learned was to not take everything for granted or lift up the defeats.”

In its own way, running is therapeutic for Mr. Reissnecker.

“It makes me quiet, clears out my mind” he said. “Some people do yoga for mental clarity. I run. It makes me more emotionally balanced and helps me overcome difficult situations.”