BACKGROUND: Sunitinib malate is approved multinationally for the treatment of metastatic renal cell carcinoma (mRCC) and advanced imatinib-refractory gastrointestinal stromal tumour (GIST). Greater exposure to sunitinib is associated with improved efficacy. Therefore, minimising the impact of adverse events (AEs) on patient quality of life is important to enable patients to achieve optimal exposure to sunitinib and maximum clinical benefit. DESIGN: This report describes four patient cases in which sunitinib was utilised for the management of advanced malignancies: two cases describe mRCC patients who received first-line sunitinib and two cases describe the use of targeted therapies, including sunitinib, in patients with advanced GIST. RESULTS: In all four cases, effective AE management enabled patients to receive long-term therapy with sunitinib and achieve sustained clinical benefit. The two mRCC cases show prolonged responses and manageable AEs with sunitinib. The two GIST cases demonstrate that patients with imatinib-refractory GIST with KIT exon 9 mutations, including elderly patients, can achieve sustained responses to sunitinib. CONCLUSIONS: These case studies support the long-term efficacy and safety of sunitinib in the management of mRCC and imatinib-refractory GIST and demonstrate how AE management can be used to optimise patient responses.