Axitinib for the Treatment of Metastatic Renal Cell Carcinoma

Abstract

Axitinib is a novel, oral, multitargeted tyrosine kinase inhibitor, which inhibits vascular endothelial growth factor receptors 1, 2, and 3 at subnanomolar concentrations in vitro. In the phase III clinical trial in patients with metastatic renal cell carcinoma, axitinib showed a high objective response rate, and significantly prolonged progression-free survival compared with sorafenib. Thus, it is the first drug that has proven the concept of sequencing tyrosine kinase inhibitors in second-line treatment in a phase III prospective randomized trial. Although generally well tolerated and associated with a low incidence of grade 3 or 4 toxicities, axitinib shows a distinct pattern of adverse events that require monitoring and management. The most common adverse events observed with axitinib include diarrhea, hypertension, fatigue, nausea, and vomiting. This article summarizes the most important adverse events observed and proposes recommendations for their monitoring, prevention, and treatment. The recommendations are based on the existing literature and discussion by an expert group of international physicians and nurses specialized in oncologic treatment of metastatic renal cell carcinoma, which gathered in July 2011 in London, UK. Proactive assessment and management of adverse events during axitinib therapy can minimize treatment interruptions and ensure optimal effect of treatment.

New First Line Treatment Options of Clear Cell Renal Cell Cancer Patients with PD-1 or PD-L1 Immune-Checkpoint Inhibitor-Based Combination Therapies

“…Axitinib is associated with the well-known chronic VEGFR-TKI toxicity, most commonly diarrhea, hypertension, fatigue, hypothyroidism, hand-foot syndrome (palmar-plantar erythrodysaesthesia syndrome) and gastrointestinal side effects (nausea, loss of appetite, etc.) [15,16]. For ICIs, however, the main focus is on immune-mediated side effects.…”

Podcast to Discuss Therapy Management for Patients with Metastatic Renal Cell Carcinoma Receiving First-Line Axitinib Plus an Immune Checkpoint Inhibitor

“…When I use axitinib as a monotherapy in the refractory setting, the common toxicities are well-established toxicities for patients getting these VEGFR TKIs. That includes diarrhea, hypertension, fatigue, nausea, and vomiting [ 21 , 22 ]. And it really is important to understand the monotherapy toxicity because we're here today really to talk about the combination of toxicities.…”

Hematogenous Renal Cell Carcinoma Metastasis in the Postoperative Temporal Bone

“…Clinical application of molecular targeted therapy has been the first-line option for metastatic RCC since the beginning of this century [1]. Although median progression-free survival is reportedly 6–11 months with molecular targeted therapy, compared with 5–6 months with the previously dominant immunotherapy, molecular targeted therapy remains palliative [2]. Metastatic RCC cells can reach the head and neck area via normal hematogenous flow.…”