Clear-Cell RCC: Best Practices in Patient Monitoring
Expert insight into monitoring patients with advanced kidney cancer, covering the frequency of clinic visits, blood work, and CT scans, as well as signs and symptoms that might indicate disease progression.
Summary:
The patient under discussion received cabozantinib in the second line for refractory kidney cancer, progressing further and subsequently undergoing third-line treatment with tivozanib. The TIVO-3 trial, which led to tivozanib’s approval for refractory kidney cancer, demonstrated its superiority over sorafenib in patients with highly refractory disease, having undergone at least two prior treatment regimens.
Tivozanib, a potent VEGF receptor tyrosine kinase inhibitor (TKI), distinguishes itself from other TKIs like cabozantinib due to its more selective VEGF inhibition, resulting in less off-target toxicity. The trial exhibited increased hypertension with tivozanib compared to sorafenib, but notably, there was less diarrhea and hand-foot syndrome. The observed overall survival trend favored tivozanib with a hazard ratio of 0.89, although statistical significance was not reached. The unique toxicity profile of tivozanib makes it a potential option for patients intolerant to other TKIs, particularly those experiencing dose-limiting toxicities like diarrhea or hand-foot syndrome. However, its suitability may be compromised in patients with preexisting hypertension on multiple medications, as tivozanib could exacerbate blood pressure issues.
When analyzing trial data, it’s crucial to consider the comparator drug, and in TIVO-3, sorafenib served as the control. This trial enrolled patients at the third and fourth lines of treatment, showcasing its applicability in a heavily pretreated population. The patients in TIVO-3 appeared relatively healthier with lower ECOG performance status scores, a point to note when translating the findings to real-world scenarios where patients may have more compromised health. One speaker emphasizes the importance of supportive care, especially in the third- and fourth-line settings. While TIVO-3 presented tivozanib as a valuable tool for refractory disease, supportive care plays a pivotal role in managing patients with treatment-related adverse effects, contributing significantly to their overall well-being and potentially extending life. This nuanced approach ensures that treatment decisions align with individual patient needs and health status.
Summary is AI-generated and reviewed by Cancer Network editorial staff.
