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For individuals with metastatic renal cell carcinoma who have progressed on earlier regimens, such as axitinib, this study found Tivozanib to be effective.

Metastatic renal cell carcinoma (mRCC) is a challenging and complex disease to manage. Recent advancements in mRCC management have led to combinations of immune checkpoint inhibitors and vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs) being used. Tivozanib is a highly specific VEGFR-TKI that has been approved by the FDA for patients with relapsed or refractory mRCC following two or more systemic therapies. 

The Evolution of mRCC Treatment 

In recent years, the treatment of mRCC has progressed to include combinations of immune checkpoint inhibitors and VEGFR-TKIs. This approach has significantly improved the outcome for patients diagnosed with mRCC.

There has been speculation that tivozanib may not be as effective in patients who have previously used axitinib due to their similar mechanisms of action. However, the TIVO-3 trial aimed to investigate this by studying the outcomes of such patients, and the results have been published in the journal Oncologist.

Comparing Tivozanib and Sorafenib for Advanced Renal Cell Carcinoma

The study included 457 patients with advanced RCC. Of these, 350 patients were randomized to receive either tivozanib or sorafenib. Additionally, 172 (49%) patients had previously received treatment with axitinib.

Tivozanib in Advanced Renal Cell Carcinoma Patients

The study found that tivozanib was associated with a significant progression-free survival (PFS) benefit over sorafenib, particularly in patients who had previously received treatment with axitinib. The median PFS was 5.5 months in the tivozanib group compared to 3.7 months in the sorafenib group (HR 0.68). The response rate (RR) was also higher in the tivozanib group compared to the sorafenib group (13% vs. 8%). These findings were consistent regardless of the line in which the study treatment was rendered.

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Incidence of Treatment-Related Adverse Events in Axitinib-Pretreated Patients
Treatment-related adverse events were reported among 145 patients who had received prior treatment with axitinib, with 28% requiring a dose reduction, 53.3% requiring a treatment interruption, and 25.6% requiring treatment discontinuation.

It was concluded that tivozanib provides an additional treatment option for patients with mRCC who have progressed on prior therapies, including axitinib.

Source:
Meza, L., McDermott, D. F., Escudier, B., Hutson, T. E., Porta, C., Verzoni, E., Atkins, M. B., Kasturi, V., Pal, S. K., & Rini, B. (2023). Tivozanib in Patients with Advanced Renal Cell Carcinoma Previously Treated With Axitinib: Subgroup Analysis from TIVO-3. Oncologist, 28(3), e167-e170. https://doi.org/10.1093/oncolo/oyac255