Axitinib is an oral multikinase inhibitor, which is licenced for use in advanced renal cell carcinoma after failure of prior systemic treatment. We have assessed the efficacy and general tolerability of axitinib in a real world setting and audited our local dose escalation/reduction practice.
Using our electronic patient records and chemotherapy prescribing systems, 43 patients with advanced renal cell carcinoma on axitinib were identified.
31 patients had clear cell carcinoma, 12 had papillary withFirst 17 females and 26 males between the ages of 37-86 years (median of 69). First line: 5patients within A PREDICT trial. Second line: 33 patients who had sunitinib (n = 17), pazopanib(n = 14), everolimus (n = 1), interferon alfa (n = 1) as first line. 4 patients had axtinib as third line, 1 as fourth line treatment after failure of previous systemic treatment lines. 39 (90.7%) patients were commenced on 5mg, 3(6.9%) on 3mg due to borderline performance status and 1 on 7mg for reasons unknown. 28 (65%) reported fatigue with 18 (41.9%), requiring either treatment breaks or steroid use.20 (46.5%) had hypothyroidism. 14 (32.5%) had grade 2-3 hypertension. 7(16.3%) had grade 1-2 diarrhoea. 2 (4.65%) had grade 2 palmar plantar syndrome. Doses were escalated in 15 cases. In 4 cases from 5mg to 7mg due to disease progression (cycles 4, 9,10) and in 11 cases due to good tolerance. Dose of 10mg was achieved in 2 cases. In 2 cases the doses were reduced back from 7mg to 5mg due to grade 3 fatigue Doses were reduced 13 cases. In 7 cases, dose reduction from 5mg to 3mg due to grade 3 fatigue. (n = 4) and grade 2-3 diarrhoea (n = 3). In 3 cases dose reduction from 5mg to 4mg due to grade 3 fatigue (n = 2) and grade 3 diarrhoea (n = 3). In 15 (34.8%) cases, neither escalation nor reduction was done, only 3 had grade 2 side effects of anorexia, 1 of diarrhoea and 1 had a grade 3 hypertension. The remaining 8 (18.6%) either had grade 1 side effects or no side effects and would have benefited from a dose increase. The average no of axtinib cycles to progression was 10.3 (range 2-34).
Side effects experienced are similar to those listed in the literature. Patients commenced on appropriate doses. Changes currently being made to prescribing system to facilitate appropriate changes to doses.
The Royal Free Hospital Hampstead
Has not received any funding
All authors have declared no conflicts of interest.