(235) Understanding and Managing Oral VEGF Inhibitor Toxicities in Renal Cell Carcinoma

Poster Abstract: Background/rationale:
Oral VEGF inhibitors have changed the therapeutic landscape of metastatic renal cell carcinoma. Although these agents have improved clinical outcomes, they also display a wide variety of adverse events that can affect quality of life. In previous clinical trials, 60-80% of patients required dose reduction or interruptions and up to 20-50% of patients discontinued therapy dose due to adverse effects. Often time’s patients in the real-world setting have more comorbidities and are not monitored as closely as study patients which could lead to significant complications, so pharmacists can play a big role in medication adherence and toxicity management. This project seeks to evaluate current toxicity rates and adherence with renal cell carcinoma oral VEGF inhibitors and to look for opportunities for pharmacists to improve patient care.

Objective(s):
The purpose of this study is to determine if the real world rates of adverse effects are similar to those seen in clinical trials and assess a pharmacist’s role in providing supportive care to patient experiencing adverse effects.

Methods:
To identify a study population, investigators referenced a list of patients who filled cabozantinib, axitinib, or lenvatinib at our institution’s specialty pharmacy from 2018 to 2023. Retrospective chart review was then completed to collect the VEGF inhibitor regimen, onset and duration of adverse events, required dose reductions or omissions, reason for discontinuation, antihypertensive added during therapy, adverse event leading to corticosteroid use, or any toxicity requiring referral, hospitalization, or addition of supportive care medications.

Results:
Results pending.

Discussion/conclusion:
Pending based on results.

References (must also be included in final poster): - Schmidinger M, Danesi R. Management of Adverse Events Associated with Cabozantinib Therapy in Renal Cell Carcinoma. Oncologist. 2018 Mar;23(3):306-315. doi: 10.1634/theoncologist.2017-0335. Epub 2017 Nov 16. PMID: 29146618; PMCID: PMC5905684.
- Choueiri TK, Hessel C, Halabi S, et al. Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): Progression-free survival by independent review and overall survival update. Eur J Cancer. 2018 May;94:115-125. doi: 10.1016/j.ejca.2018.02.012. Epub 2018 Mar 20. Erratum in: Eur J Cancer. 2018 Nov;103:287. PMID: 29550566; PMCID: PMC6057479.
- Motzer RJ, Escudier B, Tomczak P, et al Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol. 2013 May;14(6):552-62. doi: 10.1016/S1470-2045(13)70093-7. Epub 2013 Apr 16. Erratum in: Lancet Oncol. 2013 Jun;14(7):e254. PMID: 23598172.
- Motzer R, Alekseev B, Rha SY, et al. CLEAR Trial Investigators. Lenvatinib plus Pembrolizumab or Everolimus for Advanced Renal Cell Carcinoma. N Engl J Med. 2021 Apr 8;384(14):1289-1300. doi: 10.1056/NEJMoa2035716. Epub 2021 Feb 13. PMID: 33616314.
- Mayer, B., Carroll, E., Rhoades, M., & Zook, F. (2023, October 17). Tolerance of oral targeted agents in patients with advanced or metastatic RCC with and without renal impairment. The Journal of Hematology Oncology Pharmacy. 2023 October; Vol. 13, No. 5.