(060) Documented Dose Modifications of Oral VEGF Tyrosine Kinase Inhibitors in Patients with Clear Cell Renal Cell Cancer

Poster Abstract: Background/Rationale
The management of advanced clear cell renal cancer (ccRCC) continues to evolve. Current practice guidelines include oral multitargeted tyrosine kinase inhibitors (TKI) that target vascular endothelial growth factor receptors (VEGFR) as a first line treatment option for advanced disease. Oral VEGF inhibitors have proven to be effective in treatment of ccRCC but are associated with both class-specific and agent-specific toxicities. Guidelines for dose modifications are outlined in FDA approved labeling for each drug, but it is unclear how frequently dose modification(s) of oral VEGF inhibitors occur in practice. This retrospective chart review of adults with ccRCC receiving oral VEGF inhibitor therapy aims to determine the frequency of documented dose modifications of oral VEGF inhibitors due to treatment-related toxicities. The results from this pilot study will help to provide insight into current practice and serve to develop strategies to optimize prescribing and recording of dose modifications of oral anticancer therapy for patients with ccRCC.

Objective
Determine the frequency of documented dose modifications within the first six months of therapy of oral VEGF inhibitor due to treatment-related toxicities when used in the treatment of metastatic ccRCC.

Methods
A single-center, retrospective study was conducted to evaluate the frequency of documented dose modification(s) of oral VEGF inhibitor within the first six months of therapy in individuals with metastatic ccRCC receiving an oral VEGF inhibitor alone or in combination with other anticancer therapies. For those patients with a documented dose modification, the frequency of temporary discontinuation(s), permanent discontinuation(s), dose reduction(s), and drug holiday(s) was determined. Patients included in the study were individuals 18 years of age or older with a diagnosis of ccRCC receiving one of the following VEGF inhibitors: sunitinib, pazopanib, axitinib, lenvatinib, cabozantinib. Eligible patients received treatment from August 2017 to December 2023. Study endpoints will be described with descriptive statistics. The study protocol was approved by the University of Cincinnati Institutional Review Board.

Results
Data collection is ongoing.

Conclusion/Discussion
Discussion and conclusion to be completed after data collection is complete.

References (must also be included in final poster): Hirsch L, Flippot R, Escudier B, Albiges L. Immunomodulatory roles of VEGF pathway inhibitors in renal cell carcinoma. Drugs 2020;80:1169-1181.

NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer version 2.2022. September 8, 2021. NCCN.org.

Paschke L, et al. AntiVEGF-TKI treatment and new renal adverse events not reported in phase III trials. Eur Thyroid J 2018;7:308-312.

Semeniuk-Wojtaś A, Lubas A, Stec R, Szczylik C, Niemczyk S. Influence of Tyrosine Kinase Inhibitors on Hypertension and Nephrotoxicity in Metastatic Renal Cell Cancer Patients. Int J Mol Sci. 2016;17(12):2073. Published 2016 Dec 9. doi:10.3390/ijms17122073