Efficacy and safety of pazopanib in advanced renal cell carcinoma treated at University Malaya Medical Centre (UMMC)

Abstract

Background: Pazopanib is a vascular endothelial growth factor (VEGF) tyrosine kinase inhibitor (TKI) that was approved as first line treatment for advanced renal cell carcinoma (aRCC). The pivotal trial showed significant increase in median progression free survival (mPFS) of 9.2 months versus 4.0 months with placebo and objective response rate of 30%. Median overall survival (mOS) was 28.4 months with pazopanib. Local data on efficacy and safety of pazopanib is lacking. This study reviewed the efficacy and safety of pazopanib in aRCC in University Malaya Medical Centre (UMMC). Methods: We retrospectively reviewed outcome of patients with advanced renal cell carcinoma who received pazopanib from January 2012 to March 2017. Analysis was done in July 2017. Results: Twenty-one patients were enrolled – 16 (76.2%) were males and five (23.8%) were females. The mean age at diagnosis was 61.9 years old. Majority of the patients were of Chinese ethnicity, ( n = 13, 61.9%). Fourteen patients (67%) were diagnosed as metastatic disease at presentation and all had cytoreductive nephrectomy. Eighteen patients (86%) had clear cell histology. The most common metastatic site was lung (66.7%) followed by bone and liver. Except for one, all patients were treated with pazopanib in the first line setting. Majority of the patients (76.2%) was started on pazopanib within a year after diagnosis. Fourteen patients (66%) were started on 800 mg daily as the initial dose. From the analysis, the best tumour response is partial response ( n = 8, 38%) followed stable disease ( n = 4, 19%). Six patients (28.6%) had progressive disease while three other patients were not assessable. The mPFS was 9 months (95% CI: 7.2 – 10.8) and mOS was 24 months. For toxicity analysis, only 17 patients had side-effects documented in our database. The most common side effects were hypertension (19%) and hand-foot syndrome (19%) followed by diarrheoa (14.3%). Conclusions: In general, pazopanib is well tolerated and demonstrated good PFS and OS in our study population, comparable to previous studies and real-world data.