Dr. Alva on the Toxicity Profiles of TKIs in RCC

Ajjai Shivaram Alva, MBBS, an associate professor at the University of Michigan, discusses class-specific toxicities of TKIs in metastatic renal cell carcinoma (mRCC).

Adverse events such as hypertension, rashes on the hands and feet, cardiac toxicity, gastrointestinal (GI) toxicities such as diarrhea and mucositis, dysphonia, transaminitis, and liver toxicity result from the drug’s mechanism of action, says Alva. The frequency of these events vary with each drug, but by and large, they are shared with the class of VEGF TKIs.

For example, tivozanib (Fotivda) can cause more dysphonia and axitinib (Inlyta) can cause more diarrhea. Additionally, sunitinib (Sutent) can cause more diarrhea and other GI toxicities. These drugs are also given on different schedules. For example, sunitinib is given every 4 weeks with 2 weeks off, whereas axitinib is a short-acting drug that’s given twice daily, explains Alva. Moreover, the starting dose of axitinib can be adjusted as necessary. Other TKIs are given once daily.