Dr. Rini on the Mechanism of Action of Tivozanib in Relapsed/Refractory RCC

Brian I. Rini, MD, professor of medicine and inaugural chief of Clinical Trials at Vanderbilt-Ingram Cancer Center, discusses the mechanism of action of tivozanib (Fotivda) in relapsed/refractory renal cell carcinoma (RCC).

On March 10, 2021, the FDA approved tivozanib for the treatment of patients with relapsed/refractory advanced RCC following 2 or more prior systemic therapies.

Similar to axitinib (Inlyta), tivozanib is a potent and selective VEGF inhibitor, says Rini. Conversely, agents such as cabozantinib (Cabometyx), lenvatinib (Lenvima), and sorafenib (Nexavar) are less selective and inhibit an array of other targets, says Rini.

Currently, it is not fully understood whether a more selective or less selective VEGF inhibitor is optimal for patients with RCC, says Rini. More selective inhibitors confer less toxicity compared with less selective inhibitors; however, efficacy differences are not well established, Rini adds. However, findings from the phase 3 TIVO-3 trial, which led to the regulatory approval of tivozanib in relapsed/refractory advanced RCC, demonstrated superior efficacy with tivozanib vs sorafenib in this patient population, Rini says. As such, the more selective agent appeared to yield higher efficacy compared with the less selective agent in this study, concludes Rini.