Efficacy And Safety Of Pazopanib In The First-line Treatment Of Advanced Renal Cell Carcinoma

Objective:To analysis of the efficacy and safety of pazopanib in the first-line treatment of advanced renal cell carcinoma(RCC)patients in the real world.Methods: From August 2017 to February 2020,patients with advanced RCC who were treated with pazopanib in the urology department of our hospital were included in this study.Pazopanib(800 mg)was administered orally once a day.The dosage was adjusted according to the efficacy or the severity of adverse reactions.Each time,the dosage was gradually increased or decreased to the tolerable level by 200 mg.The efficacy evaluations were based on the Response Evaluation Criteria in Solid Tumors.Adverse events were graded according to National Cancer Institute Common Toxicity Criteria for Adverse Events version 4.0.Objective response rate(ORR),Disease Control Rate(DCR),Progress Free Survival(PFS),Overall Survival(OS)and 1-year PFS of drug treatment were observed.Results:A total of 23 patients were included in the study,including 6 females and17 males.The median age was 58(29～74)years.Of them,15 cases were clear-cell RCC,7 cases were non-clear RCC and 1 case was unable to judge pathology type.All patients were followed up,the median follow-up time was 15.1 months.Of the 22 patients who could evaluate the efficacy,complete response(CR)was observed in 0 patient;Partial response(PR)was observed in 7 patients(31.8%);Stable disease(SD)was observed in11 patients(50.0%);Progress of disease(PD)was observed in 4 patients(18.1%).The ORR was 31.8%(7/22)and DCR was 81.8%(18/22).The total median PFS was 17.8months(95% confidence interval: 5.071-30.529);The median OS was not reached;The PFS rate in one year was 68.75%.During the therapy,all patients had adverse events.The most of adverse events were mild to moderate(grade 1～2),which could be controlled and reversible after symptomatic treatment,dose reduction or discontinuation.Most of the patients could tolerate it.The main 1～2 grade adverse events were hair fading(18/23,78.3%),diarrhea(12/23,52.2%),fatigue(12/23,52.2%),nausea(11/23,47.8%),stomatitis(10/23,43.5%),hypertension(9/23,39.1%),alopecia(9 /23,39.1%),vomiting(8/23,34.8%),hand-foot syndrome(HFS)(7/23,30.4%).The main grade 3～4adverse events were hypertension(5/23,21.7%),HFS(5/23,21.7%),alanine aminotransferase(ALT)elevation(5/23,21.7%),aspartate aminotransferase(AST)elevation(4/23,17.4%),diarrhea(3/23,13.0%),neutropenia(2/23,8.7%).Conclusions:The first-line treatment of advanced renal cell carcinoma with pazopanib has high DCR and long PFS.During the treatment,most of the adverse events are grade 1～2,which can be controlled and reversible after treatment,dosage reduction or discontinuation.Most of the patients can tolerate the adverse events,but attention should be paid to the prevention of gastrointestinal bleeding and other serious adverse events.