On 10 March 2021, the US Food and Drug Administration (FDA) approved tivozanib (Fotivda, AVEO Pharmaceuticals, Inc.), a kinase inhibitor, for adult patients with relapsed or refractory advanced renal cell carcinoma (RCC) following two or more prior systemic therapies.

Efficacy was evaluated in TIVO-3 (NCT02627963), a randomised (1:1), open-label, multicentre study of tivozanib versus sorafenib in patients with relapsed or refractory advanced RCC who received two or three prior systemic treatments, including at least one VEGFR kinase inhibitor other than sorafenib or tivozanib. Patients were randomised to either tivozanib 1.34 mg orally once daily for 21 consecutive days every 28 days or sorafenib 400 mg orally twice a day continuously, until disease progression or unacceptable toxicity.

The main efficacy outcome measure was progression-free survival (PFS), assessed by a blinded independent radiology review committee. Other efficacy endpoints were overall survival (OS) and objective response rate (ORR).

Median PFS was 5.6 months (95% confidence interval [CI] 4.8, 7.3) in the tivozanib arm (n = 175) compared with 3.9 months (95% CI 3.7, 5.6) for those treated with sorafenib (hazard ratio [HR] 0.73; 95% CI 0.56, 0.95; p = 0.016).

Median OS was 16.4 (95% CI 13.4, 21.9) and 19.2 months (95% CI 14.9, 24.2), for the tivozanib and sorafenib arms, respectively (HR 0.97; 95% CI 0.75, 1.24).

The ORR was 18% (95% CI 12%, 24%) for the tivozanib arm and 8% (95% CI 4%, 13%) for the sorafenib arm.  

The most common (≥20%) adverse reactions were fatigue, hypertension, diarrhoea, decreased appetite, nausea, dysphonia, hypothyroidism, cough, and stomatitis. The most common grade 3 or 4 laboratory abnormalities (≥5%) were decreased sodium, increased lipase, and decreased phosphate.

The recommended tivozanib dose is 1.34 mg once daily (with or without food) for 21 consecutive days every 28 days until disease progression or unacceptable toxicity.

Full prescribing information for Fotivda is available here.

The FDA approved this application 3 weeks ahead of the FDA goal date.

Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System.

For assistance with single-patient INDs for investigational oncology products, healthcare professionals may contact FDA’s Oncology Centre of Excellence Project Facilitate.