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Treatment Name: Pazopanib (Votrient®)

Pazopanib (Votrient®) is a Chemotherapy Regimen for Renal Cell Carcinoma - Kidney Cancer

How does pazopanib work?
Pazopanib is designed to slow the growth of cancer cells by inhibiting (stopping or slowing) several mechanisms that the cell uses to grow and survive. Pazopanib is in a class of medications called Tyrosine Kinase Inhibitors (TKI's).

Goals of therapy:
Pazopanib is taken to shrink tumors and decrease symptoms of renal cell carcinoma (RCC). Pazopanib is not commonly given with the goal of cure.

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Schedule

  • Usual starting dose: 800 mg (four 200 mg oral capsules) by mouth Once Daily-every day, on an empty stomach (one hour before or two hours after a meal)

Pazopanib is usually taken at home. Typically, therapy is continued until the drug no longer works or unacceptable toxicity is experienced.

Note: Individual doses may vary based upon your doctor's recommendation, or drug availability.

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Side Effects

In clinical studies, the most commonly reported side effects with pazopanib are shown here. Side effects sometimes have percentage ranges [example: 37 – 43% had low white cells] because they differed between clinical studies:

  • Fatigue (19 - 55%)
  • Diarrhea (52%)
  • Low white blood cells (37 - 43%)
  • Increased bleeding risk [low platelets] (32 - 41%)
  • High blood pressure (40%)
  • Hair color changes (30 - 38%)
  • Anemia [low red blood cells] (26 - 31%)
  • Rash and blistering on soles of hands and feet (6 - 29%)
  • Nausea (26%)
  • Altered sense of taste (26%)
  • Decreased appetite (24%)
  • Vomiting (21%)
  • Rash (18%)
  • Constipation (17%)
  • Weight loss (10 - 15%)
  • Hair loss (14%)
  • Muscle weakness (14%)
  • Bleeding (14%)
  • Mouth sores (9 - 14%)
  • Abdominal pain (11%)
  • Headache (11%)

On average, 14 - 24% of patients discontinue pazopanib due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue DiarrheaDiarrheaPainPainNausea and VomitingNausea and VomitingConstipationConstipationHair LossHair LossBleedingBleedingAnemiaAnemia

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment, then every other week for the first 9 weeks, then as clinically indicated. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), urinalysis, and thyroid stimulating hormone (TSH).

How often is imaging needed?

Imaging may be checked before treatment, then every six weeks for six months, then every 8 to 12 weeks until the end of treatment. Imaging may include: computerized tomography (CT) scans, magnetic resonance imaging (MRI), and bone scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue pazopanib as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Pazopanib should not be taken with certain medications used for heartburn known as Proton Pump Inhibitors (PPI's) or H2-receptor antagonists. Examples of these are: omeprazole (Prilosec®), lansoprazole (Prevacid®), ranitidine (Zantac®), and famotidine (Pepcid®). Short-acting antacids such as Calcium Carbonate (Tums®) may be used if separated at least 2 hours before and 2 hours after taking pazopanib
  • Pazopanib can possibly impair your body’s ability to heal wounds. Talk to your oncologist about any planned surgeries and let your surgeon know you are taking this drug
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for renal cell carcinoma (kidney cancer). Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Pazopanib (Votrient®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Pazopanib (Votrient®). Depending upon your income, they may be able to help cover the cost of:

  • Pazopanib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Pazopanib (Votrient®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Pazopanib (Votrient®)

Individual Drug Label Information

Pazopanib (Votrient®)

  • Pazopanib is an oral 200 mg capsule 
  • FDA Box Warning for liver toxicity. Liver function tests will be monitored periodically during treatment and pazopanib may be temporarily or permanently stopped if moderate to severe liver dysfunction is seen 
  • Take on an empty stomach, 1 hour before eating or 2 hours after eating. Food increases blood levels of pazopanib and can increase risk of experiencing side effects 
  • Capsules should be swallowed whole and never chewed, crushed, or opened 
  • If you miss a dose, take the dose as soon as possible on the same day, then return to the normal schedule. If it is within 12 hours of your next dose, wait until your next dose is due and do not make up the missed dose 
  • Store at room temperature, 68°-77°F (20°-25°C) in a cool, dry place 
  • Dosage adjustments may be required for liver dysfunction 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions 
  • May interact with grapefruit and grapefruit juice causing increased blood levels of pazopanib. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of pazopanib. This could decrease the effectiveness
  • May cause fetal harm; avoid use during pregnancy. Speak with your doctor if your are breast feeding to determine what is best for your infant as it is not know if this drug is in breast milk
General Pazopanib (Votrient) Side Effects 
  • May cause decreased heart function or heart arrhythmias. Echocardiograms and electrocardiograms may be done periodically to monitor your heart function and rhythm  
  • Thyroid and adrenal gland problems can occur. You doctor may do tests to monitor your thyroid and adrenal glands during therapy 
  • Various gastrointestinal side effects can occur such as nausea, vomiting, abdominal pain, mouth sores, and diarrhea. Talk to your doctor or pharmacist for ways to manage these side effects 
  • Can cause blisters or rash on the palms of your hands and soles of your feet. Use a non-alcoholic moisturizer on your hands and feet to help prevent this from happening 
  • Can cause high blood pressure. Consider keeping a blood pressure monitor at home. Your doctor may prescribe a medication to help lower your blood pressure if needed 
  • Can cause an opening in the wall of your stomach or intestines. Seek help immediately if you experience severe abdominal pain with fever, nausea, or vomiting 
  • May increase your risk of developing a blood clot. Notify your doctor if you experience trouble breathing, severe chest pain, or redness, pain, and swelling in your arms or legs
  • Click on the pazopanib (Votrient) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue BleedingBleedingConstipationConstipationPainPainAnemiaAnemiaBlood ClotsBlood Clots

See DailyMed package insert.

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References

1. Sternberg CN, Hawkins RE, Wagstaff J, et al. A randomised, double-blind phase III study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma: Final overall survival results and safety update. European Journal of Cancer. 2013;49:1287-1296.

2. Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in Locally Advanced or Metastatic Renal Cell Carcinoma: Results of a Randomized Phase III Trial. J Clin Oncol. 2010;28:1061-1058.

3. Motzer RJ, Hutson TE, Cella D, et al. Pazopanib versus Sunitinib in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2013;369:722-731.

Created: August 16, 2015 Updated: November 3, 2016

What is Renal Cell Carcinoma - Kidney Cancer?

A malignant disease of the cells found in the kidney. Renal cell carcinoma (RCC) is a rare condition and is the most commonly diagnosed type of kidney cancer. Known causes of RCC include smoking, obesity, hypertension, family history of RCC, and a genetic disease known as Von Hippel-Lindau disease. The stage of RCC can vary at diagnosis and throughout treatment. RCC uses the TNM (Tumor, Node, Metastasis) staging system and is grouped into stages I, II, III, and IV. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Sternberg CN, Hawkins RE, Wagstaff J, et al. A randomised, double-blind phase III study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma: Final overall survival results and safety update. European Journal of Cancer. 2013;49:1287-1296.

2. Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in Locally Advanced or Metastatic Renal Cell Carcinoma: Results of a Randomized Phase III Trial. J Clin Oncol. 2010;28:1061-1058.

3. Motzer RJ, Hutson TE, Cella D, et al. Pazopanib versus Sunitinib in Metastatic Renal-Cell Carcinoma. N Engl J Med. 2013;369:722-731.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium