Axitinib (INLYTA)

Renal cell carcinoma, metastatic

Renal cell carcinoma, metastatic

• Oral: 5 mg twice daily continuously until disease progression or unacceptable toxicity.
• Dose can increase up to 10 mg twice daily.
• Given both as monotherapy or in combination with pembrolizumab.

Available as 1 mg and 5 mg tablets. Tablets contain lactose monohydrate. A nasogastric solution can be prepared for patients unable to swallow them and who need NG administration, please discuss with your pharmacy team. Store at room temperature.

TKI (tyrosine kinase inhibitor) that works as a VEGF (vascular endothelial growth factor) inhibitor

Take with or without food

If a dose is missed, patients should be instructed not to take the missed dose but to resume with the next scheduled dose.

Common: Diarrhea, Hypertension, Fatigue.

Less Common: Hemoglobin increase, Thrombocytopenia, Cardiac events (congestive heart failure, myocardial infarction), Retinal vein/artery occlusion,Gastric hemorrhage, Gastrointestinal perforation, Fistula, Cerebral events (cerebrovascular accident, reversible posterior leukoencephalopathy syndrome, transient ischemic attack, cerebral hemorrhage), Hematuria, Proteinuria, Hemoptysis, Hypertensive crisis, Deep vein thrombosis, Pulmonary embolism.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, sodium, potassium, creatinine, total protein, albumin, bilirubin, alkaline phosphatase urine analysis, uric acid, TSH.

During treatment: CBC & differential and platelets, urine analysis, creatinine, uric acid, ALT, bilirubin. TSH every other cycle or if clinically indicated.

If clinically indicated: MUGA scan or echocardiogram.

Note: Additional monitoring is required for pembrolizumab if being used in combination.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Avoid grapefruit, grapefruit juice, Seville oranges, or Seville orange juice.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Hypertension is common with VEGF inhibitors. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions. Hypertension should be well controlled prior to starting axitinib.
• Thyroid dysfunction, in particular hypothyroidism, may occur with this treatment. Monitor for signs and symptoms of thyroid dysfunction and manage as clinically appropriate.
• Impaired wound healing is associated with VEGF inhibitors, drug may need to be held and restarted if patient requires surgery, discuss with team.

BC Cancer. BC Cancer Drug Manual. Axitinib. Vancouver, British Columbia: BC Cancer Agency.. Available at http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Axitinib_monograph_1March2014.pdf. Updated March 1, 2014 Accessed January 25, 2024.

Lexicomp. Axitinib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/3632443?cesid=5Q5i1CNoZrF&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Daxitinib%26t%3Dname%26acs%3Dtrue%26acq%3Daxitinib. Updated January 24, 2024. Accessed January 25, 2024.

Cancer Care Ontario. Axitinib - Drug Formulary. Cancer Care Ontario website.https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44296 Updated February 2023. Accessed January 25, 2024.Pfizer Products Inc. INLYTA® Product Monograph. Kirkland, Quebec: Pfizer Products Inc. Updated March 13, 2019