Axitinib/Axitinib initial dose and dosage adjustment

The recommended starting dose of Axitinib for the treatment of renal cell carcinoma (RCC) is 5 mg taken orally twice a day, 12 hours apart. It is recommended to swallow the whole pill with water, and it can be taken with or without food. In combination therapy, dose management is particularly critical. For example, when combined with Avelumab or Pembrolizumab as first-line treatment for advanced RCC, axitinib is still started at 5 mg BID, but doctors usually gradually adjust the dose based on patient tolerance and toxicity.

The dose increase must meet the following conditions: the patient has not experienced grade 2 or above toxic reactions for at least two consecutive weeks (according to CTCAE classification standards), the blood pressure is well controlled, and no antihypertensive drugs are needed. In this case, consider gradually increasing the dose to 7 mg twice daily, or even up to a maximum of 10 mg. It is generally recommended that the frequency of dose adjustment is once every two weeks to fully observe the efficacy and side effects of the drug.

On the contrary, when patients experience adverse reactions such as hypertension, proteinuria, fatigue, hand-foot syndrome or abnormal liver function, they should consider reducing the dose to 3 mg twice a day. In severe cases, the medication can be suspended and gradually resume use after the symptoms are relieved. It is important to note that if the patient vomits or misses a dose, it is not recommended to take a supplementary dose. The patient should continue to take the regular dose at the next scheduled time to prevent toxicity or efficacy fluctuations caused by fluctuations in drug concentration.

In the context of combined immunotherapy, immune drugs are usually injected at a fixed time (such as pembrolizumab once every 3 weeks), while axitinib needs to be taken continuously to maintain blood concentration, so the timing of the two is particularly critical. Doctors need to flexibly adjust the dose and monitoring frequency of axitinib according to the cycle of immune drugs to ensure the safety and effectiveness of treatment.

Reference materials:https://en.wikipedia.org/wiki/Axitinib