Pazopanib (Votrient)

Pazopanib is pronounced pas-oh-pan-ib. It is also called Votrient. It is a type of biological therapy called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins which act as chemical messengers (enzymes) in cells. There are a number of different tyrosine kinases and they stimulate cancer cells to grow.

Pazopanib blocks a number of these proteins and is called a multi tyrosine kinase inhibitor (multi TKI). It stops cancer cells forming blood vessels that they need in order to grow. This is called anti angiogenesis treatment.

Pazopanib is a treatment for advanced kidney (renal) cancer. Researchers are also looking at pazopanib as a treatment for a number of other cancers.

Pazopanib is a tablet you take once a day with a glass of water. You should take it either an hour before you eat or 2 hours afterwards. You usually carry on taking it for as long as it works.

Some drugs may increase the side effects of this drug and reduce how well it works, including antibiotics and anti fungal medicines. You should avoid grapefruit and grapefruit juice as they can increase the side effects.

It is very important that you take tablets according to the instructions your doctor or pharmacist gave you. Whether you have a full or empty stomach, for example, can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

The side effects associated with pazopanib are listed below. Remember that most people only have one or two or a few of them. If you have side effects, they are usually mild.

More than 10 in every 100 people have one or more of these.

• Diarrhoea in about 1 out of 2 people (50%) – it is usually mild but do tell your doctor or nurse as you can have medicines to control it
• A mild rash, or red, dry itchy skin in about 3 out of 10 people (30%)
• Tiredness (fatigue) during and after treatment
• Feeling weak, and lacking in energy and strength
• Hair colour changes in 4 out of 10 people (40%) and less commonly hair thinning
• Feeling sick in about 1 in 4 people (25%) but this is usually well controlled with anti sickness drugs
• Raised blood pressure (hypertension)
• An increased risk of bleeding such as nosebleeds or bleeding gums – if you notice blood in your stool or vomit, contact your doctor straight away
• Loss of appetite
• Headaches
• Stomach ache
• An effect on the liver which is unlikely to cause symptoms, and usually goes back to normal after the treatment ends – you will have regular blood tests to check how your liver is working and may stop treatment if tests show that your liver is being affected by the drug
• Taste changes
• Pazopanib could harm a developing baby – do talk to your doctor about contraception before having treatment if there is any chance you or your partner could become pregnant
• Pazopanib may be present in breast milk so it is not advisable for women to breastfeed during treatment or for 2 months after the last dose

Between 1 and 10 in every 100 people have one or more of these.

• Hand foot syndrome – soreness and redness of the palms of the hands and soles of the feet happens in less than 1 in 10 people (10%)
• Indigestion, bloating and wind (flatulence)
• Skin changes may include an itchy rash or blistering – if it is severe your doctor may reduce the dose or stop treatment
• Changes to your thyroid gland  – you will have blood tests to check your level of thyroid hormones
• Low magnesium, calcium and other minerals in your blood – you will have regular blood tests to check the levels

With this drug, some people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion

Fewer than 1 in 100 people have these.

• Severe lung problems occur in fewer than 1 in 100 (1%) people – if you have a cough, high temperature and are short of breath contact your treatment centre urgently
• A hole in the bowel wall has occurred but this is very rare
• Heart problems causing changes to your blood pressure, dizziness, chest pain or changes in your heart beat. These are quite uncommon and nearly always get better when treatment stops. Tell your doctor if you have had heart problems before or if you have any of these side effects
• Changes to the blood supply to the brain which can rarely lead to a stroke – contact your treatment centre urgently if you have symptoms of a stroke, which include your face drooping to one side, you can’t smile normally, you can’t lift your arms or they become weak or numb, or your speech is slurred or garbled

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You should have a contact number for your chemotherapy nurse, clinic or ward nurse. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.