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Interesting to share. Votrient is better tolerable with better quality of life than sunitinib according to NEJM 2014 papers. However, reviewing the patient medication especially if he is taking any drug would interact and suppress the liver metabolism by Cytochrome should be considered and 400 mg should be considered. While the patient having HTN and other side effects revealing better efficacy,and side effect management and symptoms control would help. if the symptoms is affecting the daily life activity and grade 3-4 would consider switching to other TKI. In this case restating images to evaluate efficacy in 6-8 weeks interval per the trial protocol. So I would suggest to repeat scan and discuss either to continue with symptoms support and reduce to 400 then increase back slowly or switch to Sutent or other TKI.
If there is objective response to pazopanib, lower doses to control toxicity. I've seen response to pazopanib at dose of 200 mg/day.
I believe that under pazopanib doses can reduce the toxicity of this patient, but I fear that this doosagens are not really effective in the treatment of renal tumors.
Trade to Temsorolimus because it was the only drug that showed overall survival gain in such a scenario disease, when the disease can be classified as high risk, or even Interferon and bevacizumab, is also there to Temsirolimus prohibitive toxicity.
Would also might consider of PD1/PDL1, molecular alteration testing if possible and checkpoint inhibitors therapy.
Pending Moderator approval.
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