Tivozanib (Fotivda)

Tivozanib is a type of targeted cancer drug. You pronounce it as tye-voh-zah-nib. It is also known as Fotivda. 

It is a treatment for a type of kidney cancer called renal cell cancer. It is for people with advanced cancer.

How does tivozanib work?

Tivozanib is a targeted cancer drug which blocks vascular endothelial growth factor (VEGF). VEGF is a protein which helps the cancer cells to grow by sending signals to each other. Blocking VEGF helps to stop the growth of cancer cells.

How do you have tivozanib?

Tivozanib is a capsule. 

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have tivozanib?

You have tivozanib as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

You take tivozanib once a day for 3 weeks and then have a week of not taking it. This 4 week period is a cycle of treatment .  

You continue having tivozanib as long as it is working and the side effects aren't too bad. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Loss of appetite and weight loss

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Headache

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

High blood pressure (hypertension)

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Less often you might have high blood pressure that could be ongoing and severe. 

Shortness of breath and cough 

You might have shortness of breath and a cough. Contact your advice line or tell a member of your healthcare team if you do. 

Voice changes

Your voice could become hoarse or weak. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Diarrhoea 

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Sore, red hands and feet (hand foot syndrome)

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Pain 

This can include pain in the:

• joints
• muscles
• back 
• part of the body where the cancer is 
• chest
• sides

Tiredness and lack of energy (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

• a drop in red blood cells (anaemia) causing tiredness and shortness of breath

• a decrease in the amount of hormones the thyroid gland makes (hypothyroidism) causing weight gain, tiredness and lack of energy

• unable to get to sleep or stay asleep (insomnia)

• changes to the sensations in the hands and feet including tingling, numbness and pain

• a sensation of the surroundings spinning or moving (vertigo)

• dizziness

• changes to taste including loss of taste

• changes to eyesight (vision) including blurred vision and reduced vision

• ear problems such as ringing in the ears (tinnitus) or blocked ears

• heart problems such as heart attack, chest pain (angina) and a fast heartbeat (tachycardia)

• bleeding in a part of your body - such as the mouth, stomach or brain

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

• a warm, hot, red face (flushing)

• nose problems such as a runny nose, blocked nose or nosebleed

• inflammation of the pancreas causing severe stomach pain which may spread to your back

• difficulty swallowing

• indigestion, acid reflux and wind (flatulence)

• swollen tummy (abdomen)

• dry mouth or sore gums

• constipation

• changes to blood test results

• skin problems such as a rash, acne, itching, dryness, reddening and peeling

• hair loss

• protein in the urine

• chills and feeling cold

• high temperature

• swelling of the arms, hands, legs and feet (oedema)

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• a rash with pus due to a fungal infection

• a decrease in the number of platelets causing an increased risk of bruising and bleeding

• an increase in the number of red blood cells

• an increase of the amount of hormones the thyroid gland makes causing weight loss, fast heartbeat and anxiety

• swelling in the neck caused by an enlarged thyroid gland (goitre)

• changes to memory including loss of memory

• watery eyes caused by an increase in the amount of tears

• heart failure symptoms include shortness of breath, swelling of the ankles or swelling in the lungs caused by a build up of fluid in the body

• stomach ulcer

• sweating more than usual

• weak muscles

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least a month afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.