Reduced initial Pazopanib dosing strategy for recurrent, advanced, or metastatic sarcoma: A single center experience

IntroductionPazopanib is a treatment option for patients who have advanced or metastatic soft tissue sarcoma. Although the FDA label recommends pazopanib 800 mg q24h as the initial dose, the starting dose in clinical practice can range from 200 mg to 800 mg q24h due to poor tolerability. This study describes a single institution's experience and outcomes of using pazopanib for patients with sarcoma.MethodsA retrospective chart review was conducted for adult patients with recurrent, advanced, or metastatic sarcoma who were prescribed pazopanib between 2014 and 2022 at Indiana University Simon Comprehensive Cancer Center.ResultsOf 148, 66 patients met the inclusion criteria. Median starting dose and frequency of pazopanib was 300 mg q24h (range, 200 mg q48h-800 mg q24h) with 200 mg q24h (48%) being the most common. Median time on pazopanib was 5.5 months (range, 0.62-100 months). Median progression free survival was 4.4 months (95% CI, 3.3-9.4), and median overall survival was 29 months (95% CI, 21.8-NE). The most common toxicities were fatigue (51%), hypertension (37%), nausea/vomiting (34%), and diarrhea (33%). Treatment interruptions occurred in 45% of patients, and dose reductions in 30% of patients.ConclusionsLower starting dose of pazopanib did appear to reduce the risk of various side effects compared to the PALETTE trial, suggesting a potential benefit of this dosing strategy given similar clinical efficacy. Further comparative studies examining lower initial dose vs full-dose initiation are needed to determine differences in patient tolerability and clinical outcomes.