Arzneimittelinteraktionen als Herausforderung bei der Monotherapie des fortgeschrittenen oder metastasierten klarzelligen Nierenzellkarzinoms mit VEGFR-assoziierten Tyrosinkinase-Inhibitoren

Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) play a central role in the treatment of advanced or metastatic clear-cell renal cell carcinoma (mRCC) - either in combination therapy or, in selected cases, as monotherapy. However, due to their mechanisms of action, these therapeutic agents may induce typical adverse drug reactions (ADRs), commonly referred to as class effects. The use of multiple medications, particularly in older patients with comorbidities, can further increase the risk of ADRs through potential drug-drug interactions. Managing VEGFR-TKI-related adverse effects in the context of patient co-/multimorbidity and possible drug-drug interactions represents a substantial challenge for both clinicians and patients. This article provides practical recommendations for side-effect and medication management, with a particular focus on pharmacokinetic and pharmacodynamic drug-drug interactions. Tivozanib, a potent VEGFR-TKI, is well-suited and recommended as a first-line treatment option for mRCC due to its comparatively favorable safety profile and beneficial interaction potential.