Real-World Outcomes of Pazopanib in Stage IV Renal Cell Carcinoma: A Single-Center Observational Study from Indonesia

Indratama Budiwicaksono; Nugroho Budi Utomo

doi:10.70716/mohr.v4i3.631

Authors

Indratama Budiwicaksono Medical Doctor Professional Program, Universitas Airlangga, Surabaya, Indonesia
Nugroho Budi Utomo Rumah Sakit Pusat Angkatan Darat (RSPAD) Gatot Soebroto, Jakarta, Indonesia

DOI:

https://doi.org/10.70716/mohr.v4i3.631

Keywords:

renal cell carcinoma, pazopanib; , metastatic RCC, overall survival, real-world evidence

Abstract

Renal cell carcinoma (RCC) in Indonesia is frequently diagnosed at an advanced stage. Although immune checkpoint inhibitor-based combinations are recommended as first-line therapy, access remains limited in many public healthcare settings, and pazopanib continues to be widely used in routine clinical practice. This single-center observational study evaluated real-world outcomes of pazopanib in adult patients with stage IV RCC treated at a tertiary referral center in Indonesia between January 2020 and December 2025; patients treated for less than one month were excluded. Overall survival (OS) was estimated using the Kaplan–Meier method, while disease progression and treatment exposure were analyzed descriptively. Sixteen patients were included. Median age was 54 years (range, 24–69), and clear-cell RCC was the predominant histological subtype (93.8%). Disease progression occurred in 8 patients (50.0%), most commonly in the lungs. At the end of follow-up, 5 patients (31.3%) were alive, 5 (31.3%) had died, and 6 (37.5%) were lost to follow-up. Mean OS was 29.5 months (95% CI, 18.2–40.7 months), while median OS was not reached. Pazopanib remains a feasible treatment option for selected patients with stage IV RCC in resource-constrained settings where access to immunotherapy is limited.

Downloads

Download data is not yet available.

References

Ardiansyah, N., & Safriadi, F. (2023). Characteristics of kidney cancer patients at Hasan Sadikin Hospital, Bandung. Indonesian Journal of Cancer, 17(4), 338–342. https://doi.org/10.33371/ijoc.v17i4.1125

Barragan-Carrillo, R., Saad, E., Saliby, R.-M., Sun, M., Albiges, L., Bex, A., Heng, D., Mejean, A., Motzer, R. J., Plimack, E. R., Powles, T., Rini, B. I., Zhang, T., & Choueiri, T. K. (2025). First and second-line treatments in metastatic renal cell carcinoma. European Urology, 87(2), 143–154. https://doi.org/10.1016/j.eururo.2024.10.019

Bukavina, L., Bensalah, K., Bray, F., Carlo, M., Challacombe, B., Karam, J. A., Kassouf, W., Mitchell, T., Montironi, R., O'Brien, T., Panebianco, V., Scelo, G., Shuch, B., van Poppel, H., Blosser, C. D., & Psutka, S. P. (2022). Epidemiology of renal cell carcinoma: 2022 update. European Urology, 82(5), 529–542. https://doi.org/10.1016/j.eururo.2022.08.019

Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., Asante, A., & Wiseman, V. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system: A cross-sectional study. BMC Health Services Research, 25(1), 48. https://doi.org/10.1186/s12913-024-11951-8

Choueiri, T. K., Powles, T., Burotto, M., Escudier, B., Bourlon, M. T., Zurawski, B., ... Motzer, R. J. (2021). Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. The New England Journal of Medicine, 384(9), 829–841. https://doi.org/10.1056/NEJMoa2026982

Dabkara, D., & Biswas, B. (2022). Recent advances in first-line management of metastatic renal cell carcinoma. Indian Journal of Medical and Paediatric Oncology, 43(2), 195–200. https://doi.org/10.1055/s-0041-1731968

Duha, D. A., Harahap, E. U., Santoso, R. B., & Bramono, I. A. (2022). Kidney cancer profile in National Cancer Center (NCC) Dharmais Cancer Hospital. Indonesian Journal of Cancer, 16(4), 226–230. https://doi.org/10.33371/ijoc.v16i4.904

Erman, M., Biswas, B., Danchaivijitr, P., Chen, L., Wong, Y. F., Hashem, T., Lim, C. Sen, Karabulut, B., Chung, H.-J., Chikatapu, C., Ingles, S., Slimane, K., & Kanesvaran, R. (2021). Prospective observational study on pazopanib in patients treated for advanced or metastatic renal cell carcinoma in countries in Asia Pacific, North Africa, and Middle East regions: PARACHUTE study. BMC Cancer, 21(1), 1021. https://doi.org/10.1186/s12885-021-08738-z

Febriyani, F., Santoso, R. B., Harahap, E. U., & Bramono, I. A. (2026). Low-dose pazopanib in metastatic renal cell carcinoma: A retrospective survival study. Indonesian Journal of Cancer, 20(2). https://doi.org/10.33371/ijoc.v20i2.1541

Frampton, J. E. (2017). Pazopanib: A review in advanced renal cell carcinoma. Targeted Oncology, 12(4), 543–554. https://doi.org/10.1007/s11523-017-0511-8

Ginting, K., Sembiring, E., & Herawaty, Z. (2026). Determinants of health literacy regarding breast cancer based on the health belief model framework in North Sumatra. Media of Health Research, 4(2), 339–347. https://ejournal.publine.or.id/index.php/mohr/article/view/543

Hamid, A. R. A. H., Umbas, R., Oka, A. A. G., Mochtar, C. A., Djatisoesanto, W., Soedarso, M. A., Safriadi, F., Danarto, R., Warli, S. M., Zaharuddin, A., Seputra, A. K. P., Sihombing, A. T., & Hakim, L. (2019). Pedoman tata laksana kanker ginjal (2nd ed.). Ikatan Ahli Urologi Indonesia.

Khomarun, Mutaqin, W. R., & Noerdjanah. (2026). Education for stroke caregivers to reduce burden. Media of Health Research, 4(2), 263–273. https://ejournal.publine.or.id/index.php/mohr/article/view/532

Kosen, S. (2022). Coverage and implementation of healthcare delivery for cancer under national health insurance: Experience of Indonesia. The Lancet Regional Health - Southeast Asia, 6, 100065. https://doi.org/10.1016/j.lansea.2022.100065

Ljungberg, B., Albiges, L., Abu-Ghanem, Y., Bedke, J., Capitanio, U., Dabestani, S., Fernández-Pello, S., Giles, R. H., Hofmann, F., Hora, M., Klatte, T., Kuusk, T., Lam, T. B., Marconi, L., Powles, T., Tahbaz, R., Volpe, A., & Bex, A. (2022). European Association of Urology guidelines on renal cell carcinoma: The 2022 update. European Urology, 82(4), 399–410. https://doi.org/10.1016/j.eururo.2022.03.006

Mann, C. J. (2003). Observational research methods: Research design II: Cohort, cross-sectional, and case-control studies. Emergency Medicine Journal, 20(1), 54–60. https://doi.org/10.1136/emj.20.1.54

Motzer, R. J., Jonasch, E., Agarwal, N., Alva, A., Bagshaw, H., Baine, M., Beckermann, K., Carlo, M. I., Choueiri, T. K., Costello, B. A., Derweesh, I. H., Desai, A., Ged, Y., George, S., Gore, J. L., Gunn, A., Haas, N., Johnson, M., Kapur, P., ... Gurski, L. A. (2024). NCCN Guidelines® insights: Kidney cancer, version 2.2024. Journal of the National Comprehensive Cancer Network, 22(1), 4–16. https://doi.org/10.6004/jnccn.2024.0008

Niewada, M., Macioch, T., Konarska, M., Mela, A., Goszczyński, A., Przekopińska, B., Rajkiewicz, K., Wysocki, P., & Krzakowski, M. (2023). Immune checkpoint inhibitors combined with tyrosine kinase inhibitors or immunotherapy for treatment-naïve metastatic clear-cell renal cell carcinoma: A network meta-analysis. Focus on cabozantinib combined with nivolumab. Frontiers in Pharmacology, 13, Article 1063178. https://doi.org/10.3389/fphar.2022.1063178

Putri, P. D. (2024). Pengaruh pengetahuan, tingkat pendapatan, dan persepsi terhadap minat wanita usia subur untuk melakukan screening kanker serviks di Puskesmas Wanajaya Bekasi tahun 2023. Media of Health Research, 2(1), 24–34. https://doi.org/10.70716/mohr.v2i1.64

Rini, B. I., Plimack, E. R., Stus, V., Gafanov, R., Hawkins, R., Nosov, D., ... Powles, T. (2019). Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. The New England Journal of Medicine, 380(12), 1116–1127. https://doi.org/10.1056/NEJMoa1816714

Schmidinger, M., Bamias, A., Procopio, G., Hawkins, R., Sanchez, A. R., Vázquez, S., Srihari, N., Kalofonos, H., Bono, P., Pisal, C. B., Hirschberg, Y., Dezzani, L., Ahmad, Q., & Jonasch, E. (2019). Prospective observational study of pazopanib in patients with advanced renal cell carcinoma (PRINCIPAL study). The Oncologist, 24(4), 491–497. https://doi.org/10.1634/theoncologist.2018-0787

Sternberg, C. N., Davis, I. D., Mardiak, J., Szczylik, C., Lee, E., Wagstaff, J., Barrios, C. H., Salman, P., Gladkov, O. A., Kavina, A., Zarbá, J. J., Chen, M., McCann, L., Pandite, L., Roychowdhury, D. F., & Hawkins, R. E. (2010). Pazopanib in locally advanced or metastatic renal cell carcinoma: Results of a randomized phase III trial. Journal of Clinical Oncology, 28(6), 1061–1068. https://doi.org/10.1200/JCO.2009.23.9764

Thaib, P. K. P., & Rahaju, A. S. (2022). Clinicopathological profile of clear cell renal cell carcinoma. International Journal of Health & Medical Sciences, 5(1), 91–100. https://doi.org/10.21744/ijhms.v5n1.1846

Tucci, M., Mandarà, M., Giuliani, J., Durante, E., Buttigliero, C., Turco, F., Palesandro, E., Campisi, I., Singh, N., Muraro, M., Munoz, F., & Fiorica, F. (2024). Treatment options in first-line metastatic renal carcinoma: A meta-analysis of 2556 patients treated with immune checkpoint inhibitor-based combinations in randomized controlled trials. Cancer Treatment Reviews, 127, 102745. https://doi.org/10.1016/j.ctrv.2024.102745

von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X