Tivozanib stops the cancer cells from developing new blood vessels. This reduces their supply of oxygen and nutrients, so that the tumour shrinks or stops growing. This type of targeted therapy is called an angiogenesis inhibitor.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Tivozanib comes as capsules you take at home.
During treatment you usually see a cancer doctor, a cancer nurse or specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
While you are taking tivozanib, you will have regular blood samples taken to check different things. For example, the level of your blood cells and how well your liver, kidneys and thyroid gland are working. You may also have a urine test before, and possibly during, treatment to check your kidneys.
Your doctor, nurse or pharmacist will discuss your treatment plan with you. They will give you the capsules to take home with you.
Your doctor, nurse or pharmacist will explain your treatment plan. You will usually carry on taking tivozanib for as long as it is working for you and the side effects can be managed. Do not stop taking tivozanib without talking to your doctor first.
If you have certain side effects, or changes in your blood test results, your doctor may tell you to stop taking tivozanib for a short time or to reduce the dose you take.
Always take your capsules exactly as your nurse or pharmacist explained. This is important to make sure they work as well as possible for you.
You take tivozanib once a day. You take tivozanib every day for 21 days. Then you have a break of 7 days when you do not take it. These 28 days are called a cycle of treatment.
There are some important things to remember when taking your capsules:
- They should be swallowed whole with a glass of water. Do not chew, dissolve or open the capsules before you take them.
- If you forget to take your capsules or are sick after taking them, just take your next dose at the usual time – don’t take a double dose.
- Keep the capsules in the original packaging and at room temperature, away from heat and direct sunlight.
- Keep the capsules in a safe place, out of the sight and reach of children.
- Get a new prescription before you run out of capsules and make sure you have plenty for the holidays.
- If treatment is stopped, return any remaining capsules to the pharmacist.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
High blood pressure
Tivozanib can cause high blood pressure. You may need to take drugs to control this during your treatment. Tell your doctor or nurse if you have ever had problems with high blood pressure or take drugs for this.
Your doctor or nurse will check your blood pressure regularly. They may also show you how to check your blood pressure at home. Tell them if you have any headaches. Sometimes this is a symptom of high blood pressure.
High blood pressure may increase the risk of a mini stroke or stroke. Call 999 to get help straight away if you or someone else notices:
- you are confused
- you have difficulty speaking
- drooping of the face
- numbness or weakness on one side of your body.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice
You may be given anti-diarrhoea tablets to take at home.
Your voice may become hoarse or sound different to usual. This usually gets better after treatment ends. Tell your doctor or nurse if you have a sore throat.
Sore and red hands and feet
You may get sore and red palms of hands and soles of feet. You may also notice stinging or tingling in them. The skin may also begin to peel. This is called palmar-plantar or hand-foot syndrome. It usually gets better after treatment ends.
Tell your doctor or nurse about any changes to your hands or feet. They can give you advice and prescribe creams to improve any symptoms you have. It can help to:
- keep your hands and feet cool
- moisturise your hands and feet regularly
- avoid tight-fitting socks, shoes and gloves.
Your doctor may need to reduce the dose of tivozanib or interrupt the treatment if:
- the soreness does not get better
- blistering develops.
Very occasionally, people may need to stop having the treatment completely.
Effects on the skin
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Your doctor can give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
Tummy pain and heartburn
Tivozanib can cause pain or discomfort in your tummy (abdomen). It can also cause heartburn (indigestion). Your doctor can give you drugs to help with these side effects.
Rarely tummy pain can be a sign of a more serious problem. Always tell your doctor if:
- the pain does not improve or gets worse
- you have a swollen tummy
- you feel shivery or have a high temperature
- blood in your stools (poo).
You may get pain in your muscles or joints, or in the area where your cancer is.
If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Effects on the heart
This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Bruising and bleeding
Tivozanib can increase your risk of bleeding. Rarely this can be serious. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:
- bleeding gums
- coughing or vomiting blood
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on your skin that may look like a rash.
Contact the hospital straight away if you have any bleeding that does not stop.
Effects on the nervous system
This treatment can affect the nervous system. Very rarely, it can cause a brain condition called PRES (posterior reversible encephalopathy syndrome). Symptoms include:
- seizures (fits)
- extreme tiredness
- loss of eyesight or other eyesight changes
- weakness in an arm or leg.
Contact the hospital straight away if you have any of these symptoms. It is important not to drive or operate machinery if you notice these effects.
Effects on the thyroid gland
Tivozanib can affect the way the thyroid gland works. It will go back to normal after treatment.
You will have regular blood tests to check your levels of hormones that are made by the thyroid. This side effect is usually mild and may not cause symptoms. Your doctor may give you drugs to take if your hormone levels are low.
Effects on the kidneys and liver
This treatment can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have regular blood and urine tests during your treatment to check how well your kidneys and liver are working.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
You may have difficulty sleeping while you are taking tivozanib. Talk to your doctor or nurse if this is difficult to cope with.
You may feel dizzy during this treatment. Tell your doctor or nurse if this is difficult to cope with. If you feel dizzy, do not drive or operate machinery.
Build-up of fluid
Your ankles and legs may swell because of fluid building up. Tell your doctor or nurse if this happens.
Runny or blocked nose
Tivozanib may cause a runny or blocked nose. This is usually mild. Ask your doctor or nurse for advice if this is a problem for you.
Eyesight and hearing changes
You may notice changes to your vision during this treatment. Or you may develop mild ringing in your ears (tinnitus). Tell your doctor or nurse if this happens.
Your hair may get thinner but you are unlikely to lose all the hair from your head. Your nurse can talk to you about ways to cope with hair loss.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment may affect the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. It usually improves slowly after treatment finishes.
Constipation and wind
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.
You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Tivozanib capsules contain a food colouring called tartrazine. If you are allergic to tartrazine, talk to your doctor before taking this treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.