Tivozanib is a potent and highly specific orally available, tyrosine kinase 
inhibitor that targets vascular endothelial growth factor (VEGF) receptor-1, 
VEGF receptor-2, and VEGF receptor-3 at very low concentrations with a long 
half-life (4 days). After its promising activity in xenograft and preclinical 
models, tivozanib was evaluated in early phase clinical trials in various solid 
tumors. The phase III trial (TIVO-1) compared tivozanib with sorafenib in 
metastatic clear cell renal cell carcinoma (RCC). Because of detrimental overall 
survival (OS), Oncology Drug Advisory Committee (ODAC) voted against its 
approval in RCC. Tivozanib is also being evaluated in various other solid tumors 
like breast, gastrointestinal cancers, hepatocellular cancer, sarcomas, and 
gynecological cancer. In BATON-CRC trial, low-serum neuropilin-1 (NRP-1) levels 
were associated with better progression-free survival (PFS) in patients treated 
with tivozanib. The NRP-1 will be evaluated as a biomarker for tivozanib 
response in future clinical trials. Ongoing clinical trial will further 
characterize activity of tivozanib in hepatocellular carcinoma, sarcomas, and 
gynecologic cancers.