TiNivo-2: An innovative Phase 3 trial in advanced renal cell carcinoma (aRCC)1

The Science Behind the Study

While overall survival in aRCC has significantly improved, the need remains for more effective and tolerable treatment options in later-line disease.1

Current options include vascular endothelial growth factor (VEGFR) inhibitors, which have demonstrated clinical efficacy but may be associated with limiting adverse events, such as tiredness, diarrhea, liver failure, and hand-foot syndrome.2-4

Further evaluation is needed to inform clinical decisions in relapsed/refractory (R/R) disease.1 TiNivo-2 is designed to assess the potential synergies of tivozanib—a recently approved oral VEGF tyrosine kinase inhibitor (TKI)—in combination with nivolumab, an immunotherapy.5,6

It is hypothesized that tivozanib and nivolumab together may provide additional benefits in aRCC, as tivozanib may enhance PD-1 activity through its effects on T-regs.5

TiNivo-2 aims to establish a new standard of care for second-line aRCC treatment by evaluating this unique TKI/PD-1 inhibitor combination.

Tivozanib has High Potency and Selectivity7

PD parameters

Tivozanib’s Long Half-Life Creates a Unique PK Profile7

PK parameters

Tivozanib Significantly Reduces T-Regs8

Results 1
  • Cabozantinib and lenvatinib are not shown because absolute oral bioavailabilities are not reported in the literature.
  • The plots provide an overall assessment of differences between VEGFR-TKIs; the evaluation is substantially qualitative since threshold values cannot be assessed.

Tivozanib is approved for adults with rrRCC following two or more prior systemic therapies.9

Tivozanib was approved for rrRCC based on results from TIVO-3, the first Phase 3 trial to include a predefined population of RCC patients who had received prior immunotherapy.9 The Phase 1/2 TiNivo trial aimed to build on these results by examining the combined effects of tivozanib with nivolumab on aRCC.

Nivolumab is a human immunoglobulin G4 (IgG4) that blocks the interaction between PD-1, PD-L1 and PD-L2. The FDA has approved nivolumab for patients with aRCC as a first-line treatment in combination with cabozantinib or with ipilimumab and as a single agent in patients with aRCC who have received prior anti-angiogenic therapy.10

Preliminary results from 25 patients in the Phase 1/2 TiNivo trial evaluating tivozanib and nivolumab indicated anti-tumor activity in patients who received the combination, regardless of whether they were treatment naïve or had prior exposure to other treatments.11

Find out more about this trial >>

Open access article for TiNivo trial >>

TiNivo-2 Study Design

TiNivo-2 is an open-label, randomized, controlled, multicenter, multinational, parallel-arm Phase 3 trial. The study aims to enroll 326 patients with refractory advanced renal cell carcinoma (aRCC) across 190 clinical sites. Patients will be assigned to treatment groups in a 1:1 ratio; 163 will receive the tivozanib/nivolumab combination and 163 will receive tivozanib alone.6

Patients will be given oral tivozanib once daily with a dosing cycle of 3 weeks on and 1 week off. Patients who receive nivolumab will be infused with one treatment at a specified dose on specified days of each cycle.

Primary Outcome6

Progression-free survival

  • Definition: time from randomization to first documentation of objective tumor progression (progressive disease, radiological) according to Response Evaluation Criteria In Solid Tumors (RECIST), or death due to any reasons, whichever comes first
  • Timeframe: until progressive disease

Secondary Outcomes6

Overall Survival

  • Definition: time from the date of randomization to date of death due to any cause
  • Timeframe: from screening (Days -28 to -1) until death

Objective Response Rate

  • Definition: proportion of subjects with confirmed complete response or confirmed partial response according to RECIST relative to the total population of randomized subjects
  • Timeframe: from screening (Days -28 to -1) until PD or death

Number of subjects with serious and non-serious adverse events

  • Definition: assessment of the safety and tolerability
  • Timeframe: from screening (Day -28 to Day -1) to follow-up visit (30 days after last dose of study drug ±
  • 7 days)

Find out more about the TiNivo-2 study design >>

Eligibility Criteria

Patients with advanced renal cell carcinoma (aRCC) who are 18 years or older are eligible for the TiNivo-2 trial if
they have taken 1 or 2 prior lines of therapy, including an immune checkpoint inhibitor (ICI).

Additional inclusion criteria are as follows:

  • Radiographic disease progression during or following at least 6 weeks of treatment with ICI for locally advanced or metastatic RCC with a clear cell component either in first- or second-line treatment
  • Recovery from adverse events of a prior therapy or return to baseline
  • Histologically or cytologically confirmed RCC with a clear cell component
  • Measurable disease per Response Evaluation Criteria In Solid Tumors (RECIST) criteria Version 1.1
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

Patients are not eligible for the trial if they have:

  • Taken more than 2 prior lines of therapy in the advanced or metastatic setting
  • A history of life-threatening toxicity related to prior immune therapy
  • An active, known, or suspected autoimmune disease
  • Uncontrolled hypertension
  • Taken more than 1 prior line of therapy with a checkpoint inhibitor in the metastatic setting

If you are a healthcare provider, review the information below to see if your patients may be eligible for the TiNivo-2 study.

Read more about the eligibility criteria for this study >>

If you have any questions about the trial or are interested in participating or enrolling patients, contact:

AVEO Clinical Development
(857) 400-0101

The clinical trial identifier for TiNivo-2 is NCT0498720.

TiNivo-2 Trial Sites

These sites are currently open.

Actively recruiting:

Banner MD Anderson Cancer Center – Laboratory
Gilbert, Arizona 85234

Arizona Oncology – Tucson – Wilmot Road
Tucson, Arizona 85711-2701

Genesis Cancer and Blood Institute
Hot Springs, Arkansas 71913

City of Hope Comprehensive Cancer Center
Duarte, California 91010

Orange Coast Memorial Medical Center
Fountain Valley, California 92708

Providence Medical Foundation
Fullerton, California 92835

Chao Family Comprehensive Cancer Center, UC Irvine
Irvine, California 92868

University of California San Diego
La Jolla, California 92037

Saddleback Medical Center
Laguna Hills, California 92653

Long Beach Memorial Medical Center – Todd Cancer Institute
Long Beach, California 90806-1707

Leland Stanford Junior University
Redwood City, California 94063

Kaiser Permanente Riverside Medical Center
Riverside, California 92505

US Oncology – Rocky Mountain Cancer Centers – Midtown
Denver, Colorado 80218-1237

Veterans Affair Medical Center
Denver, Colorado 80220-3808

John Hopkins Medicine – Sibley Memorial Hospital
Washington, District of Columbia 20016

Florida Cancer Specialists & Research Institute
Fort Myers, Florida 33140

Florida Cancer Specialists & Research Institute (FCS) – Tampa Cancer Center Location
Saint Petersburg, Florida 33705

Florida Cancer Specialists – Hematology/Oncology
West Palm Beach, Florida 33401

Illinois Cancer Specialists
Arlington Heights, Illinois 60005-2380

NorthShore University Health System
Evanston, Illinois 60201

The University of Kansas Cancer Center
Westwood, Kansas 66205-2005

University of Kentucky UK Markey Cancer Center
Lexington, Kentucky 40536

Tulane Cancer Center Clinic – Oncology
New Orleans, Louisiana 70112

New England Cancer Specialists
Scarborough, Maine 04074

John Hopkins Medicine – Hematology/Oncology
Baltimore, Maryland 21287

University of Maryland Medical Center – Greenebaum Cancer Center
Baltimore, Maryland 21201

Maryland Oncology Hematology
Clinton, Maryland 20735

Dana-Farber Cancer Institute – Medicine
Boston, Massachusetts 02215

Henry Ford Hospital
Detroit, Michigan 48202

Karmanos Cancer Institute
Detroit, Michigan 48201

St. Vincent Frontier Cancer Center
Billings, Montana 59102-6746

Nebraska Cancer Center
Omaha, Nebraska 68130

Oncology Hematology West PC dba
Nebraska Cancer Specialists

Omaha, Nebraska 68130

Memorial Sloan Kettering Cancer Center – Basking Ridge – Oncology
Basking Ridge, New Jersey 07920

Memorial Sloan Kettering Cancer Center – Monmouth – Oncology
Middletown, New Jersey 07748-3052

Memorial Sloan Kettering Cancer Center – Bergen – Oncology
Montvale, New Jersey 07645

Raymond G. Murphy VA Medical Center
Albuquerque, New Mexico 87108

University of New Mexico – Comprehensive Cancer Center
Albuquerque, New Mexico 87131-0001

New York Cancer and Blood Specialists
Bronx, New York 10469

Roswell – Roswell Park Cancer Institute – Medical Oncology
Buffalo, New York 14263

Memorial Sloan Kettering Cancer Center – Commack
Commack, New York 11725

Memorial Sloan Kettering Cancer Center – Westchester
Harrison, New York 10604

Memorial Sloan Kettering Cancer Center (MSKCC) – Memorial Hospital
New York, New York 10065

North Shore Hematology Oncology Associates dba NY Cancer and Blood Specialists
New York, New York 10028

New York Cancer and Blood Specialists – Oncology
Port Jefferson Station, New York 11794

Stony Brook University Cancer Clinical Trials
Stony Brook, New York 11794

Memorial Sloan Kettering Cancer Center – Nassau
Uniondale, New York 11553

Cleveland Clinic
Cleveland, Ohio 44195-0001

Northwest Cancer Specialists, P.C.
Tigard, Oregon 97223

Lehigh Valley Physician Group
Allentown, Pennsylvania 18103-6218

Penn State Hershey Cancer Institute
Hershey, Pennsylvania 17033

Fox Chase Cancer Center – Medical Oncology
Philadelphia, Pennsylvania 19111-2497

Allegheny General Hospital (AGH)
Pittsburgh, Pennsylvania 15212-4756

UH Cleveland Medical Center
Columbia, South Carolina 29210

Chattanooga Oncology and Hematology Associates
Chattanooga, Tennessee 37404

Baptist Cancer Center
Memphis, Tennessee 38120

Tennessee Oncology, PLLC
Nashville, Tennessee 37203

Vanderbilt-Ingram Cancer Center
Nashville, Tennessee 37232

Texas Oncology – Central Austin Cancer Center
Austin, Texas 78731

Texas Oncology – Baylor Charles A. Sammons Cancer Center
Dallas, Texas 75246

US Oncology Texas Oncology (CCC of South Texas) – San Antonio Medical Center
San Antonio, Texas 78240

Baylor Scott and White Research Institute Hematology/Oncology
Temple, Texas 76508

Inova Schar Cancer Institute – Medical Oncology
Fairfax, Virginia 2203

Virginia Oncology Associates
Norfolk, Virginia 23502

University Of Washington – Medical Center
Seattle, Washington 98109

Northwest Medical Specialties PLLC Recruiting
Tacoma, Washington 98405-5016

The trial is continuing to add clinical sites. Tell colleagues who are interested in enrolling patients that the trial is now open. Contact us to discuss new site opportunities.

AVEO Clinical Development
(857) 400-0101

Check here for trial site updates >>

Enroll your patients in the Phase 3 TiNivo-2 Trial

Let patients and colleagues know about this unique trial for advanced renal cell carcinoma (aRCC).

If you have any patients who are eligible and might be interested in participating or if you have any questions
about the trial, please contact:

AVEO Clinical Development
(857) 400-0101

Participate as an investigator

The trial is continuing to add clinical sites and is looking for additional investigators to participate.

If you or a colleague would like to join as an investigator and have questions about enrolling your institution,
please contact:

AVEO Clinical Development
(857) 400-0101

AVEO Oncology

Passionately pursuing a better life for patients with cancer

AVEO is an oncology-focused biopharmaceutical company committed to delivering medicines that provide a better life for cancer patients. We have numerous compounds in clinical testing across different cancer types.

View our clinical trial pipeline here >>


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  2. Barata PC, De Liano AG, Mendiratta P, et al. The efficacy of VEGFR TKI therapy after progression on immune combination therapy in metastatic renal cell carcinoma. Br J Cancer. 2018;119(2):160-163.
  3. Stukalin I, Dudani S, Wells C, et al. Second-line VEGF TKI after IO combination therapy: Results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC). J Clin Oncol. 2020;38(6):684.
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  6. ClinicalTrials.gov. Study to compare tivozanib in combination with nivolumab to tivozanib monotherapy in subjects with renal cell carcinoma. Accessed December 21, 2021. https://clinicaltrials.gov/ct2/show/NCT04987203
  7. Fogli S, Porta C, Del Re M, et al. Optimizing treatment of renal cell carcinoma with VEGFR-TKIs: a comparison of clinical pharmacology and drug- drug interactions of anti-angiogenic drugs. Cancer Treat Rev. 2020;84:101966.
  8. Data on file. AVEO Pharmaceuticals, Inc.
  9. FOTIVDA (tivozanib) [package insert]. Boston, MA: AVEO Pharmaceuticals, Inc, March 2021.
  10. OPDIVO (nivolumab) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company, March 2022.
  11. Albiges L, Barthélémy P, Gross-Goupil M, Negrier S, Needle MN, Escudier B. TiNivo: safety and efficacy of tivozanib-nivolumab combination therapy in patients with metastatic renal cell carcinoma. Ann Oncol. 2021;32(1):97-102.