Pilot Study of Pazopanib With Low Fat Meal (PALM) in Advanced Renal Cell Carcinoma

Inclusion Criteria:

* Adult (\>18 years of age) with unresectable locally advanced or metastatic renal cell carcinoma with a clear cell component.
* Subjects must have measurable disease per RECIST 1.1 criteria.
* Subjects must not have had prior pazopanib therapy.
* Subjects must have an ECOG (Eastern Cooperative Oncology Group scoring system used to quantify general well-being and activities of daily life; scores range from 0 to 5 where 0 represents perfect health and 5 represents death.) performance status of less than or equal to 2.
* Up to 3 lines of prior VEGF (vascular endothelial growth factor) or VEGFR (vascular endothelial growth factor receptor) targeted therapy are permitted. Any prior therapy should have been completed ≥ 2 weeks prior to start of study therapy.
* Subjects may have received any number of the following therapies: cytokine therapy (e.g. high dose interleukin-2) or checkpoint inhibitor therapy (e.g. anti-PD1/PDL1, anti-CTLA4) or mTOR inhibitor therapy (e.g. everolimus, temsirolimus).
* Adequate organ and marrow function (Absolute neutrophil count \> 1000/mm3, platelets \> 100,000/mm3, aspartate aminotransferase/ alanine aminotransferase/ total bilirubin \< 1.5 X ULN (upper limit of normal). Patients with Gilbert's disease are exempt.
* Subject must be willing and able to take pazopanib with a low-fat meal every day as specified in the protocol.
* Subjects must be willing and able to come off any PPI(proton pump inhibitor)/other strong CYP3A4 inhibitors or inducers/simvastatin.
* Ability to understand and the willingness to sign a written informed consent.
* All subjects, including those who are surgically sterilized, must be willing to use an effective method of contraception.

Exclusion Criteria:

* Any concurrent health condition that in the view of the treating physician would pose excessive risk to the patient if enrolled in the study.
* Subjects with a history of hemoptysis, cerebral hemorrhage, clinically significant GI hemorrhage, myocardial infarction within the past 6 months.
* Patients at significant risk for GI (gastrointestinal) perforation or fistula.
* Pregnant or nursing mothers.
* Untreated CNS (central nervous system) metastasis. If treated CNS metastasis/es, treatment of CNS disease (surgery or radiation) must have been completed at least 30 days prior to registration. Patients could still be on steroids.
* Subjects with known history of Cirrhosis, HIV, Hepatitis B or C.
* Averaged QTc baseline in 3 ECGs (electrocardiograms) at least 5 minutes apart of ≥450 ms.
* Congestive Heart Failure (NYHA Class III/IV) or LVEF (left ventricular ejection fraction) \<50% at baseline.
* Uncontrolled hypertension (HTN) despite medical management (blood pressure (BP) ≥ 160/100.