Study may signify shift in RCC standard of care

The tyrosine kinase inhibitors pazopanib (Votrient) and sunitinib (Sutent) had similar benefits in delaying progression of advanced renal cell carcinoma, but the safety profile and many measures of quality of life favored pazopanib, according to data from a recently published multicenter study.

Study authors say the findings suggest a potential shift in standard of care in metastatic kidney cancer.

“Tolerability is a big part of the equation when drugs work equally well,” said senior author Toni Choueiri, MD, of Harvard Medical School, Boston. “If patients are going to live the same life span, why not use the one that’s better tolerated?”

The phase III trial compared the efficacy, safety, and tolerability of pazopanib and sunitinib. The study, which was published in the New England Journal of Medicine (2013; 369:722-31), included 1,100 metastatic kidney cancer patients treated at multiple centers in 14 countries.

The median time before the cancer progressed was comparable: 8.4 months for pazopanib and 9.5 months for sunitinib. Median overall survival was also similar-28.4 months for patients taking pazopanib and 29.3 months for sunitinib.

Pazopanib patients had a higher rate of liver enzyme abnormalities, in some cases leading to discontinuation of the drug. However, pazopanib patients had lower rates of blood cell abnormalities, hand and foot soreness, mouth sores, low thyroid activity, nausea, and fatigue.

Most important, researchers said, pazopanib was rated superior to sunitinib on 11 of 14 measures of quality of life. In addition, pazopanib patients had fewer phone consultations with providers and visited emergency rooms less frequently-a difference the authors said is significant because it could influence cost-benefit comparisons.

“The takeaway is that both of these drugs have similar effectiveness and both are options for treatment in kidney cancer,” said lead author Robert Motzer, MD, of Memorial Sloan-Kettering Cancer Center, New York. “But many of the side effects that are more severe with sunitinib are the ones that bother patients on a day-to-day basis, and patients reported better quality-of-life scores when treated with pazopanib. This trial has changed our preference here at Memorial Sloan-Kettering from sunitinib to pazopanib.”

The study was funded by GlaxoSmithKline Pharmaceuticals.

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