Although pazopanib and sunitinib have similar survival benefits in patients with metastatic renal cell carcinoma, pazopanib offers lower rates of adverse events and higher quality of life, reports a head-to-head trial in the New England Journal of Medicine.
The multicenter, international trial included 1110 patients with clear-cell, metastatic renal cell carcinoma. Patients were randomly assigned to open-label treatment in 6-week cycles with pazopanib, 800 mg once daily; or sunitinib, 50 mg once daily for 4 weeks (followed by 2 weeks off). Progression-free survival and overall survival were compared, along with safety outcomes and quality-of-life scores.
In terms of progression-free survival, pazopanib was noninferior (clinically similar) to sunitinib: median 8.4 and 9.5 months. The median overall survival was 28.4 and 29.3 months, respectively.
Certain adverse events were more frequent with sunitinib, including fatigue, 63 percent versus 55 percent; hand-foot syndrome, 50 percent versus 29 percent; and thrombocytopenia, 78 percent versus 41 percent. Pazopanib was superior to sunitinib in most domains of health-related quality of life, with the largest differences in fatigue, hand-foot syndrome, and mouth sores. Some measures of medical resource use, including emergency department visits, were lower with pazopanib.
Tyrosine kinase inhibitors are recommended first-line therapy for patients with metastatic renal cell carcinoma. Previous studies have suggested improved safety with pazopanib; this phase 3 trial is the first direct comparison of pazopanib versus sunitinib.
Although the two drugs are similarly effective, pazopanib is associated with improved safety outcomes and quality of life. The authors note that such outcomes “assume special importance in comparative-effectiveness research when clinically similar treatments are being considered” [Motzer RJ, et al. Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med 2013; 369:722–731].
