Pazopanib is as effective as sunitinib as first-line therapy for metastatic renal cell carcinoma (RCC) in terms of progression-free survival, but it is associated with fewer adverse events and better quality of life, according to a head-to-head comparison of the two drugs.
Robert J. Motzer, MD, of Memorial Sloan-Kettering Cancer Center in New York, and colle agues randomly assigned 1,110 patients with clear-cell metastatic RCC to receive a continuous dose of pazopanib (557 patients; 800 mg once daily) or sunitinib in six-week cycles (553 patients; 50 mg once daily for four weeks, followed by two weeks without treatment). None of the patients had previously received systemic treatment for RCC.
Disease-progression events occurred in 336 patients (60%) in the pazopanib group and in
323 patients (58%) in the sunitinib group. The median progression-free survival was 8.4 months with pazopanib and 9.5 months with sunitinib, the researchers reported in the New England Journal of Medicine (2013;369:722-731). The differences in outcomes between the two groups were not statistically significant.
In addition, compared with pazopanib recipients, patients in the sunitinib group had a higher incidence of fatigue (63% vs. 55%), hand–foot syndrome (50% vs. 29%), and thrombocytopenia (78% vs. 41%), according to the investigators. Pazopanib-treated patients had a higher incidence of increased levels of alanine aminotransferase compared with the sunitinib group (60%, vs. 43%). During the first six months, pazopanib recipients experienced significantly more improvements from baseline in 11 of 14 health-related quality-of-life domains as measured by various instruments, especially the domains related to fatigue or soreness in the mouth, throat, hands, or feet, they noted.
“The management of adverse events resulting from the use of targeted agents is known to increase medical treatment costs and medical resource utilization,” the authors wrote. “Our study showed lower monthly use of medical resources with pazopanib than with sunitinib. These end points, plus health-related quality of life and the safety profile, assume special importance in comparative-effectiveness research when clinically similar (noninferior) treatments are being considered.”