November 2012, Vol 1, No 5

← Back to Issue

Frontline Therapy of Metastatic Renal Cell Carcinoma: Pazopanib as Effective as Sunitinib

Phoebe Starr

Uncategorized

According to a phase 3 noninferiority trial, paz­opanib is similarly effective as sunitinib, with some advantages in its side effect profile. The COMPARZ trial, reported at the 2012 ESMO Congress, met its primary end point by demonstrating that paz­opanib was noninferior to sunitinib, a standard frontline therapy in this setting. The distinct side effect profiles of these drugs should be considered when selecting frontline therapy, according to experts.

Lead author Robert Motzer, MD, Memorial Sloan-Kettering Cancer Center (MSKCC), New York City, said that the study showed similar efficacy for pazopanib and sunitinib.

“The differentiated safety profile of pazopanib shows a lower incidence of hand-foot syndrome, fatigue, sto­matitis, and mucositis. Higher liver function abnormalities were observed with pazopanib,” Motzer said. A benefit in quality of life (QOL) was also reported for paz­opanib in the COMPARZ study, which is the largest randomized trial conducted in metastatic renal cell carcinoma (mRCC) thus far.

COMPARZ randomized 1110 patients with mRCC to either pazopanib or sunitinib. Baseline demographic and disease characteristics were well balanced between the 2 arms. Median age was 61years, about 72% were male, and 83% had prior nephrectomy. Patients from all risk groups were allowed in the trial; the majority had good and intermediate risk according to MSKCC criteria.

Median progression-free survival was 8.4 months with pazopanib versus 9.5 months with sunitinib, a nonsignificant difference for noninferiority, with a hazard ratio of 1.047.

Adverse events differed according to treatment. More frequent elevations in liver enzymes and whitening of the hair were reported in patients treated with paz­opanib, while those treated with sunitinib had higher rates of fatigue, hand-foot syndrome, taste alteration, and thrombocytopenia. In Motzer’s opinion, the side effect profiles “tip the scale in favor of pazopanib” as firstline treatment for mRCC.

The QOL analysis showed greater patient satisfaction with pazopanib therapy, with less fatigue and physical symptoms compared with sunitinib. Earlier this year at the 2012 ASCO Annual Meeting, Escudier and colleagues reported results of a patient preference study called PISCES. In this study, 70% of patients preferred pazopanib and 22% preferred sunitinib (Abstract CRA4502).

Formal discussant of this trial, Tim Eisen, MD, University of Cambridge, UK, said that he found the data on similar efficacy for the 2 drugs more convincing than the QOL data. He pointed out that QOL assessments were made every 28 days, which favors pazopanib; 28 days is at peak exposure to sunitinib, which is given on a 4 weeks on, 2 weeks off schedule, while pazopanib is given continuously. He said the QOL from PISCES were more convincing in favor of pazopanib.

Interview with the Innovators - November 19, 2012

Cultivating Personalized Medicine Clinical Acumen in the Management of Breast Cancer:

An Interview with Edith Perez, MD

If any cancer can be said to have launched personalized medicine into orbit and establish it as the standard for all cancer therapy to aspire toward, it is breast cancer. The discovery of the estrogen receptor (ER) and HER2 biomarkers has astonished healthcare professionals and the public alike and raised [ Read More ]

Uncategorized - November 19, 2012

Crizotinib Extends Survival Versus Chemotherapy in Advanced NSCLC

The PROFILE 1007 trial, reported at the 2012 ESMO Congress, showed positive results for a targeted therapy in patients whose tumors expressed that target. The first-in-class ALK inhibitor crizotinib prolonged progression-free survival (PFS) and improved response rates compared with single-agent chemotherapy in patients with advanced, previously treated, ALK-positive (ALK+), non–small [ Read More ]