Alternating Pazopanib and Everolimus Treatment Schedule Not Effective for RCC

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Alternating treatment with pazopanib and everolimus failed to prolong progression-free survival compared with continuous pazopanib.
Alternating treatment with pazopanib and everolimus failed to prolong progression-free survival compared with continuous pazopanib.

Alternating treatment with pazopanib and everolimus failed to prolong progression-free survival compared with continuous pazopanib in patients with metastatic clear cell renal cell carcinoma (mccRCC), a study published in JAMA Oncology has shown.1

To evaluate whether a rotating treatment schedule delays progression mccRCC, researchers sought to evaluate the efficacy and safety of alternating pazopanib with everolimus vs continuous pazopanib therapy.

For the multicenter, open-label ROPETAR trial (Clinicaltrials.gov Identifier: NCT01408004), researchers enrolled 101 patients with treatment-naive progressive mccRCC. Participants were randomly assigned to receive an 8-week alternating schedule of pazopanib 800 mg orally daily and everolimus 10 mg orally daily, or pazopanib 800 mg daily continuously until disease progression. Following progression, patients in the rotating arm made a final rotation to either drug and those in the pazopanib only arm initiated everolimus.

Results showed that 45% (95% CI, 33-60) of patients in the rotating treatment arm and 32% (95% CI, 21-49) of those given continuous pazopanib did not experience first progression or death at 1 year.

Researchers found that median time until first progression or death was 7.4 months (95% CI, 5.6-18.4) and 9.4 months (95% CI, 6.6-11.9) for rotating treatment and pazopanib, respectively.

The study further demonstrated that mucositis, anorexia, and dizziness occurred more frequently in the alternating treatment group during first-line treatment, and researchers observed no significant difference in quality of life between arms.

The findings ultimately suggest that first-line therapy with a vascular endothelial growth factor inhibitor like pazopanib remains the optimal treatment strategy for patients with mccRCC.

Reference

1. Cirkel GA, Hamberg P, Sleijfer S, et al. Alternating treatment with pazopanib and everolimus vs continuous pazopanib to delay disease progression in patients with metastatic clear cell renal cell cancer: the ROPETAR randomized clinical trial. JAMA Oncol. 2016 Dec 1. doi: 10.1001/jamaoncol.2016.5202. [Epub ahead of print]
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