Pazopanib tolerated best in kidney cancer study

A trial comparing pazopanib and sunitinib found pazopanib to have better safety and health-related quality-of-life profiles among persons with metastatic renal cell carcinoma (RCC).

The COMPARZ clinical trial, funded by GlaxoSmithKline, was designed to demonstrate the noninferiority of pazopanib (GlaxoSmithKline's Votrient®) to sunitinib (Pfizer's Sutent®). The drugs, both tyrosine kinase inhibitors, are FDA-approved for the treatment of advanced RCC as well as other cancers.

In the study, 557 people with clear-cell metastatic RCC were randomized to receive a continuous dose of pazopanib 800 mg once daily. Another 553 such patients were assigned to receive sunitinib in 6-week cycles (50 mg once daily for 4 weeks, followed by 2 weeks without treatment).

Pazopanib and sunitinib proved to be similar in terms of progression-free and overall survival, reported Toni K. Choueiri, MD, director of the Kidney Cancer Center at Dana-Farber/Brigham and Women's Cancer Care in Boston, Massachusetts, and fellow investigators in The New England Journal of Medicine (2013;369:722-731). Median time to cancer progression was 8.4 months with pazopanib and 9.5 months with sunitinib. Median overall survival was 28.4 months with pazopanib and 29.3 months with sunitinib.

However, the sunitinib group had a higher incidence of fatigue (63%, compared with 55% of the pazopanib users), hand-foot syndrome (50% vs 29%), and thrombocytopenia (78% vs 41%).

The pazopanib patients had a higher incidence of increased levels of alanine aminotransferase: 60%, compared with 43% in the sunitinib group. In some cases this side effect led to discontinuation of the drug.

Pazopanib was rated superior in quality-of-life measures. The mean change from baseline in 11 of 14 health-related quality-of-life domains during the first 6 months of treatment favored pazopanib over sunitinib, particularly in domains related to fatigue or soreness in the mouth, throat, hands, or feet. Pazopanib users also had fewer phone consultations with providers and visited emergency rooms less frequently.
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