First-line sunitinib or pazopanib in metastatic renal cell carcinoma: The Canadian experience

  • Aly-Khan A. Lalani Cross Cancer Institute, University of Alberta, Edmonton AB
  • Haocheng Li Departments of Oncology & Community Health Sciences, University of Calgary, Calgary, AB
  • Daniel Y.C. Heng Tom Baker Cancer Centre, University of Calgary, Calgary, AB
  • Lori Wood Queen Elizabeth II Health Sciences Centre, Halifax, NS
  • Austin Kalirai Faculty of Sciences, University of Alberta, Edmonton, AB
  • Georg A. Bjarnason Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
  • Hao-Wen Sim Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON
  • Christian K. Kollmannsberger BC Cancer Agency Vancouver Cancer Center, Vancouver BC
  • Anil Kapoor Juravinski Cancer Centre, Hamilton, ON
  • Sebastien J. Hotte Juravinski Cancer Centre, Hamilton, ON
  • Marie Vanhuyse Montreal General Hospital, McGill University, Montreal, QC
  • Piotr Czaykowski Cancer Care Manitoba, Winnipeg, MB
  • M. Neil Reaume The Ottawa Hospital Cancer Center, Ottawa, ON
  • Denis Soulieres Centre Hospitalier de l'Université de Montréal, Montréal, QC
  • Peter Venner Cross Cancer Institute, University of Alberta, Edmonton, AB
  • Scott North Cross Cancer Institute, University of Alberta, Edmonton, AB
  • Naveen S. Basappa Cross Cancer Institute, University of Alberta, Edmonton, AB

Abstract

Introduction: Clinical trial data has shown pazopanib to be noninferior in overall survival (OS) compared to sunitinib as first-line treatment for metastatic renal cell carcinoma (mRCC). The purpose of this study was to evaluate outcomes and compare dose-modifying toxicities of mRCC patients treated with suntinib or pazopanib in the real-world setting.

Methods: Data were collected on mRCC patients using the prospective Canadian Kidney Cancer Information System (CKCis) database from January 2011 to November 2015. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method.

Results: We identified 670 patients treated with sunitinib (n=577) and pazopanib (n=93). There were no significant differences in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk groups (p=0.807). Patients treated with sunitinib had improved OS compared with pazopanib (median 31.7 vs. 20.6 months, p=0.028; adjusted hazard ratio [aHR] 0.60; 95% confidence interval [CI] 0.38‒0.94). Time to treatment failure (TTF) was numerically, but not statistically, improved with sunitinib (medians 11.0 vs. 8.4 months, p=0.130; aHR 0.87; 95% CI 0.59‒1.28). Outcomes with individualized dosing on sunitinib were unavailable for this analysis. Patients treated with sunitinib had a higher incidence of mucositis, hand-foot syndrome, and gastroesophageal reflux disease; patients treated with pazopanib had a higher incidence of hepatotoxicity.

Conclusions: In Canadian patients with mRCC, treatment with sunitinib appears to be associated with an improved OS compared to pazopanib in the first-line setting. Patient selection factors and the contemporary practice of individualized dosing with sunitinib may contribute to these real-world outcomes and warrant further investigation.

Published
2017-04-11
How to Cite
Lalani, A.-K., Li, H., Heng, D., Wood, L., Kalirai, A., Bjarnason, G., Sim, H.-W., Kollmannsberger, C., Kapoor, A., Hotte, S., Vanhuyse, M., Czaykowski, P., Reaume, M. N., Soulieres, D., Venner, P., North, S., & Basappa, N. (2017). First-line sunitinib or pazopanib in metastatic renal cell carcinoma: The Canadian experience. Canadian Urological Association Journal, 11(3-4), 112-7. https://doi.org/10.5489/cuaj.4398
Section
Original Research