Data from the COMPARZ trial indicate that both sunitinib and pazopanib are suitable frontline treatments for patients with advanced renal cell carcinoma. These agents are somewhat different, Eric Jonasch, MD, points out, but provide similar efficacy with reasonable toxicity profiles.

As the COMPARZ trial was under way, data was emerging on an alternate dosing schedule for sunitinib, Robert A. Figlin, MD, suggests. The standard schedule for sunitinib is 4 weeks of treatment at 50 mg/day followed by 2 weeks of rest (4/2). However, an alternate schedule of 2 weeks of sunitinib at 50 mg/day followed by 1 week of rest (2/1) seems to effectively maintain both the dose intensity and quality of life for patients.

This alternate schedule seems to substantially reduce the incidence of grade 3 toxicity, notes Brian I. Rini, MD. However, prospective studies are still required to further validate this approach. Following 4 years of experience with this tactic, Jonasch notes, the 2/1 schedule is now offered as a first option at MD Anderson.

The paradigm with targeted therapies that has grown out of a decade worth of experience is to maintain dose intensity whenever possible, Figlin notes. Unlike with chemotherapy, this approach can be accomplished by looking for alternative strategies.