Frontline Therapy Selection in Metastatic RCC

Bevacizumab plus interferon is an excellent choice for first-line treatment for patients with renal cell carcinoma (RCC) at low- or intermediate-risk, states Susanne Osanto, MD. Pazopanib, sunitinib, and interleukin-2 are other options to consider, and physician preferences regarding these choices vary globally. In the Netherlands, adds Osanto, physicians tend to favor oral drugs.

The choice between sunitinib and pazopanib may hinge on the toxicity profiles, says Osanto. The COMPARZ trial investigated the noninferiority of pazopanib versus sunitinib, as well as the tolerability of the drugs. The study showed that pazopanib was noninferior and had a very favorable toxicity profile compared with sunitinib, she notes. Pazopanib has more hepatoxitcities, and it is important to monitor patients regularly for the first 4 months of treatment. Fatigue was a concern for all patients; however, she adds, this improved in the pazopanib arm and remained the same in the sunitinib arm.

The double-blind randomized PISCES trial examined patient and physician preference with pazopanib versus sunitinib. In the trial, patients started on one drug and crossed over to the other. The study found that about 70% of patients had a clear preference for pazopanib, notes Osanto. The results showed that quality of life and fatigue were among the reasons for these patient preferences. The physicians also favored pazopanib. However, in clinical practice, the decision is very individualized, as there are some patients who tolerate sunitinib much better, she adds.