Frontline TKI Selection in Metastatic RCC

Most patients with metastatic renal cell carcinoma (RCC) have good a performance status. In these patients, a tyrosine kinase inhibitor, such as sunitinib or pazopanib, is the usual first-line option, notes Benard Escudier, MD. Interferon with bevacizumab, however, is still used in some patients, such as those who have lung metastases, he adds.

For Susanne Osanto, MD, the patient’s comorbidities play a role in the decision between sunitinib and pazopanib. Prior to the data reported from COMPARZ, Osanto tended to prefer sunitinib in patients with liver metastases and a large tumor burden. However, the drugs appear to be equally effective for most patients, she notes, adding that pazopanib is the drug of choice in elderly patients who are very frail, since it is easier to administer.

The PISCES trial was a patient preference study looking at pazopanib and sunitinib in RCC. The results showed that patients and physicians preferred pazopanib over sunitinib. Comorbidities are not really a factor for Escudier, who says he uses pazopanib more often than he uses sunitinib. However, he adds, there are not enough data to support the use of pazopanib in patients with non-clear cell histology RCC.