Sunitinib Versus Pazopanib in Renal Cell Carcinoma

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The randomized, controlled, noninferiority COMPARZ trial examined the frontline administration of pazopanib versus sunitinib in 1110 patients with metastatic renal cell carcinoma, describes Saby George, MD. Individuals were administered sunitinib at 50 mg once daily for 4 weeks, followed by 2 weeks of rest, or 800-mg pazopanib daily. Primary and secondary outcomes evaluated efficacy and quality of life.

The efficacy data seen with the two agents were similar; however, the study suggested that individuals on pazopanib had superior quality of life. Pazopanib was deemed noninferior to sunitinib for progression-free survival (HR = 1.05; 95% CI, 0.90-1.22). Similarly, pazopanib was noninferior for overall survival (HR = 0.91; 95% CI, 0.76-1.08).

Both treatments carry a black box warning for life-threatening liver toxicity, which is seen more frequently with pazopanib, notes George. Monitoring should include routine liver function tests. Individuals with severe liver dysfunction, including markedly abnormal bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, will require discontinuation of the TKI therapy, says George.

Sumanta Kumar Pal, MD, comments that he prefers to start with sunitinib, as he is more familiar with its side effect profile. Overall, in the COMPARZ trial sunitinib was associated with more adverse events, including fatigue (63% vs 55%), hand-foot syndrome (50% vs 29%), and thrombocytopenia (78% vs 41%), respectively. However, pazopanib was associated a higher incidence of increased levels of ALT (60% vs 43% with sunitinib).