Kidney cancer patients favor pazopanib over sunitinib
Wednesday, 6 June 2012- Researchers said here they were stunned by the clear preference for treatment with the targeted agent pazopanib (Votrient) over sunitinib (Sutent) for treatment of metastatic renal cell carcinoma.
For the primary endpoint in the study – patient preference, 70% of patients in the double-blind, crossover study, opted for treatment with pazopanib compared with 22% of the patients preferring treatment with sunitinib (P<0.001), said Dr.Bernard Escudier, of Institut Gustave Roussy, Villejuif, Paris, France, at a press briefing during the annual meeting of the American Society of Clinical Oncology (ASCO).
Escudier said that when they began the 22-week trial -- 10 weeks on one drug, a 2-week break and then 10 weeks on the second drug – the expectation was that about half the patients would prefer pazopanib and about 30% would prefer sunitinib.
"This result was very surprising for me. We never expected such a big difference between the two drugs. It was a very striking and very significant difference," Escudier said in response to questions from reporters.
The press conference moderator, Dr. Carol Aghajanian, of Memorial Sloan Kettering Cancer Center in New York City, said the results should be considered valid because the patients, doctors, pharmacists, and sponsors did not know which patients were on which drug at any point in the trial.
"Both these drug are comparable in efficacy," Dr. Nicholas Vogelzang, a spokesman for ASCO and a professor of medicine at the University of Nevada Medical School in Las Vegas, told MedPage Today. "I will tell my patients that 70% of French patients prefer it, and I think that will matter to patients. This is a practice changing study."
In the trial 169 patients were randomly assigned to either 800 mg a day of pazopanib or 50 mg of sunitinib for 4 weeks, followed by placebo for 2 weeks and then 4 more weeks of sunitinib. Then, after the 14-day break they switched regimens. After the 22 weeks, patients were then able to select their treatment of preference for additional therapy.
Escudier said only about 8% of patients were unable to discern a difference in treatment.
When asked about their reasons for selecting one drug over another, about 70% selected pazopanib for a better quality of life, compared with less than 20% of the sunitinib patients. About 50% of the patients on pazopanib said they experienced less fatigue compared with about 15% of patients on sunitinib.
Roughly 45% of patients on pazopanib said that they had fewer changes in food taste with the drug compared with about 10% of sunitinib patients. In every category listed, patients preferred pazopanib over sunitinib, Escudier reported.
When physicians were asked about patient preferences, they estimated that about 60% of patients preferred pazopanib, 21% favored sunitinib and about 19% thought it didn't make a difference, Escudier said. The researcher, however, said he believed that many of the doctors' views were influenced by the patients.
Vogelzang said that in his practice about 70% of patients with metastatic renal cell carcinoma are now treated with sunitinib, and the rest with pazopanib and other approved medications. "This is going to change," he said.
Source: B. Escudier, et al., "Patient preference between pazopanib and sunitinib: Results of a randomized double-blind, placebo-controlled, cross-over study in patients with metastatic renal cell carcinoma -- PISCES study, NCT 01064310," American Society of Clinical Oncology 2012; Abstract CRA4502.