Comparison of Drugs for Advanced Kidney Cancer Suggests Side Effects Are More Manageable with Newer Option

For the past seven years, the leading targeted drug for advanced kidney cancer has offered longer survival for patients with this disease, which often is difficult to treat. But recent multinational research led by Memorial Sloan Kettering that directly compared this drug with a newer one has indicated that while the two medications have similar benefits for disease control, the newer drug has less-troublesome side effects.

The late-stage clinical trial was the first head-to-head comparison of sunitinib (Sutent^®) to pazopanib (Votrient^®). These oral drugs both target angiogenesis, a process that causes the formation of blood vessels feeding kidney cancer tumors. Headed by medical oncologist Robert J. Motzer – who steered the development of both medications – the study was published today in the New England Journal of Medicine.

Memorial Sloan Kettering researchers have participated in or led the development of five of the seven drugs approved by the US Food and Drug Administration for patients with advanced kidney cancer since 2005. Pazopanib was FDA approved in 2009.

“Today, many different cancer drugs show similar survival benefits side by side, and when they do, other priorities like safety and quality of life assume a greater importance,” explains Dr. Motzer, who has led more than 50 clinical trials on advanced kidney cancer. “Until now, sunitinib was really the established drug, and pazopanib was kind of the underdog.”

Quality of Life Score s Higher with Pazopanib

In the phase III study, Dr. Motzer and his team of international scientists randomized 1,110 patients with metastatic renal cell carcinoma into two groups, with half taking pazopanib and the other half taking sunitinib.

While the two drugs – which are comparable in cost – were shown to offer similar benefits in terms of controlling the disease and prolonging patients’ lives, sunitinib was associated with more troublesome side effects including fatigue, mouth sores, depression, altered sense of taste, and rashes on the hands and feet. Side effects linked to pazopanib, such as changes in liver function, were more easily tolerated by patients, Dr. Motzer says.

 “The takeaway is that both of these drugs have similar effectiveness and both are options for treatment in kidney cancer,” he adds. “But many of the side effects that are more severe with sunitinib are the ones that bother patients on a day-to-day basis, and patients reported better quality-of-life scores when treated with pazopanib. This trial has changed our preference here at Memorial Sloan Kettering from sunitinib to pazopanib.”