Sunitinib vs. everolimus: PFS, toxicity differ in study
Greater radiographic PFS with sunitinib, but lower toxicity observed with everolimus
Durham, NC—In a head-to-head comparison, sunitinib (Sutent) prolonged radiographic progression-free survival (PFS) compared with everolimus (Afinitor), but with greater toxicity, in patients with specific subtypes of metastatic renal cell carcinoma (RCC) and non-clear cell histology, said Andrew J. Armstrong, MD, MSc.
“Sunitinib resulted in improved PFS both in good- and intermediate-risk patients and papillary and unclassified histologies, whereas everolimus resulted in improved PFS in both poor-risk and chromophobe subtypes. Sunitinib and everolimus resulted in different rates of expected toxicities, with slightly more severe toxicities with sunitinib but more drug discontinuations due to toxicity from everolimus,” said Dr. Armstrong, co-director of the Genitourinary Oncology Research Program, Duke Cancer Institute, Durham, NC.
Non-clear cell RCC is a genetically and histologically diverse collection of heterogeneous diseases that account for about 25% of kidney cancers, most commonly comprised of papillary types 1 and 2, chromophobe, and a group of diseases called unclassified carcinomas, each with varying prognoses.
Published evidence from single-arm trials, uncontrolled case series, and expanded access studies supports a front-line standard of care systemic therapy. Evidence from individual studies supports an anti-vascular endothelial growth factor (VEGF) or anti-mTOR approach to non-clear cell RCC, “but the data are limited by heterogeneity across different risk groups and lines of therapy,” so conclusive evidence is therefore not strong, Dr. Armstrong said.
He presented the study at the 2015 American Society of Clinical Oncology annual meeting in Chicago. Results were subsequently published in Lancet Oncology (2016; 17:378-88).