819P - Real world outcomes of patients with metastatic renal cell carcinoma (mRCC) using first-line sunitinib or pazopanib: the Canadian experience

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Anti-Cancer Agents & Biologic Therapy
Renal Cell Cancer
Presenter Aly-Khan Lalani
Citation Annals of Oncology (2016) 27 (6): 266-295. 10.1093/annonc/mdw373
Authors A. Lalani1, H. Li2, D. Heng3, L. Wood4, A. Kalirai5, G. Bjarnason6, H. Sim7, C.K. Kollmannsberger8, A. Kapoor9, S.J. Hotte10, M. Vanhuyse11, P. Czaykowski12, M..N. Reaume13, D. Soulieres14, P. Venner1, S. North1, N. Basappa1
  • 1Medical Oncology, University of Alberta Cross Cancer Institute, T6G1Z2 - Edmonton/CA
  • 2Oncology & Community Health Sciences, University of Calgary, Calgary/CA
  • 3Medical Oncology, Tom Baker Cancer Centre, T2N 4N2 - Calgary/CA
  • 4Medical Oncology, QEII Health Sciences Centre, Halifax/CA
  • 5Faculty Of Sciences, University of Alberta, Edmonton/CA
  • 6Medical Oncology, Sunnybrook Odette Cancer Center, Sunnybrook HSC, M4N 3M5 - Toronto/CA
  • 7Medical Oncology, Princess Margaret Hospital, Toronto/CA
  • 8Medical Oncology, BCCA Vancouver Cancer Centre, V5Z4E6 - Vancouver, BC/CA
  • 9Surgery, McMaster Institute of Urology, L8N 4A6 - Hamilton/CA
  • 10Medical Oncology, Juravinski Cancer Centre, Hamilton/CA
  • 11Medical Oncology, McGill University Health Center The Montreal General Hospital, H3G 1A4 - Montreal/CA
  • 12Medical Oncology, CancerCare Manitoba MacCharles, Winnipeg/CA
  • 13Medical Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa/CA
  • 14Medical Oncology, Université de Montreal, Montreal/CA

Abstract

Background

Standard first-line treatment for mRCC includes VEGF-targeted therapy. Clinical trial data has shown similar efficacy between sunitinib and pazopabib; however, a real world experience in Canadian patients is unknown. We aim to determine outcomes and compare toxicities of patients with mRCC treated with first-line sunitinib or pazopanib.

Methods

Data were retrieved from the prospective Canadian Kidney Cancer Information System (CKCis) database from January 2011 to November 2015. Patients with clear cell mRCC treated with first-line sunitinib or pazopanib were included. Time-to-Treatment Failure (TTF) and overall survival (OS) were calculated using Kaplan-Meier methods. Cox regression analysis allowed for adjustment of International Metastatic RCC Database Consortium (IMDC) criteria and age was treated as a continuous variable. Fisher's exact tests were used to compare dose-modifying toxicities between the two therapies.

Results

Our cohort included 670 patients: 93 treated with pazopanib and 577 with sunitinib. Median TTF was greater in patients treated with sunitinib versus pazopanib (6.0 vs 3.7 mos, p = 0.046) and maintained significance when adjusted for IMDC criteria (hazard ratio [HR] 0.61, 0.41-0.90 95% CI, p = 0.013). Median OS was better in patients treated with sunitinb (31.9 vs 20.6 mos, p = 0.028) and maintained significance when adjusted for IMDC criteria (HR 0.60, 0.38-0.95 95% CI, p = 0.028). Common toxicities requiring dose modification, including fatigue and diarrhea, were similar between both groups. However, patients treated with sunitinib had a significantly higher incidence of mucositis, hand-foot syndrome, and GERD; patients treated with pazopanib had a significantly higher incidence of liver toxicity and a trend towards weight loss.

Conclusions

In Canadian patients with clear cell mRCC, survival and treatment duration appears to favour sunitinib over pazopanib. Plausible explanations include potential differences in patient selection for pazopanib, the contemporary experience with individualized dosing on sunitinib, and small sample size. These data on real world toxicities are informative and may aid physicians and patients in guiding treatment decisions.

Clinical trial identification

Legal entity responsible for the study

Canadian Kidney Cancer Information System (CKCis), Kidney Cancer Canada

Funding

Canadian Kidney Cancer Information System (CKCis), Kidney Cancer Canada

Disclosure

D. Heng: Consulting or Advisory Role - Astellas Pharma; Bristol-Myers Squibb; Janssen; Novartis; Pfizer L. Wood: Research Funding - Bristol-Myers Squibb (Inst); GlaxoSmithKline (Inst); Pfizer (Inst); Roche Canada (Inst) Travel, Accommodations, Expenses - Novartis Other Relationship - Janssen Oncology; Pfizer. H-W. Sim: Travel, Expenses – Roche. A. Kapoor: Honoraria - Amgen; GlaxoSmithKline; Novartis; Pfizer Speakers' Bureau - Amgen; GlaxoSmithKline; Novartis; Pfizer Research Funding – Novartis. S.J. Hotte: Consulting or Advisory Role - Astellas Pharma; Janssen Pharmaceuticals. M. Vanhuyse: Consulting or Advisory Role - Astellas Pharma; Bayer Schering Pharma; Pfizer; Sanofi Research Funding - sanofi (Inst). M.N. Reaume: Consulting or Advisory Role - GlaxoSmithKline; Janssen; Novartis; Pfizer; Sanofi Canada S. North: Honoraria - Astellas Pharma; Janssen-Ortho; Novartis; Pfizer. N. Basappa: Honoraria - Astellas Pharma; Janssen; Novartis; Pfizer; Sanofi Consulting or Advisory Role - Amgen; Astellas Pharma; Bayer; Janssen; Novartis; Pfizer; Trelstar Research Funding - Pfizer (Inst) All other authors have declared no conflicts of interest.