Pazopanib versus sunitinib for the treatment of metastatic renal cell carcinoma patients with poor-risk features

Purpose With the exception of temsirolimus, clinical trials in metastatic renal cell carcinoma (mRCC) with poor-risk features are lacking. We previously showed that vascular endothelial growth factor receptor tyrosine kinase inhibitors are active and well tolerated by poor-risk group. This study evaluated and compared the efficacy and safety of pazopanib and sunitinib in this group. Methods We reviewed the medical records of all patients with mRCC who had received pazopanib or sunitinib at Asan Medical Center. We only assessed patients who had three or more poor-risk features as determined in the advanced renal cell carcinoma trial. Results Between December 2006 and April 2015, a total of 172 patients who met the inclusion criteria received pazopanib ( n = 72) or sunitinib ( n = 100). The clinical characteristics were as follows in the pazopanib/sunitinib groups: median age = 60/57 years (range 34–80/17–83); clear cell type = 65/80 (90/80 %); and prior nephrectomy = 46/56 (64/56 %). The disease control rates in the pazopanib/sunitinib groups were 82/60 % ( p = 0.002). With a median follow-up duration of 14.2 months (range 1.6–65.0), the median overall survival and progression-free survival in the pazopanib/sunitinib groups were 14.4/8.9 ( p = 0.030) and 9.8/4.3 months ( p = 0.040), respectively. The common all-grade toxicities for pazopanib/sunitinib were anemia (32 vs. 77 %), neutropenia (33 vs. 56 %), increased aspartate aminotransferase or alanine aminotransferase levels (36 vs. 35 %), fatigue (38 vs. 55 %), and hand–foot syndrome (17 vs. 51 %). Conclusions Pazopanib and sunitinib are both active and well tolerated in mRCC patients with poor-risk features, but pazopanib might be more effective in this group.